Cannabidiol Epilepsy

The significance of Dravet Syndrome in the medicinal marijuana movement

Chances are, you haven’t heard of Dravet Syndrome. It’s a relatively rare childhood disorder affecting 1:~20,000 individuals that begins to present itself within the first year of life in otherwise normally developing children. Despite its rarity, the struggle to treat children with Dravet Syndrome has led to some of the strongest evidence in favor of removing cannabis’ Schedule I classification and legitimized its use in modern medicine.

Children with Dravet Syndrome initially have febrile seizures, triggered by a warm bath or fever, that progress into frequent full-blown myoclonic seizures seizures as the child ages. Additionally, these children become developmentally delayed, display severe cognitive impairment, and present abnormal social behaviors consistent with autism. It’s a devastating disorder that stresses the quality of life for patients and their caregivers.

The epileptic seizures in Dravet Syndrome are particularly challenging to treat. Take the case of Charlotte Figi, a young girl with Dravet Syndrome living in Colorado. Charlotte’s seizure frequency escalated to over 300 per week. Doctors prescribed her a host of traditional anti-epileptic medications, but to no avail; her seizures were only briefly kept in check, or her seizures worsened. Further, Charlotte experienced a host of unwanted side-effects. She needed a different treatment strategy

Dravet Syndrome is caused by a genetic mutation that reduces the excitability of inhibitory neurons in the brain. This results in a tipping of the brain’s excitatory:inhibitory balance towards excitation. Too much excitation, and seizures develop. Current medications prescribed to combat seizures do a poor job at selectively increasing the brain’s inhibitory function without leading to debilitating side effects. So using traditional anti-epileptic medications only leads to poor control over seizures in Dravet Syndrome. That’s where cannabis comes in.

After exhausting their options, Charlotte’s parents threw a  hail-mary. They had heard rumors that cannabis could potentially reduce seizure activity, so they decided to get their hands on some. They obtained a CBD-rich marijuana extract and held their breath.

To their amazement and delight, the CBD-rich marijuana extract substantially reduced Charlotte’s seizures. Further, they noted developmental improvement all in the absence of side effects. This CBD-rich marijuana extract is now known as Charlotte’s Web, distributed by the Stanley Brothers, and has led to a migration of families with children with treatment-resistant epilepsies to move to states with legal medical marijuana in hopes of finding an effective treatment.

And the medical community caught on. In the late 90’s, GW Pharmaceuticals in England obtained the first legal grow license for medicinal purposes in the late 90’s. Then, at the beginning of this year, their 99% CBD extract, Epidolex cleared Phase III clinical trials demonstrating efficacy in reducing seizures in children with Dravet Syndome (note: in a smaller trial, they found that it also reduces seizures in other treatment-resistant epileptic disorders such as Lennox-Gastaut Syndrome). This is one of the first and largest human clinical trials to-date demonstrating the effectiveness of cannabis, particularly CBD, in a medicinal context.

Anecdotal accounts of cannabis success in treating epilepsy have been told for centuries, but its recent scientific assessment has legitimized its use in medicine. It’s also highlighted the fact that CBD has a far more favorable side-effect profile than many other traditional medications.  This has supported research in an array of other medical conditions in need of safe and effective treatment options, such as pain, anxiety, and neurodegenerative disease.

The problem remains, however, that CBD falls under the Schedule I classification of the Controlled Substance Act. By definition of its Schedule I classification, CBD has no medicinal benefit. Clearly, this is at odds with the success of the clinical trials in treating epilepsy. The accumulating evidence for cannabis treatment, not only in epilepsy, but in pain, anxiety, and even autism, is leading to an increase in the number of funded and approved human clinical trials and the allotment of federal funds for medicinal cannabis research. It’s only a matter of time before the accumulation of evidence overturns cannabis’ Schedule I classification.