• Cannabidiol (CBD) is a derivative of hemp that can be used alongside other treatments to help manage severe forms of epilepsy in children and adults, including Dravet syndrome and Lennox-Gastaut syndrome.
• Although CBD products are available over the counter, only prescription CBD medications are approved and regulated by the U.S. Food and Drug Administration (FDA).
• CBD does not cause intoxication and is generally safe to use but can interfere with other medications.

Finding an effective treatment for epilepsy is not easy, especially for people with treatment-resistant epilepsy. In this type of epilepsy — also known as refractory epilepsy or intractable epilepsy — people experience seizures that are uncontrolled despite treatment with anti-seizure medications. Since the U.S. legalized hemp and CBD products in 2018, CBD has become more popular and is recognized as a potential additional treatment option for epilepsy.

CBD and tetrahydrocannabinol (THC) come from the Cannabis sativa plant, commonly referred to as marijuana. THC is the chemical that is responsible for the “high” associated with smoking marijuana.

Although marijuana and hemp are technically the same cannabis plant, they differ in THC content. Hemp contains small amounts of THC (less than 0.3 percent by dry weight). Because there is such a small amount of THC found in the hemp plant, you don’t have to worry about getting intoxicated from CBD products, such as CBD oil. CBD has been studied for potential medical use, including treating several neurological and psychiatric conditions such as epilepsy.

Which Types of Epilepsy Can Be Treated With CBD?

There are many forms of epilepsy that occur in people of all ages. Clinical studies have shown that CBD is most useful for severe or treatment-resistant epilepsy. In some studies, CBD has also proved particularly effective and therapeutic for children with severe epilepsy.

Two types of epilepsy are particularly hard to treat and can be quite dangerous:

• Dravet syndrome, also known as severe myoclonic epilepsy of infancy
• Lennox-Gastaut syndrome, a combination of several types of seizures

In clinical trials, CBD has been shown to help reduce seizure frequency in individuals living with Dravet syndrome or Lennox-Gastaut syndrome. These same studies have shown that CBD is safe to use long term in both children and adults, with one clinical trial treating individuals for 96 weeks.

CBD has also shown promising results in treating tuberous sclerosis complex and febrile infection-related epilepsy syndrome, two other severe conditions associated with seizures.

How Does CBD Help Epilepsy?

It’s not known exactly how CBD helps control seizures related to epilepsy. However, scientists have theories. Some researchers speculate that CBD affects seizures through its interaction with a receptor on neurons (nerve cells) within the brain. A receptor is like a lock on a neuron that can only be activated with a specific key, such as a neurochemical. In this case, a G protein-coupled receptor acts as a gate for releasing calcium, and calcium is critical for brain cell activity and communication.

Scientists also think a neurochemical called adenosine may interact with CBD. Adenosine is the brain’s natural anticonvulsant (anti-seizure medication). Research in rats supports the idea that CBD increases how much adenosine is available in the brain.

Another brain cell receptor that may be affected by CBD is TRPV1 — also known as the capsaicin receptor and the vanilloid receptor 1. This receptor is more prevalent in people with epilepsy, and CBD is known to make these receptors less sensitive. The complex interactions between CBD and several different brain receptors and adenosine are believed to work with each other to decrease seizure activity.

Over-the-Counter and Prescription CBD Products

CBD products, including tinctures, concentrates, and capsules, are readily available over the counter at a variety of stores, from gas stations to specialty CBD boutiques. However, over-the-counter medical cannabis products are not approved by the FDA or regulated in the same way as prescription CBD products. This means these products carry no real guarantee of safety or efficacy. Further, they may not contain the accurate dose of CBD claimed on the label.

Prescription CBD products, on the other hand, are regulated by the FDA. These products must meet certain quality and purity standards. Therefore, you are more certain to acquire safe and effective CBD through a prescription from a doctor.

Currently, one formulation of pure CBD has secured FDA approval for the treatment of epilepsy: Epidiolex. The drug, an oral solution, secured approval in 2018 and is indicated for Lennox-Gastaut syndrome and Dravet syndrome in people ages 1 and up. It was also approved for treating seizures associated with tuberous sclerosis complex in the same age group in 2020.

Understanding Possible Risks and Side Effects of CBD

If you or a loved one is living with a treatment-resistant form of epilepsy, CBD may help. You should also understand the possible risks and side effects of CBD.

So far, scientific research and clinical trials (studies that determine a drug’s safety and effectiveness in people) show that CBD is generally safe and has few to no negative side effects. Studies show that CBD alone does not negatively affect blood pressure, heart rate, or breathing functions. There are no apparent changes in psychological function when CBD is taken by itself, without THC.

There is one big caveat in using CBD: It can cause interactions with other drugs or medications, including antiepileptic drugs. Specifically, CBD interacts with other substances metabolized by a group of enzymes known as P450 cytochromes, which are responsible for breaking down CBD. This means that if you take CBD and another drug that is broken down by these enzymes, CBD may interfere with the level of the other medication in your body.

CBD has been shown to interact with drugs including:

• Antiepileptic drugs
• Steroid medications
• Antidepressants
• Anxiety medications
• Calcium channel blockers
• Antipsychotics
• Antibiotics
• Antihistamines
• Anesthetics
• Beta-blockers
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Drug interactions can be dangerous and carry serious risks. Because CBD has the potential to interact with other drugs, seek medical advice from your regular doctor or neurologist before taking over-the-counter CBD products.

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Have you tried CBD to manage your seizures? Did you use a prescription or over-the-counter CBD product? Share your experiences or questions in a comment below, or start a conversation on your Activities page.