A CBD breakthrough
In 2018, the Food and Drug Administration (FDA) made history when it approved the first CBD (cannabidiol) drug. Although Epidiolex was specifically approved to treat two rare forms of epilepsy—Lennox-Gastaut syndrome and Dravet syndrome—doctors also prescribe it off label to successfully treat many other forms of epilepsy.
Even beyond this one prescription medication, many people with seizures claim that CBD has benefited them. This is what you need to know about CBD products, epilepsy, and seizures.
What is CBD?
CBD is one of two main active ingredients found in both the cannabis plant and the related hemp plant. The other main active ingredient is delta-9-tetrahydrocannabinol (THC) best known for causing a high. By contrast, CBD does not make you high, though it appears to have other effects on the body. (Learn more about the differences between CBD and THC.)
Most CBD in the United States comes from hemp, which farmers can grow as long as it contains no more than 0.3 percent THC, as outlined in the 2018 Farm Bill. Hemp has a number of other uses and can be found in rope, paper, carpets, and more. (Here’s how CBD oil compares to hemp oil.)
Epilepsy vs. seizures
Though all forms of epilepsy involve seizures, having a seizure doesn’t mean you have epilepsy. According to the National Institute of Neurological Disorders and Stroke, you must have at least two seizures to be diagnosed with epilepsy. There are many kinds of seizures, and people with epilepsy may have more than one type.
Any number of things can cause epilepsy and seizures. Some forms are inherited, while others may result from conditions like a brain tumor, stroke, infection, and head injury. There are also cases with no obvious cause.
(Here are some unexpected epileptic seizure triggers to know.)
Epidiolex and seizures
In general, there’s scant research on how CBD may help with different health conditions. Epidiolex is an exception. Two landmark trials in The New England Journal of Medicine, published in 2017 and 2018, showed that cannabidiol reduced seizures in individuals with Dravet syndrome and Lennox-Gastaut syndrome. „The studies clearly showed a statistically significant benefit in these patients,” says Bonni Goldstein, MD, medical director and owner of Cannacenters, and author of Cannabis is Medicine: How Medical Cannabis and CBD are Healing Everything from Anxiety to Chronic Pain. All of the participants had tried and failed multiple other drugs.
The rest of what we know about CBD and seizures is based on lab and animal studies (which require additional research to confirm) as well as on personal stories. That means the over-the-counter products out there are largely untested.
(Here’s what to know about CBD oil.)
How does it work?
No one knows exactly how CBD works to reduce seizures, though 2019 research in Neurology suggests that it impacts several different pathways in the body. One of these may be the endocannabinoid system, according to a 2019 study in the International Journal of Molecular Sciences. This system regulates many different functions in the body, from stress and anxiety to brain development to appetite and weight loss.
More specifically with regard to seizures, CBD may „cool down” or „bring down” the more excitable neurotransmitters in the endocannabinoid system, says Martin A. Lee, co-founder and director of Project CBD, a California nonprofit that promotes CBD research, and author of Smoke Signals: A Social History of Marijuana–Medical, Recreational, and Scientific.
Is CBD safe?
Epidiolex passed enough safety thresholds to warrant FDA approval. In the two NEJM studies, side effects tended to be mild to moderate, with difficulty sleeping, lowered appetite, and diarrhea topping the list. Some participants also had abnormal results on liver function tests, especially at the higher dose (20 milligrams per kilogram).
Over-the-counter preparations of CBD are generally considered safe, says Dr. Goldstein. That’s as long as they’re free of contaminants like toxic metals, which can be hard to determine since these products aren’t regulated.
Before trying CBD, make sure it doesn’t interact with another medication you may be taking. The National Library of Medicine keeps a complete list of potential interactions.
The two Epidiolex studies looked at doses of 10 milligrams and 20 milligrams per kilogram. Based on these results, the FDA recommends a starting point of 2.5 mg/kg twice a day, increasing after a week to 5 mg/kg twice daily. The maximum would be 20 mg/kg per day. When you factor in the weight of an adult or child, that’s a lot of CBD. Epidiolex itself costs more than $32,000 a year without insurance.
Commercially available CBD can also cost big bucks, especially at the higher levels needed for seizures, says Dr. Goldstein. One dropper of some common CBD oils delivers anywhere from 7 mg to 60 mg per dropper or more.
General CBD dosing
CBD has been studied as a treatment for sleep problems, anxiety, and pain in a wide range of doses, from 1 mg per day to 400 mg per day or more. Higher doses can lead to side effects like sleepiness (and can be expensive), so experts generally recommend using CBD at the lowest effective amount. A study published in 2019 in The Permanente Journal, for instance, dosed participants with 25, 50, or 75 mg/day.
Types of products
Epidiolex is a liquid solution. When buying on your own, you’ll encounter oils that can be ingested, tinctures to put under your tongue, creams applied on your skin, CBD edibles like chocolate and CBD gummies, as well as inhalable CBD products (vaping, but this can be dangerous and lead to EVALI, a vaping-related lung disease). For seizures, something other than topical products would probably more useful, says Lee.
But you’re not finished yet. Not only will you have to choose among forms, but you’ll also have to decide which ingredient formula you would like. There are three main ones:
Full-spectrum CBD: Products with this label contain all of the components of the hemp plant (Cannabis sativa), including CBD, small traces of THC, and terpenes, which are plant compounds.
Broad-spectrum CBD: This labeling means the product contains all of the plant’s components except THC.
CBD isolates: The product only contains only CBD.
Broader-spectrum products generally have more effect, says Lee.
Is it legal to buy CBD?
As long as it’s prescribed correctly by a licensed medical professional, Epidiolex is legal. Other sources of CBD occupy a legal and regulatory gray zone. It helps to know where your CBD comes from—cannabis (marijuana) or hemp.
To date, 36 states, plus the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands, have legalized medical marijuana, which contains CBD, according to the National Conference of State Legislatures. The federal Drug Enforcement Administration (DEA), on the other hand, has not followed suit. The agency still includes marijuana on its roster of Schedule I controlled substances.
CBD that comes from hemp is regulated in a different way. With the 2018 Farm Bill, hemp products, which contain no more than 0.3 percent THC, are not considered controlled substances under federal law. Some states restrict buying hemp-based CBD products, however.
Epidiolex is legal even in states where CBD is still illegal.
How to buy CBD
Regardless of which formula you choose, the process for buying responsibly is the same. It’s best to work with a knowledgeable medical professional or a licensed dispensary.
Always do your own research, looking for companies that verify all product ingredients via third-party labs. Ask for a Certificate of Analysis. An FDA survey found that many CBD products don’t contain the levels of CBD stated on the label—some had no CBD whatsoever, while others had way more THC than indicated.
Buy only U.S.-grown products. This minimizes the chances of contamination. Make sure you can contact the company via e-mail or phone in case you have any questions (many companies have online chats as well).
(Got pain? These are the best CBD oils for pain.)
Best CBD products for epilepsy
Always work with your doctor if you’re planning to use CBD products. If you get the OK to try CBD, here are some quality products that meet experts' qualifications.
Charlotte’s Web CBD Oil
Charlotte’s Web is named for Charlotte Figi, whose challenges with Dravet Syndrome and success with medical marijuana helped propel the legalization movement. This particular oil is highly concentrated, with 60 mg of CBD per dropper. It’s available in mint chocolate, lemon twist, and orange blossom flavors.
Myriam’s Hemp 100 CBD
Myriam’s Hemp is named after a woman who found that cannabis oils with her chemotherapy helped stabilize her after a terminal brain cancer diagnosis in 2013. This hemp oil contains 20 mg per serving size. The half-ounce size will give you about 75 doses ($67.50). The largest and most expensive (2 ounces) will give you four times that much.
Haleigh’s Hope Starter Bottle
This inexpensive starter bottle contains 30 doses at 10 mg each. Haleigh’s Hope products all contain some THC in varying ratios (but never more than 0.3 percent). The hemp is grown in Colorado and each batch is tested by a third party. You’ll get a syringe with each bottle for easier dosing.
Each dose contains 50 milligrams of full-spectrum CBD in organic olive oil, for a full bottle of 30 doses. It’s part of Canniatric’s hemp line of products. The company specializes in CBD for children and bills itself as „improving the quality of life for children suffering from pediatric conditions.” You can search for a certificate of analysis on the Canniatric website.
Nuleaf Naturals Full Spectrum Hemp Oil
This hemp oil contains 60 mg of CBD per dose. The smallest bottle (300 mg, $38.50) contains only five doses. The largest (6,000 mg) contains 100 doses, but it’s pricey: $439. Nuleaf Naturals provides Certificates of Analysis for all of its products and offers discounts for subscriptions.