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CBD and Childhood Seizures

Pediatric Seizures and CBD (and Other Cannabinoids)

Disclaimer: The information contained in this article is not intended as medical advice. CBD and cannabis are not FDA approved. Breastfeeding and lactating women should avoid using CBD tinctures, CBD edibles, and CBD topicals unless directed by their doctor. Please consult with your own healthcare provider before using any new CBD products.

Risks, Potential Benefits, and Scientific Basics Of CBD

The Risks Of CBD for Children

Cannabinoids like cannabidiol (CBD) have been shown to be incredibly safe and reportedly reduce epileptic seizures in both children and adults. However, there are a few risks associated with using cannabis or CBD products to treat pediatric seizures:

RISK 1: Although CBD and other cannabinoids can reduce seizures, they also have the capacity to increase seizures and the intensity of seizures in certain patients. This occurs occasionally and depends on your child’s genetic makeup as well as how their body chooses to metabolize medicines and cannabis in general. If this happens, the results are easy to observe and are not typically dangerous nor permanent. In other words, if you find that your child is doing worse with cannabis, you will notice it right away. At that point, you should change your treatment plan.

RISK 2: Cannabis can interact with specific drugs. Some anti-epileptic drugs, including ones your child may already be taking, may interact with plant cannabinoids, including full-spectrum CBD oil. This is thought to be due to a group of enzymes, called cytochrome P450 enzymes, which are found primarily in the liver. These enzymes break down both cannabinoids and, in some cases, also break down drugs used to treat epilepsy. If this happens, cannabinoids could compete with your child’s medications for metabolism. This can result in either higher or lower blood levels of the anti-seizure drugs. Your neurologist can easily monitor higher or lower levels of your child’s anti-epileptic medicines by checking blood levels and later making adjustments to the dosages if needed.

RISK 3: Losing access to cannabis, particularly CBD oil. This can be devastating if cannabis is successfully able to help your child decrease or even stop some of their anti-seizure medications. Losing access to cannabis in that case could jeopardize the health and safety of your child. This can happen in many ways:

  • If your child gets admitted to the hospital and the hospital policy does not allow cannabis or CBD hemp oil to be administered
  • You travel out of state to a location where cannabis or medicinal hemp is not available
  • You begin working with a healthcare provider who does not understand the great potential of cannabinoid medicine. Some healthcare providers may even decide to report a family to child protective services
  • The formulation or strain of your medicinal cannabis becomes unavailable due to scarcity

It is important that, once you start taking cannabis or CBD oil, you find a way to continue this therapy for the safety of your own child. If you decide to begin using cannabis treatment in your child, make sure you have the right health care team on board. A good team includes:

  • A good, open-minded neurologist who is somewhat informed about alternative medicine such as cannabinoids
  • A cannabinoid medicine specialist (i.e. a nurse, physician, or naturopathic provider)
  • A legal dispensary or reputable cannabinoid medicine supplier

When it comes to your child’s medicinal cannabis or CBD and making sure that it is the same every time, you need to be able to know answers to the following questions:

  • What is the potency of the batch that works, and will the next batch be the same?
  • What components are in the batch that works, and does the next batch have the same components (i.e. CBD percentage, terpenes and percentage, THC percentage, etc)?
  • Is every cannabinoid batch made with organic, pesticide-free, and heavy-metal-free ingredients?

Laboratory analysis, called a certificate of analysis (COA) and a lot of back in forth with the producer of your cannabinoid treatment and your cannabis/CBD practitioner will also be necessary. Having an open communication relationship with your cannabinoid specialist is essential for your child’s success with CBD treatment.

The Benefits Of CBD For Epileptic Children

There are many potential benefits of using cannabis to treat anyone with seizures, including children. Research has successfully shown that cannabinoids have effective and potent anti-convulsive properties. GW Pharmaceuticals has developed the first FDA-approved plant-derived cannabinoid called Epidiolex, which showcases these properties. Cannabinoids have also shown their ability to reduce the frequency, duration, intensity, and recovery time of seizures. Check out these sources for more information about the benefits of CBD for children with epileptic seizures:

All of these beneficial effects of CBD are known to be important for learning and childhood development in little ones with epileptic seizures.

Cannabinoids like CBD have also been known to have neuroprotective properties in animal studies. This is not only significant for those with seizures, but also for those suffering from traumatic brain injuries, strokes, and neurodegenerative disorders like dementia, Alzheimer’s, and Parkinson’s disease. Cannabinoids have shown promise in decreasing brain damage, promoting neuronal healing, and speeding up brain tissue recovery after injury. Neuroprotection is beneficial for anyone with a seizure disorder, even if cannabinoids do not fully control the seizure activity itself. Cannabinoids protect the patient by preventing additional damage and promoting the healing process.

Cannabinoids are potent muscle relaxants, which are helpful for hypertonic muscles often found in pediatric patients with seizures, especially during a seizure. Cannabis and CBD also have great therapeutic properties for digestion. They can safely and effectively stimulate appetite while decreasing pain. Here is a list of a few other tremendous benefits of cannabis:

  • Improvement in behavior
  • Increased and improved sleep
  • Decreased self-harming activity (i.e. biting, hair pulling, headbanging, etc.)
  • Improved communication (an early sign often seen before seizures are controlled)
  • Improved cognition (early sign)
  • Livelier, more interactive personality (early sign)
  • Increased ability to learn new things (early sign)

The last four benefits of CBD are often seen before seizures are controlled or therapeutic doses are established. They are good early signs that medical cannabis or CBD is working for your child.

Refractory seizures are seizures that are not controlled with traditional prescription seizure medications. When the typical seizure medications do not work, many parents are left feeling hopeless, helpless, and fearful for their children’s wellbeing. There is now concrete evidence to suggest the efficacy of cannabis and CBD in the treatment of epilepsy, particularly concerning refractory epilepsy. In one study, a total of 261 patients were studied to determine the efficacy of CBD. Of these, 135 had also reached 36 weeks treatment at the time of data analysis. Initial doses were 2–5 mg/kg per day, up-titrated until intolerance or to a maximum dose of 25–50 mg/kg. Median reduction in monthly motor seizures was 45%, whereas 47% of all patients experienced a ≥ 50% reduction in seizures and 9% of all patients were seizure-free with maintenance of clinical effect at 36 weeks. Keep in mind that, though this type of study shows promising results, more research is necessary to establish all of the benefits of cannabis and how to optimally use it in children. Be advised that most anti-epileptic drugs that are used in children today have never been tested in children since this type of research is generally considered unethical. Use is based on the known effects anti-seizure medications have had on adults and animals.

The Endocannabinoid System

The human body has a system that contains naturally occurring cannabinoids, called the endocannabinoid system (ECS). The ECS is a physiologic system that is present throughout all tissues in the body for the purpose of maintaining a constant line of communication between the other systems (think of it like a network). The ECS also maintains the general health of our other systems, kind of like a maintenance crew. The ECS is especially concentrated in the nervous system. You and your child’s bodies are always making the endocannabinoids that interact with the ECS. Human endocannabinoids are molecules that function in a very similar way as the cannabinoids found in the cannabis plant. For example, one endocannabinoid called anandamide (‘ananda’ from the Sanskrit word meaning “bliss”) is very similar in structure and function to THC.

A good example of how plant cannabinoids assist our own ECS can be seen after a traumatic brain injury. After such an injury, your cannabinoid system is highly active, working to decrease any damage and promote the healing and repair process. Adding plant cannabinoids, such as full-spectrum CBD, during this process functions to replace and replenish cannabinoids that are being used up. The addition of plant cannabinoids like CBD will allow regular functions to continue, such as seizure control, while providing protection, decreasing damage, and speeding up recovery.

The cannabis plant has many different active constituents. A few of them show promise in benefitting patients with seizures. These constituents include:

  • Tetrahydrocannabinol (THC). This is the cannabinoid that can have an intoxicating or psychoactive effect (THC should only be consumed by adults in states where medical and/or recreational marijuana is legal). But, in low doses, THC can be used without any impairment, and it is known to have anti-convulsive properties. THC is also a great neuroprotectant, meaning that it has the potential to improve neuronal structure and function.
  • Cannabidiol (CBD). CBD, one of the non-psychoactive compounds found in both the cannabis and hemp plant, also has anti-convulsive and neuroprotectant properties. An additional benefit of CBD is that it does not cause any impairment (or “high”), and it reduces inflammation among many other benefits.
  • THCA. THCA is the raw, unheated state of THC. This compound works well at incredibly low doses for patients with seizures.
  • Terpenes. Terpenes are aromatic oils that contribute to the flavor profile of different cannabinoids, such as CBD and THC. Some have fruity properties, while others are woody, minty, or piney. 

There are a number of other cannabinoids that show promise in alternative medicine, and they are currently being studied for anti-seizure treatments. However, the current focus is mostly on THC, CBD, and THCA. Unlike most pharmaceutical-grade medications, these cannabinoids do not have just one mechanism of action. Instead, they have multiple mechanisms that sync up, allowing them to reduce seizures effectively and naturally. In other words, these plant cannabinoids are doing many things in your body all at once. The body is complex and multifaceted, meaning that it will function much better with the help of natural medicines that are capable to keep up.

It goes without saying that these compounds seem to work better when they are combined with each other than when they work all alone. This synergy is known as the “entourage effect,” and it is a common feature in most all plant-based medicines. Botanical medicines have their pros and cons, but perhaps the best pro is that they tend to be safer than pharmaceutical medicines many times over.

Dosing CBD by Body Weight

Because of the general nature of cannabis, its specific interaction with the human body, and individual genetics, there is a broad range of safe, effective doses from one patient to the next. In Israel, where much cannabis research originates from, cannabis is approved as a natural treatment option for many conditions, including epilepsy. There, available ratios of CBD to THC for the treatment of epilepsy are 2:1, 5:1, and 20:1, with the last being the most commonly used ratio for epilepsy. This ratio refers to the amount of CBD to THC — for example, 2:1 means 2 parts CBD to 1 part THC.

Some patients respond to dosages as low as 0.05 mg/kg (milligrams of CBD per kg of body weight), while other patients need as much as 25 mg/kg. That is a 500-fold difference between the two dosages! Even within that wide range, there is NO documented fatal toxicity. If fact, cannabis is so safe that even if you accidentally gave your child 1000 times the described dosage range, there would be no brain damage, organ damage, nor systemic toxicity. In an official drug report commissioned by United States President Richard M. Nixon in 1972 and formulated from a series of research papers, it was discovered that small rodents could ingest up to 3000 mg per kg of body weight and still not suffer any fatal outcomes. That is comparable to a 154-pound human eating 46 pounds (21 kg) of 1% marijuana or 10 pounds of 5% hashish at one time! In another study, monkeys were given 92 mg/kg of pure THC intravenously with no fatalities. That is comparable to a 154-pound human smoking 3 pounds (1.28 kg) of 1% marijuana, which is 250,000 times the usual smoked dose and over 1,000,000 times the minimal effective dose (assuming 50% destruction of the THC by smoking).

Some would say it is virtually impossible to consume enough cannabis to cause any serious damage to the brain or body. An example comparison is acetaminophen (Tylenol), where the fatal dose develops at only 140 mg/kg of body weight, a little less than 10 times the recommended pediatric dose of 15 mg/kg of body weight. Another example is carbamazepine (Tegretol), a common anti-seizure medication used in children. The toxic dose for repeat carbamazepine users is documented to range from 2393 mg to 4463 mg, and in first-time users 824 mg to 2116 mg. In fact, it is recommended that children do not exceed 35 mg/kg in a 24-hour period. Furthermore, carbamazepine is known to cause euphoria and, as a result, has a high potential for abuse among adolescents.

In addition to having a broad dosing range, cannabis also demonstrates something called a “multi-phasic dose-response.” This means that when a patient starts a very low dose of cannabinoids and gradually increases their dose over time, they gradually experience more and more benefit. Unfortunately, this also means that at a certain dosage point, increasing your dose too much can result in diminished benefits with each subsequent dose increase. This is called overmedication. If this begins to happen, it is important to notice it right away and reduce your dose back to the optimal dosage. Even though there are no documented overdoses, it is still possible to overmedicate because of the multi-phasic dose-response curve.

Naturally, the side effects of CBD and cannabis will also start to show up around the same dose where patients start building tolerance and having diminished benefits. As a result, it is best to start low and grow slow. It is recommended that you increase your child’s cannabis or CBD medication every 3-7 days by an amount that you have pre-established with the guidance of your cannabis practitioner. Closely observe your child’s responses daily, and keep a journal logging the following:

  • All of your child’s responses to cannabis or CBD oil
  • The dosage of cannabis and the times administered each day
  • The route taken (oral, sublingual, rectal, etc.)
  • Exact times administered each day
  • The constituents and potency (CBD percentage, THC percentage, THCA percentage, terpene percentage)
  • Strain name (if applicable)

Write down all of this information in your journal and always take it to your visits with your doctor or nurse practitioner. A week’s worth of information is usually enough to start seeing a pattern, though a month’s worth of journaling is even better.

It is only with methodical and consistent trials using preparations of cannabis or CBD, and with detailed laboratory analysis, that you can determine the optimal cannabis or CBD treatment for your child. Research recommends that you start with THC, CBD, THCA, or some combination of those various components of the cannabinoids. As mentioned, it is extremely important that you discuss this with your medical practitioner first in order to determine the best starting plan for your child.

THCA

CBD is a great option because the documented side effects are so tolerable — and, it’s often effective at very low dosages. Furthermore, high dosages of CBD are also well tolerated by children, teens, and adults. THC reportedly helps the efficacy of CBD by helping to “activate it” in the body. By combining a small amount of CBD with THC (less than 1% THC in some cases), patients are able to improve their results at lower dosages. As previously mentioned, THCA has also shown promise at controlling seizures in children. You may already know that the cannabis plant only produces cannabinoids in the acid form (i.e. THC-A, CBD-A, etc.), making THCA incredibly accessible. It can be extracted from any strain of a raw cannabis plant and is relatively easy to distill.

Through an external heating process, THC is converted from THCA. Before heating, THCA can be harvested and extracted to keep it in its acidic form. Both children and adults with seizures have reportedly responded to THCA at very low dosages. Furthermore, these individuals tend not to get a lot of benefit by increasing the THCA to very high dosages. In a recent publication, Drs. Sulak, Goldstein and Russel Saneto describe four case reports of patients using THCA along with conventional anti-epileptic drugs. Among these patients, small doses — around 0.1-1 mg/kg/day THCA were used — corresponded to approximately 0.01 to 0.1% of the patient’s body weight. In other words, for a child weighing 50 pounds (or 22.7 kilograms), they would have received relief from seizures having only taken between two and 23 milligrams of THCA in a day. By contrast, studies with Epidiolex, a pure 99.5% CBD sublingual spray, a dose would start at 5 mg/kg/day and usually increase to 25 mg/kg/day (the aforementioned doses of THCA are 10-100 times lower). Dr. Dustin Sulak also found that specific terpenes, along with THCA in a given cannabis strain, contributed significantly to the anti-epileptic effects enjoyed by his patients (in this case, linalool, a terpene known for the calming effects found in lavender, was necessary for these added anti-epileptic effects). Dr. Sulak has also stated that a higher dose of 2 mg/kg of THCA combined with THC is sometimes necessary for seizure control.

In many conservative states like Texas, hemp-based CBD products are the only readily available and legal option for CBD treatment. These products are typically extracted from industrial hemp, which only contains trace amounts of THC. If you are considering using these products, it is important that you take precaution. First, make sure to choose CBD products that fully disclose what other ingredients are added and what solvents were used during the extraction process (i.e. CO2, ethanol, etc). Some solvents are irritants to the nervous system, so be very careful not to expose your child to even trace amounts of these solvents. The best way to know what your product contains is by obtaining certificates of analysis from a third-party laboratory (meaning a lab outside of the manufacturer you are purchasing products from).

Each cannabinoid within the cannabis plant seems to have multiple mechanisms of action. For example, THC can reduce excitotoxicity in the brain, reduce the release of glutamate (a natural substance made in the human body that acts as a stimulator of neurons), protect the nerve cells when they are injured, and help damaged cells remain stabilized. These abilities of THC are called neuroprotection. CBD stimulates some receptors, inhibits other receptors, and increases the amount of endocannabinoids in the brain by increasing production and decreasing inflammation. THCA has shown anti-inflammatory properties and has the ability to penetrate the nervous system. There is still much to learn about these plant cannabinoids, so stay tuned for more information as future studies are released. 

Cannabis and Breakthrough Seizures

Studies have shown patients receiving relief with the use of THC as a rescue formula for persistent generalized seizures. Some patients have used an alcohol-based THC and rub it into the gums of their child during an active seizure. Others administer THC rectally in a similar fashion to other rescue medications such as diazepam. Still, most reported success comes from consistent use of a specific dosage of either an isolated cannabinoid (i.e. CBD) or a combination of multiple plant cannabinoids (i.e. THCA plus THC, CBD plus THCA, CBD plus THC, etc.) to help prevent seizures.

Talk to Other Parents

Based on the side effect profiles, cannabis and CBD are considerably safer when compared with the other anti-epileptic drugs, making it increasingly more likely to become a first-line therapeutic option in the future for seizure control in children. Currently, many states still consider medical cannabis and CBD to be a last resort therapy. Armed with this basic information about cannabinoids, you may begin to imagine what it might be like to use cannabis or CBD as medicine for your child. If so, it is highly recommended that you find a neurologist who is open-minded and will work with you, as well as a cannabinoid medicine specialist and a reliable cannabis or CBD supplier.

If you are considering a cannabis or CBD trial for your child, here is what you will need in a nutshell:

  • An open-minded neurologist, preferably one who is working with other cannabis or CBD patients
  • A cannabinoid medicine expert
  • A support group of other parents who are using this type of treatment — you can find many groups in online communities
  • A plan for starting a methodical cannabis or CBD trial
  • The right medicine — start with asking parents where they are getting their CBD medicine
  • A testing lab — ask other parents which labs are testing their cannabis or CBD products. It is important to note that whenever you have your child’s medicine tested, it is best to have each batch tested even if the label reads the same way. This will help ensure batch consistency. When you have medicine tested, looked for the following:
          • Potency of the various cannabinoids — this will tell you how many milligrams of THC, CBD, THCA, terpenes, etc. is in each batch
          • Contaminants like organic solvents, heavy metals, pesticides, etc. that may remain from the extraction process
  • A journal of progress — after you have acquired the right plant medicine, please keep in mind that this is a trial so you will need to closely monitor your child and record the following:
          • How frequent the seizures are
          • How intense the seizures are
          • If the seizure activity appears different and how
          • The duration of the seizure activity
          • How many seizures occurred
          • How much time it takes for your child to recover
          • Any positive signs that you see outside of seizure activity, like improvement in cognitive development or the expression of their personality
          • Bring all of these findings back to your neurologist and cannabinoid medicine specialist

Many families need to make several changes during their cannabis or CBD trial to figure out the best ratio and dosage for their child. As a result, it might take several months before you come to a resting place. Furthermore, keep in mind that as your child grows and goes through normal development, their dosages and combinations may change, sometimes drastically. For example, a child that had their seizures controlled with a low dosage of THCA may require the addition of THC after they begin their menstrual cycle or reach puberty age. The key is to remain persistent, consistent, and encouraged.

Cannabinoid medicine is very promising where pediatric epilepsy is concerned. Be empowered, and feel free to use this information to make the best decision for you and your child. If you have any other questions about the benefits of CBD for epileptic children, where to buy CBD oil, or CBD health benefits in general, please don’t hesitate to reach out to Dr. Olga at Refine Pharmaceuticals for more information. We would be happy to assist you!

 


References

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