Expert cautions against promoting CBD gel for epilepsy seizures, after study unveils long-term impact

19 Jul 2022 --- Cannabidiol (CBD) may benefit people with epilepsy by reducing seizures by 50%, according to a first of its kind study. Nonetheless, it is too soon to tell whether the impact is due to CBD itself or the ingredient’s effect on epilepsy drugs, an expert has warned.

NutritionInsight speaks with Dr. Andy Yates, pharmacy lead at the Association for the Cannabinoid Industry, who raised concerns over what the findings mean.

“Realistically, the mechanism of action in CBD is likely to potentially translate into other forms of epilepsy that causes seizures, but until it has been fully proven scientifically, this cannot be confirmed,” he explains.

CBD is metabolized by the liver and broken down by the liver, he notes. “The enzymes that break down CBD are often what also break down other types of drugs, including anti-epileptic medication. So you need to be very careful if you are already on anti-epileptic medication and you start taking CBD as you need to monitor blood levels because they can go up.”

“Then it becomes a question of whether it is the CBD causing anti-epileptic effect or if its the CBD that’s causing the classic drugs to work better because of the higher blood levels.”

Too soon to tellCBD can have adverse effects when consuming anti-epileptic medication as blood levels increase.
Yates adds that without a prescription, it may be difficult to access the correct dose and find an affordable alternative as buying it over the counter is expensive. 

“In the UK, the maximum recommended dose is only 70 mg per day of CBD,” he highlights. 

“That dose may be appropriate for some patients, but it’s not really in those ranges that an epileptic patient may require. If you want to give CBD a go, there is a high chance that you may need more than you can get over the counter.” 

“To consume 70 mg of CBD per day gets quite expensive quite quickly, a bottle of 500 mg of CBD in it can cost £30 (US$36). If you think about it, that really will only deliver you seven doses, resulting in approximately £120 (US$144) per month.”

“I would support more research in this field, but as a healthcare professional, I do feel quite uncomfortable promoting this, at this point based on the study.”

Potential adverse effects
There are various side effects of CBD usage, according to Yates. Common ones are stomach problems, lower bowel problems, drowsiness and sleepiness, and weight loss, particularly among children.

For people diagnosed with epilepsy, Yates mentions additional adverse effects to CBD that may be dangerous when a user is dosing independently, meaning without consultation with a healthcare professional. 

“I have not personally done studies on people with epilepsy, but I have read literature around it,” he remarks. “It’s worth stating that there are studies conducted on more resistant forms of epilepsy, but none of them have been proven yet. 

“CBD can be dangerous with high blood levels for children mainly, for some anti-epileptic medications you really don't want to change the blood levels too much, therefore putting the patient at risk. Again, this can only be done with help from a medical professional.”

Long-term impactSeizure reduction was only proven once the dosage was increased and when no placebo group was in the trial.
A CBD gel – pharmaceutically manufactured, clear and synthetic transdermal – was applied twice daily to the upper arms and shoulders, followed by a skin check for 12 consecutive weeks. 

The gel was developed to provide standard CBD delivery when applied twice daily. 

There were 188 participants with mixed genders in the age range 18 to 70, all of which had frontal epilepsy. Divided into three groups, the participants either did not receive any CBD or were prescribed 195 mg or 390 mg of the cannabinoid. 

All participants were diagnosed with drug-resistant epilepsy, and the division of groups was done randomly. During the first 12 weeks, no difference was shown in seizure frequency between the three groups. 

The study highlights that the median change in SF28 – seizure frequency of 28 days – was greater for the groups consuming CBD compared to the placebo group, even though differences were not significant. 

Regardless of which group they were in, all participants who completed the 12-week study were offered to enroll in an open-label extension study, adding two years to the experiment. Independent of the previous group, all were given the 390 mg daily dosage. After five months in, the dosage could be increased to 585 mg, and one month later to 780 mg.

While keeping seizure diaries as part of the requirement, the results showed a decrease in frequency six months into the experiment. 

CBD for medical use
Previously, medical CBD products have shown efficiency and have been used in treating children with epilepsy in the US since approval was granted in 2018. In the EU, using CBD for medication was approved in 2019. 

Increased focus has been on using CBD for pain relief and cancer treatments. It has also been explored as a safe weight-loss alternative and a way to tackle issues surrounding mental health such as anxiety and stress, which both have been reported to have increased after the COVID-19 pandemic.

Yates encourages not trying a new CBD product independently when having a medical condition, but that it should always go in partnership with a medical practitioner. However, he mentions a lack of demand and knowledge for using CBD for epileptic treatment. 

By Beatrice Wihlander