For a long time, cannabis was considered merely an intoxicant. In recent years, however, it has become apparent that cannabis - in the right combination and dosage - is being studied in the context of various conditions or symptoms. The topic of cannabis in epilepsy is also addressed here.
Of primary interest to researchers is whether cannabis may be associated with seizure frequency in epilepsy. If you would like to learn more about these research areas, you can find extensive information in the following guide. The legal background is also explained.
The most important facts in brief
- Since 2017, it has been possible in Germany to use medical cannabis in the context of various conditions. However, the use is only possible if other therapies do not work or do not achieve the desired effect. /li>
- A US study reported that the cannabis derivative cannabidiol was associated with a reduction in the number of epileptic seizures in some study participants. However, the study was conducted without a comparison group with placebo medication.
- It should be noted that studies and tests also show side effects that can occur when cannabis is used in the context of epilepsy. Above all, increased sleepiness and a loss of appetite were named here.
What is medicinal cannabis?
There are differences in cannabis. Therefore, it is clearly stated that the use of the flowers in the context of epilepsy can only be done if it is a medical cannabis. The medical cannabis flowers are issued on prescription. The plants are cultivated exclusively for medical use.
The cannabis flowers have a different CBD and THC nominal content. In order to better understand where the difference in THC and CBD lies, there is an overview below:
| THC | CBD |
|---|---|
| - Also often referred to simply as cannabis | - Known under the name "cannabidiol |
| - Binding to CB1 receptors | - Binds to CB1 and CB2 receptors |
| - Influences perception | - Does not influence perception |
| - Triggering of depression possible | - May have a mood-related effect; sometimes used to reduce intoxication caused by THC |
| - May reduce the ability to concentrate | - Has been studied for potential calming-related properties |
| - Medical cannabis | - Medical cannabis |
Medical cannabis contains different nominal contents of the active substances mentioned. The THC content starts at 1% and can reach up to 22%, depending on the flowers. The CBD content starts at 0.05%.
What is the legal situation in Germany?
On 1 March 2017, there was an "amendment of narcotics law and other regulations", which, among other things, also referred to medicinal cannabis. Since that date, it can be prescribed and, if the doctor sees a basis, can be used for various diseases.
Extracts of cannabis as well as cannabis flowers can be prescribed. The prescription is made via a narcotic prescription. So far, there are no special qualifications that the doctor issuing the prescription has to show. Before the law was changed, there was a procedure that patients had to go through.
In this procedure, it was necessary to apply for a so-called exemption permit through the Federal Opium Agency of the Federal Institute for Drugs and Medical Devices. This made it possible to acquire standardised cannabis extract preparations and to use them in self-therapy.
No clear indication requirements by law
It may be interesting for you to know that there are no clear indications in the law for which indications medical cannabis can be prescribed. A prescription is therefore possible for various indications. In principle, it is necessary for the doctor to state why other therapies cannot be used.
In order to have the costs covered by the health insurance fund, it is particularly important to be able to prove that other therapies have already been tried for the epilepsy but did not achieve the desired success. However, even if therapies are still open that have not yet been used, cost coverage may be possible in rare cases.
Background: What you should know about cannabis in the context of epilepsy
Cannabis has been used in medicine for a long time. It is being researched in the context of seizures in people with epilepsy. However, in order to be able to assess whether this form of research could be relevant for your situation, further information is helpful.
Is there any experience with CBD in the context of epilepsy?
There is some experience with the use of CBD in the context of epilepsy. Studies have explored whether the active ingredient may be associated with seizure reduction. For this purpose, studies were conducted with animals and also with affected humans. These experiments explored an anticonvulsive effect. We speak of "convulsive" when we are talking about a convulsive seizure.
When a drug has an anticonvulsant effect, it counteracts the seizures. In the course of these studies, researchers also explored whether cannabis use might be associated with reduced brain damage during a seizure. Animal studies have also suggested that cannabinoids may be associated with reduced seizure duration.
This is attributed in research to the substance's potential ability to modulate overactive synapses.
Are there studies on cannabis in the context of epilepsy?
In the meantime, there are some studies that deal with the effect of cannabis in epilepsy. For example, a meta-analysis was carried out by Brazilian researchers. This refers to several clinical studies in which the focus was on refractory epilepsy as the basis for research with CBD.
A test was used for the analysis. Patients received doses ranging from one to 50 g/kg of cannabis, depending on the severity of their condition. The duration of treatment ranged from three months to 12 months. The patients reported that an improvement in the frequency of seizures was observed in two-thirds.
A study was also conducted in Canada. Here researchers explored whether anticonvulsant properties could be attributed to both THC and CBD. Here, there was also the observation that cannabis oils have been studied for seizures that show resistance to drugs. In the evaluation it was reported that a reduction in seizures was observed.
Severe seizures in the context of a disease with epilepsy can limit your everyday life. There is always a risk of injury due to unexpected seizures. Cannabis is being researched in the context of seizure disorders.
Interactions and side effects - results from the study
Interesting in the context of research on cannabis in epilepsy is the question of possible side effects or also interactions with other medications. Here, the University of Alabama has published the first research results. The researchers found that the side effects are manageable and that cannabis is quite well tolerated.
Diarrhoea and an increased need for sleep are particularly common. In addition, interactions with clobazam were found. Interactions with topiramate as well as with rufinamide were also noted. If you are taking any of these drugs, you should consult your doctor about possible interactions.
Which cannabis strain has been studied for epilepsy?
In epilepsy research, studies have looked at medicines that contain a proportion of THC and CBD. Again and again, recommendations are made to rely exclusively on CBD products. Basically, it is important to talk to your doctor about a therapy. He can assess which drugs can be used in which dosage.
Again and again, people consider cannabis oil in the context of epilepsy. In principle, it is possible to administer medicinal cannabis in different ways. If you prefer to take oil, you can ask your doctor what possibilities he sees in this context. Taking cannabis in the form of a spray is also very common.
How does cannabis therapy work in the context of epilepsy?
How cannabis is used in epilepsy depends, among other things, on the form of the disease. Research has primarily focused on seizure frequency. Cannabis cannot cure the disease. However, it has been studied in the context of seizure frequency. Here, however, it depends on which active ingredients are contained.
CBD in particular is being researched. Due to the specific compound, it is not psychoactive and therefore is associated with fewer side effects than THC. It is mainly studied as an anticonvulsant. THC has been studied as having a potential reinforcing effect on epilepsy medication.
The use of cannabis in epilepsy is rarely used as the sole therapy. However, it may be possible to use a complementary therapy for your treatment.
Interesting: Research has explored whether cannabinoids may be associated with enhanced effects of some medications used for epilepsy. These include for example:
- Diazepam,
- carbamazepine,
- topiramate,
- Gabapentin and
- valproic acid.
Can side effects occur?
Before taking cannabis for epilepsy, it is first necessary to check how the interplay between benefits and side effects is. Studies have shown that 94% of participants who received a high dose were likely to experience side effects. Participants who received a lower dose experienced 84%.
However, participants who received a placebo also showed side effects. Here, as many as 72 % of the participants were affected. The probability of side effects occurring is therefore relatively high.
However, the side effects themselves are considered to be manageable. The main symptoms are an increased loss of appetite and an increased need for sleep. Nevertheless, the side effects can restrict patients and limit their daily routine. For this reason, a comprehensive explanation is particularly important.
Which CBD medications for epilepsy?
The search for a CBD medication that is approved in Germany turns out to be not so easy. For example, there is Sativex® , but it is mainly used for multiple sclerosis. For research on epilepsy, Epidiolex® is often referred to. Research has explored its use in:
- Dravet syndrome
- Lennox-Gastaut syndrome
It does not contain THC, only CBD. This prevents an effect on the psyche. The manufacturer is GW-Pharmaceuticals. For more information, it is important to contact your doctor directly and ask which drug might be suitable for treatment.
Trivia: What else you should know about CBD in the context of epilepsy
The use of cannabis in the context of epilepsy has been possible in Germany since 2017. Before that, medicines containing the active ingredient could also be used. However, the conditions were particularly strict. In the meantime, there is the option of having cannabis prescribed by a doctor.
If you are thinking about considering this option for treatment, the following information may be of interest to you:
Is there a cannabis prescription for epilepsy?
If cannabis is to be used in the context of epilepsy in Germany, the question naturally arises whether you need a prescription for it. The information on the legal situation in Germany already mentioned above is one of the most important bases for this. You can only use cannabis in the context of epilepsy if you get a prescription.
For this, it is necessary that you contact your doctor. He or she can prescribe medicinal cannabis. However, it is necessary for the doctor to know your previous therapeutic path. The costs are only covered by the health insurance if there is a very clear indication, which must be determined by the doctor.
It is also important that the therapy is tailored to your type of illness. Therefore, you should consult your doctor if you want to discuss cannabis in the context of epilepsy.
Do joints also help against epilepsy?
In principle, it does not matter how cannabis is ingested. Depending on the amount of medical cannabis, it can also be smoked. However, several problems arise here:
- The dosage is difficult.
- It is not possible to tell how well your body absorbs the cannabis.
- Consumption via a joint is legally prohibited in Germany.
The doctor does not prescribe medical cannabis so that you can smoke it. The therapy is based on taking it in the form of tablets, powder or oil. This has to do with the form of therapy. If you get cannabis yourself in the context of epilepsy, you are breaking the narcotics law.
Also, the danger of wrong dosage should not be underestimated. There are reports that patients suffering from epilepsy have shown an increased risk of seizures after using a joint.
Are children allowed to use cannabis for epilepsy?
Children can also be affected by epilepsy. Depending on the severity and frequency of the seizures, treatment with cannabis may be considered. The seizures in epilepsy can cause damage to the brain. The use of medicinal cannabis has been studied in the context of both seizure frequency and potential brain protection.
The use of cannabis in the context of epilepsy in children and adolescents is not prohibited, but is considered with caution. This is because the influence of cannabis on brain development in children and adolescents can have a negative impact. In the USA, cannabis is used in the treatment of children and adolescents in Colorado, for example.
A check of the medical records shows that seizures could be reduced by about 50% in every fourth patient.
A particularly common form of epilepsy in children is Dravet syndrome. It occurs mainly in young children. Lennox-Gastaut syndrome and absence epilepsy also occur more frequently. Research with CBD has shown notable results here. CBD is the active ingredient from cannabis that does not cause intoxication. Its use in children can therefore be considered in appropriate cases.
Important: In Germany, there has not been an approved medicine containing only CBD for a long time. The FDA acts as the drug authority in the USA and tested a drug with the active ingredient. In the meantime, Epidiolex® is also available in Germany.
Conclusion
The use of cannabis in the context of epilepsy has been a form of therapy that can be used for several years. The legal regulations were already changed in 2017 with regard to the prescription of medical cannabis. Nevertheless, it is not quite so easy to obtain a prescription. A therapy with cannabis can usually only take place when other therapies do not work.
Cannabis cannot cure epilepsy, as current studies show. However, research has explored its potential association with seizure frequency and possible protection from lasting brain damage. If you would like to discuss therapy options, you can contact your doctor directly.
Further reading: Sources and interesting links
[2] https://www.aerzteblatt.de/archiv/186476/Medizinisches-Cannabis-Die-wichtigsten-Aenderungen
[3] https://hanfverband.de/faq/bei-welchen-krankheiten-kann-medizinisches-cannabis-angewendet-werden
[4 ]https://www.hapa-medical.de/medizinisches-cannabis
[5] Treat L, Chapman KE, Colborn KL, Knupp KG. Duration of use of oral cannabis extract in a cohort of pediatric epilepsy patients. Epilepsia. 2017 Jan;58(1):123-127. doi: 10.1111/epi.13617. epub 2016 Nov 18.
[6] https://www.aan.com/PressRoom/Home/PressRelease/1544
[7] https://www.leafly.de/cannabis-bei-epilepsie/
[9] https://www.gesundheitsstadt-berlin.de/cannabis-hilft-bei-epilepsie-11313/
[10] https://www.ncbi.nlm.nih.gov/pubmed/30258398
[11] https://www.ncbi.nlm.nih.gov/pubmed/30250864
[12] https://www.ncbi.nlm.nih.gov/pubmed/30194563
[13] https://www.pharmazeutische-zeitung.de/2018-01/epilepsie-cannabidiol-reduziert-anfallhaeufigkeit/
