CBD vs.

Traditional Therapy 1

The Effect of Medical Marijuana Therapy vs. Traditional Therapy to Reduce Seizures in

Pediatric Epilepsy Patients

Kyle Gulling, Shannon Troy, Jenna Matheny, Valerie Kinsey, Ethan Thomas

Nursing Research: Dr. Ballone

Youngstown State University

CBD vs. Traditional Therapy 2

Abstract

This paper is going to discuss epilepsy disorder in pediatric patients. We will discuss what

epilepsy is and how it affects these patients lives as well. The research topic is about the effects

of traditional treatment methods versus medical marijuana, and the effects these treatments have

on the patients. Multiple research studies were examined and discussed during this report. The

findings have concluded that medical marijuana is beneficial for these patients, but there is still

limited research done for this particular topic. Patients showed less harmful side effects while

using medical marijuana and experienced less seizure activity as well. The common medications

used for seizures are beneficial, but they do have unpleasant side effects. In conclusion, this is a

growing field and there needs to be more research done on this topic to know for sure if it works.

Keywords: CBD (cannabidiol), AED (antiepileptic drugs), epilepsy

CBD vs. Traditional Therapy 3

The Effects of Medical Marijuana Therapy vs. Traditional Therapy to Reduce Seizures in

Pediatric Epilepsy Patients

Before her first birthday, Addyson Benton was diagnosed with intractable myoclonic

epilepsy. She experienced up to 1,000 seizures per day, which is approximately 1 seizure every

minute of every day. The medication regimen Addyson was put on was not adequately

controlling her seizures, so her family decided to do research on medical marijuana. This Ohio

family made the difficult decision of moving 1,000 miles across the country to Colorado to

receive a treatment that would hopefully help Addyson have the best quality of life. Her

treatment plan included cannabinol oil low in tetrahydrocannabinol (THC), in the form of a patch

that is put on her ankle. This form of treatment made a huge impact on Addyson’s life. In this

article, we are going to discuss the effect of medical marijuana therapy vs. traditional therapy to

reduce seizures in pediatric epilepsy patients.

What is Epilepsy?

First let’s discuss seizures and exactly what they are. During the event of a seizure,

neurons in the brain have a sudden burst of electrical activity. This causes changes in level of

consciousness, movement, and behavior as well as emotional changes. It also changes cognitive

function, which affects reasoning, memory, attention, and language. Chronic, recurrent,

unprovoked seizures with no underlying medical reasoning is known as epilepsy. According to

Jean Kaeberle (2018):

Epilepsy disorders are the most common treatable neurological disorders in

childhood. Diagnosis and treatment of these disorders has improved over time.

Children with epilepsy/seizure disorder are more likely to have or develop mental

health and developmental comorbidities such as depression, anxiety, attention

CBD vs. Traditional Therapy 4

deficit hyperactivity disorder, learning disabilities, and developmental delay

compared to children without epilepsy/seizure disorder. If seizures can be

controlled, quality of life will improve. (pg. 342)

According to the Mayo Clinic, symptoms include temporary confusion, staring spells,

uncontrollable jerking movements of the arms and legs, loss of consciousness or awareness, and

psychiatric symptoms such as fear, anxiety, or déjà vu. Epilepsy symptoms also vary depending

on the type of seizure these patients have. The different types of seizures are characterized by

stereotypic, episodic, and/or may be unpredicted. A stereotypic seizure is exactly what it sounds

like. These seizures happen the same way every time. Episodic seizures are ones that come and

go. Seizures can be caused by different things such as electrolyte imbalances, dehydration,

hypoglycemia, infection, or traumatic injury. There are over 20 types of epilepsy documented

today, and depending on the type of epilepsy will determine what type of treatment is effective

for these patients.

Traditional Therapy: Antiepileptic Drugs

There are many different types of “traditional treatment” used to treat epilepsy. The first

line of treatment is called antiepileptic drugs. These drugs are used when we identify that a

patient has epilepsy. The goal of antiepileptic drugs is to take the least amount of medications

with the least dose as possible. Common antiepileptic drugs (AED for short) prescribed to

children and adolescent patients are carbamazepine (Tegretol), phenytoin (Dilantin), valproic

acid (Depakote), levetiracetam (Keppra), and many more. These medications need close

monitoring, including liver function testing. In order to decide which medication will work best

for the patient, there are many factors that are looked at including which type of epilepsy they

have, tolerance to medication, and the effectiveness of the medication.

CBD vs. Traditional Therapy 5

Carbamazepine (Tegretol) is used for epilepsy because it reduces the spread of seizure

activity in the brain. It also restores nerve activity back to a normal balance. This drug has some

side effects that can deter people from wanting to use it though. These symptoms include

angioedema, Stevens-Johnson’s syndrome, erythema multiforme, pulmonary hypersensitivity,

arrhythmias, syncope, AV block, pancytopenia, hepatotoxicity, pancreatitis, and suicidality.

There is a black box warning for this drug that says it can cause a serious and possibility fatal

skin reaction called toxic epidermal necrolysis (Epocrates).

Phenytoin (Dilantin) is another drug that is commonly used to treat epilepsy. The side

effects for this drug include severe hypotension, CV collapse/arrest, hepatotoxicity, purple glove

syndrome, toxic epidermal necrosis, and tissue necrosis. The next drug is called Valproic Acid

(Depakote). This drug can cause serious side effects like hallucinations, psychosis, suicidality,

encephalopathy, cerebral pseudoatrophy, and parkinsonism. Lastly, levetiracetam (Keppra)

causes side effects like depression, psychosis, suicidality, acute renal failure, rhabdomyolysis,

and toxic epidermal necrolysis. These drugs all cause similar side effects that can be potentially

harmful to a young child (Epocrates).

Traditional Therapy: Vagus Nerve Stimulation

According to Jean Kaeberle, “vagus nerve stimulation is a technique used to treat

epilepsy that involves implanting a pacemaker-like device into the chest that generates pulses of

electricity to stimulate the vagus nerve” (pg. 343). Vagus nerve stimulation is only approved for

patients who are over the age of 4 and who were not successfully treated with two or three

different AEDs. This type of treatment is not a cure to epilepsy and patients did not have

complete elimination of their seizures. With vagus nerve stimulation, there is a 50-75% reduction

in the amount of seizures patients had. This type of treatment can possibly help with treating a
CBD vs. Traditional Therapy 6

seizure early on before the actual seizure ever happens. Some patients experience something

called auras which are, a warning before the seizure. If you notice a patient having this sign, you

can hold a special magnet to the implanted device and it will trigger the device to send a shock

and stimulate the patient. This method can be effective, but it would require a device surgically

implanted into the body.

Traditional Therapy: Dietary Modifications

Another form a traditional treatment is dietary modifications. There are three different

modifications that work for epilepsy. The first diet is the ketogenic diet. With the ketogenic diet,

you consume mainly fats and no carbohydrates. The reason why this diet is beneficial is because

ketone bodies are considered to be an anticonvulsant. The ketogenic diet is a difficult diet to

follow, just because you have to intensely measure and weigh your food out. This diet is used for

children 18 months - 9 years old, who are not controlled with other AED medications. This diet

is said to be 60% effective with a 50% reduction in seizure activity. The next diet is a modified

Adkin’s diet. This diet restricts the amount of carbohydrates to 10 grams per day. This diet is a

little easier to follow rather than the ketogenic diet. The Adkin’s diet shows a 30-45% reduction

in seizure activity in children. The last diet is the low glycemic index diet. This diet also limits

carbohydrates to 40-60 grams per day. The low GI diet has a 32% reduction in seizure activity.

These diets are challenging to follow. Children who are in school have a hard time

following these diets and make it stressful for school nurses and families to maintain these diets.

All of these diets require strict maintenance and planning in order to make sure the child follows

these specific diets. It requires a lot of cooperation between families, schools, and the children

themselves to follow all of these diet restrictions carefully.

CBD vs. Traditional Therapy 7

Traditional Therapy: Surgical Intervention

The last traditional therapy method is surgery. Surgery is considered only when AEDs

and other therapies fail to control the seizures. In order to get the surgery, you have to qualify

and be a candidate. The surgery of choice is called a temporal lobe resection. “This procedure

removes part of the temporal lobe of the brain where the epilepsy seizures originate” (Kaeberle.

J. pg.344). Temporal lobe resection is said to be very successful with 75-85% reduction in

seizure activity. Before you can get the surgery, they have to pinpoint exactly where the seizures

are happening inside the brain. Patients also go through other testing to determine if surgery is

the best option. Surgery is the last option though, because it is invasive and you also have to

qualify for it as well. Now we are going to talk about medical marijuana and if it is a better

option then these traditional therapies or not.

Medical Marijuana

“Marijuana (cannabis Sativa and cannabis Indica) is a naturally growing plant containing

more than 130 phytocannabinoids, and 300 non-cannabinoid constitutes” (Kedem, 2018). There

are two components to marijuana, including tetra hydro-cannabinoid (THC) and non-

psychoactive cannabinoid (CBD). Both THC and CBD are said to have anticonvulsant actions,

which makes them beneficial for children with epilepsy. There have been multiple studies done

to show that CBD has the ability to reduce seizure activity in comparison to THC. They are both

beneficial, but THC has a higher chance of children having cognitive impairment and psychiatric

problems. Common side effects of CBD include somnolence (or sleepiness), GI issues such as

nausea and vomiting, and food interactions, which are less dangerous of side effects than the

common antiepileptic medication side effects. CBD is not the same as THC, because THC is
CBD vs. Traditional Therapy 8

used for recreational use for people to get the “high” effect, where CBD is strictly used for

medical use.

Clinical Studies

The first study we are going to discuss is the “Efficacy of CBD-enriched medical

cannabis for Treatment of Refractory Epilepsy in Children and Adolescents.” This study was

done on children and adolescents ranging from ages 1-20 years with refractory epilepsy. All of

the patients who participated in this study were taking AEDs for 4 weeks prior to the study. For

this study, 57 patients were treated with their AED medications, while taking CBD cannabis oil

together to see if there was a decrease in seizure activity. The parents monitored the side effects

and reported the frequency of seizures during the new treatment. They also did a baseline study

for 4 weeks prior to the CBD oil treatment to be able to compare seizure activity. The CBD

cannabis oil that was used was high in CBD, and very low in THC with a 20:1 ratio. In

conclusion, there is evidence that cannabis oil can be used as a treatment for epilepsy. These

patients showed a greater reduction in seizure activity when the CBD dose was increased and the

AED dose was tapered off.

In the next research study, there were two case studies done. This study can be found in

the article “Delta9-THC Intoxication by Cannabidiol-Enriched Cannabis Extract in Two

Children with Refractory Epilepsy: Full Remission after Switching to Purified Cannabidiol”. The

first case study was done on a 10-year-old girl who was diagnosed with refractory epilepsy and

left frontal dysplasia. Before the study, she was taking Phenytoin, Topiramate, Carbamazepine,

Levetiracetam, Lamotrigine, Primidone, and Clobazam. She also had a frontal lobe resection at

the age of 8 and did not have any seizures for 4 months. Then seizures ended up returning,

despite pharmacological treatments. She was then started on oral CBD extract. This extract is
CBD vs. Traditional Therapy 9

high in CBD and low in THC as well. This 10-year-old girl took the oral CBD 3 times/day for a

year and then did a follow up after 1 year. They tapered her medications down to Topiramate,

Clobazam, and Valproate. The results to this study showed a complete remission after 4 weeks of

the CBD treatment. She showed no seizure activity while taking these treatments. She had some

side effects though which included ataxia, inappropriate laughter, reduced attention span,

aggressiveness, spasms, and bilateral eye redness. After they further adjusted her dosing, these

side effects went away within 1 week.

The second case study was done on a 7-year-old boy who was diagnosed with refractory

epilepsy as well. He was being treated with several medications including Stiripentol, Valproic

acid, Oxcarbazepine, Topiramate, Levetiracetam, Phenytoin, Phenobarbital, and Sulthiame. Even

though he was taking these medications daily, he was still suffering from 1-2 seizures each day.

CBD-enriched extract was then given to the boy twice per day at 125mg doses each time. The

study was done for 1 year and 10 months continuously. The results to this study concluded that

he was seizure free when taking CBD in combination with Topiramate and Valproate. He also

had improvements with communication, social interactions, and was also able to get involved

with extracurricular activities including swimming.

The next piece of information we found is a survey done by parents in Mexico and Latin

American countries. The survey was done to see if the quality of life was improved for patients

suffering from refractory epilepsy. Refractory epilepsy is epilepsy that is not controlled by 2 or

more anticonvulsant medications. There was 53 cases of children aged between 9 months and 18

years that were identified from these countries. 47.1% of these cases were treated with 9 or more

anticonvulsants. “The parents reported a decrease in convulsions where cannabidiol was used in

81.3% of these cases; a moderate to significant decrease occurred in 51% of cases, and 16% of
CBD vs. Traditional Therapy 10

cases were free from seizures” (Aquirre-Velazquez, pg. 2). There were no serious side effects,

but the side effects that were reported included increased appetite, and changes in sleep patterns.

The survey was done online, and the software used was http://www.eencuesta.com .

Informed consent was provided and a confidentiality clause was included for identifying details.

The parents filled out 31 questions in 9 different sections. These sections include personal

details, age of occurrence and neurological diagnosis, previous number of conventional

anticonvulsants, antiepileptic drugs prior to CBD, total number of seizures in the month

preceding CBD treatment, total number of seizures in the month following CBD treatment,

changes in emotional, cognitive, sleep, and dietary state, side effects observed during treatment

with CBD, and open feedback on the use of CBD.

The results of this survey concluded that 4.6% reported worsening symptoms and

increased seizure activity; 11.6% reported no change in condition, 83% reported that they had a

slight to significant change in their condition including decreased seizure activity, length, and

severity; and lastly, 16% of these patients actually reported being completely free of seizures.

“The recommendation is that the use of CBD in these cases is within a framework of study

where the actual efficiency can be determined and security aspects are monitored.” (Aquirre-

Velazquez)

The last study researched CBD-enriched medical cannabis for intractable pediatric

epilepsy. The study was done on 74 patients ranging from ages 1-18 years of age. These patients

were treated for a minimum of 3 months and the average treatment was done for 6 months. The

patients were not being treated with any other form of medication during this study. The parents

reported their findings and assessed the frequency of seizure activity. The doses of CBD ranged

from 1-20mg/kg/day. The results of this study showed that there was a significant decrease in
CBD vs. Traditional Therapy 11

seizure activity. 18% of these patients reported a 75-100% reduction in seizures, while only 7%

reported worsening symptoms. In conclusion, CBD enriched medical cannabis was shown to be

effective for patients who have not been able to be controlled by AEDs.

Conclusion

The research provided confirms a positive results for epileptic patients who receive this

treatment regimen. The majority experienced a decrease in epileptic episodes and number of

seizures per day, as well as the severity when treated with cannabinoids. Unfortunately, there are

limitations to the evidence provided around this regimen. The laws regarding the usage of

marijuana for medical reasons in many states creates barriers for patients to receive this

treatment. There is also a stigma associated with the use of any form of cannabis products due to

the bias created by the recreational use of marijuana. This is especially true in pediatric patients.

The research is minimal, decreasing physician motivation to prescribe this to their patients, but

research shows that it is beneficial for epileptic children.

CBD vs. Traditional Therapy 12

References

Aguirre-Velázquez, C. G. (2017). Report from a Survey of Parents Regarding the Use of

Cannabidiol (Medicinal cannabis) in Mexican Children with Refractory

Epilepsy. Neurology Research International,2017, 1-5. doi:10.1155/2017/2985729

Crippa, J. A., Crippa, A. C., Hallak, J. E., Martín-Santos, R., & Zuardi, A. W. (2016). Δ9-THC

Intoxication by Cannabidiol-Enriched Cannabis Extract in Two Children with Refractory

Epilepsy: Full Remission after Switching to Purified Cannabidiol. Frontiers in
pharmacology, 7, 359. doi:10.3389/fphar.2016.00359

Epocrates, Inc. (1998). Retrieved March 03, 2019, from http://www.epocrates.com/

FONG, S. L., & KOSSOFF, E. H. (2018). Cannabinoids as future treatment for

epilepsy. Contemporary Pediatrics, 35(11), 11–12. Retrieved from

https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,uid&db=rzh&AN=13
3008872&site=ehost-live&scope=site

Hausman-Kedem, M., Menascu, S., & Kramer, U. (2018, April 16). Efficacy of CBD-enriched

medical cannabis for treatment of refractory epilepsy in children and adolescents – An

observational, longitudinal study. Retrieved April 9, 2019,
from https://eps.cc.ysu.edu:2132/pubmed/29674131. doi:10.1016/j.braindev.2018.03.013

Kaeberle, J. (2018). Epilepsy Disorders and Treatment Modalities. NASN School Nurse, 33(6),

342-344. doi:10.1177/1942602X18785246

Ohio family who moved to Colorado finds relief for daughter’s seizures with medical marijuana.

(2015, May 21). Retrieved from http://www.foxnews.com/health/ohio-family-who-

moved-to-colorado-finds-relief-for-daughters-seizures-with-medical -marijuana
CBD vs. Traditional Therapy 13

Tzadok, M., Uliel-Siboni, S., Linder, I., Kramer, U., Epstein, O., Menascu, S., (2016). CBD-

enriched medical cannabis for intractable pediatric epilepsy.

Seizure, 35, 41-44. doi:10.1016/j.seizure.2016.01.004