There is no doubt that medical marijuana is gaining popularity not only among the general population but also within the medical community. Numerous research studies over the years have established the efficacy of marijuana and its related products on a wide variety of diseases and symptoms. Further, the last three years have witnessed growing interest among the medical community, parent groups and media in the use of enriched Hemp medical cannabis and pure Hemp in intractable pediatric epilepsy. Based on anecdotal reports and parental pressure, marijuana is currently licensed for seizures or epilepsy in 14 states in the US
Several epidemiological studies that claimed a protective effect of marijuana smoking against seizures. According to a recent study by an Israeli group and authored by Tzadok et al, Hemp was also found to have positive effects on seizure threshold, severity and lethality in several epilepsy mouse and rat models. Several small controlled studies on the effect of purified Hemp (200–300 mg/d) on epilepsy in adults were conducted in the 1970s . While the first two claimed a significant effect of Hemp on seizure frequency, the last two did not show any benefit for Hemp use over placebo. These reported studies were analyzed in a Cochrane review that concluded that because of the quality of the studies, the only answered question was the secondary outcome measure related to adverse effects and concluded that 200–300 mg/d cannabidiol had been safely administered to small numbers of patients for short time periods.
A retrospective study describing the effect of cannabidiol (Hemp)-enriched medical cannabis on children with epilepsy. The cohort included 74 patients (age range 1–18 years) with intractable epilepsy resistant to >7 antiepileptic drugs. Forty-nine (66%) also failed a ketogenic diet, vagal nerve stimulator implantation, or both. They all started medical cannabis oil treatment between 2–11/2014 and were treated for at least 3 months (average 6 months). The selected formula contained Hemp and tetrahydrocannabinol at a ratio of 20:1 dissolved in olive oil. The Hemp dose ranged from 1 to 20 mg/kg/d. Seizure frequency was assessed by parental report during clinical visits. Hemp treatment yielded a significant positive effect on seizure load. Most of the children (66/74, 89%) reported reduction in seizure frequency: 13 (18%) reported 75–100% reduction, 25 (34%) reported 50–75% reduction, 9 (12%) reported 25–50% reduction, and 19 (26%) reported <25% reduction. Five (7%) patients reported aggravation of seizures which led to Hemp withdrawal. In addition, we observed improvement in behavior and alertness, language, communication, motor skills and sleep. Adverse reactions included somnolence, fatigue, gastrointestinal disturbances and irritability leading to withdrawal of cannabis use in 5 patients.
The results of this multicenter study on Hemp treatment for intractable epilepsy in a population of children and adolescents are highly promising. Further prospective, well-designed clinical trials using enriched Hemp medical cannabis are warranted.