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Are cannabis-based products an effective treatment option for children’s epilepsy?

Research suggests encouraging signs, but not yet a comprehensive, long-term solution
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The CBD oil purchased by consumers may differ than the product used in clinical trials. DINA DONG/THE VARSITY
The CBD oil purchased by consumers may differ than the product used in clinical trials. DINA DONG/THE VARSITY

In 1922, Canadian author and women’s rights activist Emily Murphy published The Black Candle, a nakedly racist and sour declaration on drugs that would shape the country’s discourse and legizlation on marijuana. She contributed to the historical racialization of the substance as a foreign, Mexican threat that threatened the white race.

The following year, Prime Minister William Lyon Mackenzie King made cannabis illegal, a move that would eventually galvanize protests by pot enthusiasts across the country. A mere 77 years later, the Canadian courts would rule in favour of cannabis use for medicinal purposes, fundamentally shifting medical discourse and the country’s approach to health care.

A prime example of cannabis’ medical use is the alleviation of seizures in individuals with epilepsy, with studies focusing on cannabis-based products for pediatric epilepsy — or epilepsy among infants and adolescents — demonstrating promising, albeit preliminary results. 

In a meta-analysis on the efficacy of such treatments, researchers, including scientists at the University of Ottawa and the University of Toronto, have demonstrated a positive correlation between cannabis-based products and the reduction of seizures in children. Such products are non-intoxicating and do not include tetrahydrocannabinol (THC), the chief ingredient responsible for the psychoactive effect users may experience.

Evidence has shown that cannabidiol, a compound in cannabis, has a number of therapeutic effects, given its anti-inflammatory, antipsychotic, and anxiety-relieving properties. It has also shown promise for treating medical disorders such as schizophrenia, dementia, and diabetes.

Can cannabis alleviate pediatric epilepsy?

First and foremost, what is epilepsy? And how can cannabis be used to treat infants and children?

Epilepsy is a brain disorder that produces “abnormal bursts of electrical activity in the brain,” according to the National Institutes of Health. Seizure episodes can occur spontaneously, lasting anywhere from seconds to minutes, or even longer. The World Health Organization characterizes the disorder as a “major” public health concern, with around 50 million people living with the condition around the globe. According to the Public Health Agency of Canada, an average of 42 people per day are diagnosed with epilepsy in Canada, while under half — 44 per cent — are below the age of five. The vast majority of those diagnosed — roughly 60 per cent — are either young children or seniors.

If left untreated, seizures can affect individuals for a lifetime, and can occur as infrequently as one episode per year or fewer, to multiple per day. Those of us at U of T who have sat through PSY100 — Introductory Psychology — would be familiar with patient Henry Molaison, who was a notable patient with uncontrollable and frequent epileptic seizures. Students will remember in horror how surgeons removed part of Molaison’s hippocampus and most of his amygdala as a last-resort treatment option, though the data continues to have lasting influence on cognitive science. 

While removing a quintessential part of our temporal lobe is now out of fashion, health care professionals have utilized an array of solutions, from anti-seizure or anti-convulsant medication, deep brain stimulation, ketogenic diets, to cannabis oil, to treat seizures.

The causes of epilepsy are not entirely known, and are difficult to identify. Genetic predisposition, developmental deformities while in the womb, along with brain injuries, strokes, and tumors, may all be motivating causes.

What results can be gleaned?

What cannabis-based products are currently in use for epilepsy? And what distinctions ought to be made for a clear understanding of treatment options?

For children, particularly infants, with epilepsy, cannabis-related products have proven promising and have produced statistically significant results, though several researchers note that long-term effects remain unclear. In my correspondence with Jesse Elliott, a PhD candidate at the University of Ottawa’s School of Epidemiology and Public Health who published the meta-analysis, I was made aware of one critical distinction between medical versus recreational marijuana.

The CBD oil you may buy at your local Honey Pot is different to the product used in randomized controlled trials — studies in which participants are divided at random to receive one of several clinical interventions. To date, Elliott mentioned that, “There have been four [randomized controlled trials] examining the effects of cannabis-based products on severe forms of pediatric epilepsy.”

This has included children with Dravet syndrome and Lennox–Gastaut syndrome — two rare types of epilepsy that are diagnosed in infants and difficult to treat. These studies have used a purified cannabidiol called Epidiolex, a prescription drug that is not available in Canada. As a small aside, however, though such a drug is not available to Canadians, one can purchase high concentration cannabidiol oil, which includes THC, for recreational and off-label uses.

Elliott and her co-authors’ meta-analysis demonstrated that the drug successfully reduced seizures in patients, despite the “certainty of the evidence from such studies [being] very low.”

Side effects that were statistically significant included gastrointestinal adverse effects, such as vomiting and diarrhea. In statistical terms, gastrointestinal adverse effects were reported in two to 60 per cent of participants who received CBD products, making such an effect potentially unsafe for infants if used for long periods of time.

Such studies have several limitations: small sample sizes and a failure to include comparison groups, which “[hamper] the interpretation of the findings,” Elliott wrote. Without comparing treatment options, the most effective solution may still be unknown.

With only one drug used in such studies, it’s difficult to make sweeping generalizations about other cannabis-based products and their efficacy in treating pediatric epilepsy.

Finally, what of other epileptic syndromes, aside from Dravet or Lennox–Gastaut Syndrome? Such considerations ought to be tackled in future studies given that the current status on cannabidiol products for epilepsy yield inconclusive results. In other words, certainty for these products’ efficacy is still low.

Research on this topic has offered the medical community and infants with epilepsy encouraging signs, though it is by no means a comprehensive, long-term solution. Evidence and research on this topic has grown considerably in the past few years, vwith efforts to engage with this line of research being critical to helping health care professionals and families determine whether cannabis-based products are effective and safe for vulnerable populations such as children.