Cannabidiol Treatment for Severe EpilepsyNov 19, 2013
You might have heard about a new cannabis-based treatment for children with severe forms of epilepsy such as Dravet syndrome. Cannabidiol, also referred to in Utah as “Alepsia”, has been reported to be effective in reducing seizures, but some families that want access for their children can’t obtain it because it’s illegal in many states. Dr. Francis Filloux explains this proposed treatment, talks about the concerns surrounding it, including its relationship to marijuana and discusses the evidence regarding its effectiveness and why he thinks it’s a potentially viable option in certain cases. The opinions expressed in this podcast are those of the physician and do not necessarily reflect the opinions of the University of Utah, University of Utah Health Sciences or their partner organizations.
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Interviewer: There's a potential treatment for children with severe forms of epilepsy. Sounds great, but there's a problem. We're with Dr. Francis Filloux. What's the issue here?
Dr. Filloux: There are families of children with severe epilepsy who have been aware of some unusual cases where similar children have responded incredibly well by press reports to a substance called Cannabidiol, which is actually a product of the Cannabis plant, and they really want to have access to that chemical, but it is restricted for legal reasons.
Interviewer: Okay. So let's talk a little bit about the symptoms of epilepsy and what this chemical could actually do to help improve their quality of life.
Dr. Filloux: Most children with epilepsy have conditions that we can help with standard anti-seizure medicines known as anticonvulsants. That applies to maybe 70 percent of children with epilepsy, but there's a small percentage who have absolutely uncontrollable seizures and an even smaller percentage where the seizures are extremely frequent, multiple, and completely impair the person's daily life. Those individuals, unfortunately, typically don't respond to our standard anti-seizure medicines even at high dose. They suffer many side effects of those medications.
Interviewer: And there's some research that shows that Cannabidiol actually has worked in some clinical trials or empirically speaking? Give me some of the research behind this.
Dr. Filloux: I would say the data that we have now is fairly limited for human effects, but there is considerable experimental data that indicates that Cannabidiol and related products can interfere with epileptic mechanisms, both in animal models and in tissues that are analogous to epilepsy. However, what has happened more recently is that a few children with very severe epilepsy, in particular a child with a condition known as Dravet Syndrome, another with something called Doose Syndrome, have had apparently amazingly effective results from this agent. There is also some human data, although it's modest, from the 1980's and now accumulating experience among families who have just tried this on their own. Many report rather positive results with minimal side effects, so that really excited everybody in the field, and particularly families with children with such severe forms of epilepsy.
Interviewer: So in medicine, how exactly is it administered?
Dr. Filloux: The form that's currently available in Colorado is a concentrated extract of the plant that is very high in the Cannabidiol and has virtually no tetrahydrocannabinol, which is THC. So it's a highly purified, if you will, extract that contains Cannabidiol. In order to administer it, it's basically disssolved in olive oil or some form of oil that's palatable, and it's administered by mouth in oil form. I would emphasize on that point that it's not smoked, so it's not the same thing as, you know, smoking a joint or a reefer. It really has nothing to do with marijuana. It has to do with the chemical extract of the plant.
Interviewer: It's just from the same plant?
Dr. Filloux: Correct.
Interviewer: Is there kind of some back lash? People are, like, "You're trying to give marijuana to kids."
Dr. Filloux: Yeah. I think that's been a major concern, but in fact, it really shouldn't be, in my opinion, such a serious concern. The hallucinogenic or "psychoactive" substance in marijuana or in Cannabis is known as THC or tetrahydrocannabinol, and the product we're talking about is a different chemical that is in the same plant but is not psychoactive and not hallucinogenic in that sense.
Interviewer: What are the objections that people have?
Dr. Filloux: I think people have two-fold objections. The one I would describe as scientific objections, which I do think we need to grapple with, and the other are, if you will, moral or sociocultural objections. So we can address the latter easily. That's the issue of medical marijuana. It's just, like, legalizing marijuana. Is it going to lead to abuse?
Interviewer: Yeah. Is this oil going to be something the kids are going to steal and then go out and behind it?
Dr. Filloux: Yeah. And the answer is, "No." There's absolutely no abuse potential to this. There is no moral or psychosocial implication of this that's derogatory or negative for the families that would be having their children take this. I think the scientific objection is that we honestly don't have that much data with respect to how this might affect children, particularly side effects. However, it is being taken by individuals currently in the U.S. That is their choice, and I think my point would be that as physicians and health care providers, we would want to, as best we can, support families who would do this so as to maybe minimize the risks and learn the most we can about its potential benefit and efficacy.
Interviewer: So it sounds like if it wasn't related to the Cannabis plant, or if it was any other plant, there wouldn't even be an issue?
Dr. Filloux: Absolutely. This is very similar to other substances that are found, say, in health food stores or at Smith's.
Interviewer: I can go to a health food store and get hemp seeds?
Dr. Filloux: Yes.
Interviewer: That's not making me high?
Dr. Filloux: Which, incidentally, has about as much tetrahydrocannabinol as does this product.
Interviewer: And the frustration for a lot of parents, if I understand correctly, is in some states, marijuana's illegal, but in no states is this non-hallucinogenic form that could actually help severe epilepsy seizures legal. Is that correct?
Dr. Filloux: Actually, no. The Cannabidiol is available in some states, Colorado being one, but it is not available in Utah. As I understand, it cannot be transferred from one state or another because of various federal regulations.
Interviewer: Talk to me about the parents with children that have this severe epilepsy, the severe seizures and how you feel this could really benefit them.
Dr. Filloux: I take care of children with epilepsy on a daily basis. Of course, most children with epilepsy do well, but the small fraction who have very horrible epilepsies are truly, totally incapacitated from morning until night, during the night with absolutely uncontrolled seizures. It's really devastating, and, unfortunately, the medications we have to offer frequently are associated with significant side effects, which further complicate matters. So families are really seeking any option that might be beneficial, and honestly, they're willing to take some risks given that the quality of life of their children is so horribly compromised.
Interviewer: And you feel this is a good option?
Dr. Filloux: I think it is at least an option that should be made available to people in Utah if it is available to citizens of the United States in other states such as Colorado.
Interviewer: And that's really what's at issue here?
Dr. Filloux: I believe so. Yeah. I think it's access. I'm not saying that it'll work for sure. There's just too limited data to be totally comfortable that it will be as effective in everyone as it has been in a few children, but if it were my child, I would really want to have that opportunity.
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