November is Epilepsy Awareness month, and whether you are only curious, just getting started, or in the midst of cannabinoid therapy for you or a loved one, the process can be an overwhelming addition to everything you already must endure. This is where we at the Realm of Caring step in. We want to help make this challenge easier to navigate, starting with, the five things to consider when starting cannabinoid therapy with epilepsy.
1. There is clinical research to support the benefits
Among those communities looking for research to support utilizing cannabinoid therapy to potentially bring relief to symptoms, the epilepsy community is fortunate to have the human data that has been made available on cannabis.
Although evidence of cannabis to provide relief to seizure disorders dates back thousands of years, the first detailed modern study of the use of cannabis-based products for their anti-seizure benefits was published in 1843. In this study, W.B. O’Shaughnessy tested the behavioral effects in several mammals, fish, and birds. Among other subjects, the reported remarkable anti-seizure effects were witnessed among a 40-day old baby girl with recurrent convulsive seizures.
Despite plant cultivation of cannabis becoming illegal with the twentieth century, scientific advances continued as chemists and pharmacologists began diving into the chemical characterizations of the active ingredients and effects on biological activity. Many experimental studies have demonstrated that exogenous cannabinoids may prevent or modulate seizure activity; specifically with the exogenous, phytocannabinoids Cannabidiol (CBD) and Delta-9 Tetrahydrocannabinol (THC).
Since that first published study in 1843, many more exploratory studies have taken place to determine the efficacy of CBD with treatment-resistant epilepsy. From published observational data to open-label studies to well controlled randomized trials.
2. AED interactions
The first recommendation when utilizing both cannabinoid therapy and conventional pharmaceuticals for epileptic conditions is to space the administrations of the two at least 2-4 hours apart to avoid potential interactions. It is also recommended that serum AED levels and liver function tests (LFTs) be monitored closely for those choosing to incorporate CBD into an AED regimen.
Assessment of data suggests that changes in serum levels of antiepileptic drugs (AEDs) taken with CBD administration have been generally minor for the majority of AEDs tested. Sedation was a frequent result of AEDs administered with CBD. Researchers have concluded in studies that CBD in combination with pharmaceuticals may be well-tolerated, however, it should be taken into consideration that CBD is processed by the body’s cytochrome P-450 (CYP450) system. Therefore, it is best to consult with your doctor when co-administering CBD with drugs that are also metabolized by enzymes CYP3A4 or CYP2C19.
3. Patience and the biphasic response
When starting out, it is important to keep in mind that administration may be made complicated by the non-linear response of cannabinoids. It is non-linear in that our response to cannabinoid administration forms a bell curve. This means that higher amounts do not always equate to more relief. In fact, we should be cautioned to assume that higher amounts of cannabinoids will yield enhanced therapeutic effects. What you may find is that higher amounts could exacerbate seizures and related symptoms. Therefore, it is recommended that if improvements begin to diminish, especially after an increase, that you consider reducing the amount as a potential strategy.
This is why we abide by the “start low and go slow” method. This is a strategy that requires the difficult art of patience, but the goal is to find that optimal dose where relief is realized at the lowest possible amount. Every individual truly has their own, therefore we want to slowly work our way up (as needed) to the peak of that bell curve, or to the point where relief is realized.
4. Administration and extraction methods
CBD may be administered by a variety of methods. The first, and most commonly used, would be sublingual or buccal administration with an oil or tincture. Individuals also administer by capsule or tablet, through g or j tube, and rectally as a suppository.
When considering a product to buy, for potentially higher efficacy it is suggested to look for full spectrum products rich in CBD. Full Spectrum products contain all of the natural compounds of the plant in the finished product. When the process to make the product is alcohol-extracted versus CO2 extracted it results in, potentially, an even more potent product to provide benefit. The Entourage Effect explains to us that “the whole is greater than the sum of its parts”; meaning that full spectrum may have an advantage to purified CBD in that the other plant compounds act synergistically with CBD to potentiate the anticonvulsant therapeutic effects.
5. You are not alone
Possibly the most important thing to consider is that you are not alone in this process. The Care Team at Realm of Caring as well as the community we have are here for you. There have been stories of success that we love to share with you through our client spotlights. We have individuals from all walks of life looking for relief from the suffering epilepsy can bring. We have spoken with individuals who are solely using cannabinoid therapy and those using both conventional medical treatments and cannabinoid therapy. We are here for your questions and we are here to support you.
We hope to continue this conversation all month long. Look for our weekly success stories and join us for an education webinar on epilepsy: 11/25 at 11am MT.
If you have any questions about this topic, a Realm of Caring Care Specialist is here to help. Call us at 719-347-5400 option 1, email us at info@realmofcaring.org, or visit our website and sign up for a free client account at www.realmofcaring.org/client-registration.
Disclaimer
The Realm of Caring Foundation specifically invokes the first amendment rights of freedom of speech and of the press without prejudice. These statements have not been evaluated by the food and drug administration. the products discussed are not intended to diagnose, cure, prevent or treat any disease. Realm of Caring always recommends when and wherever possible that licensed local healthcare professionals be consulted.
The Realm of Caring Foundation is an independent nonprofit with its own governing board. We do not produce or sell cannabinoid products, nor do we receive funds from the sale of other company’s products.
