In NEUROLOGY NOW, February, 2017, page 12, Dr.
Dana Ekstein, senior neurologist at Hadassah Medical Center in Jerusalem, reviewed
the use of non-prescribed chemicals and herbs that epilepsy patients use to
help control seizures, to treat medication side effects, and to treat their
anxiety, depression and memory problems.
A 2012 American Health Interview Survey
revealed about eighteen percent of the American population use complementary
herbal and botanical medicines other than vitamins, and nonmineral natural
products. Among people with epilepsy half of adults and a third of children use
complementary therapies without their physicians’ knowledge. Some of these
botanicals interfere with their prescribed antiseizure medications.
Another study, a Canadian study 1, found that fifty-nine percent of patients with epilepsy and thirty-three percent of patients with psychogenic non-epileptic seizures (see my Blog #10: September 23, 2011 Is It A True Epileptic Seizure or a Faked, Psychogenic Seizure With a Psychological Cause?) who participated in the study and who used cannabis, i.e., marijuana, hashish, “pot,” etc., daily perceived improvements in seizure control, stress, sleep quality, and drug side effects. Although their perceived stress reduction may have contributed to the perceived positive impact of marijuana on seizures and nonepileptic events in adults, the researchers reported that they could not reliably conclude that Cannabis was objectively efficacious.
A Cochrane Review (Cochrane works
collaboratively with contributors around the world to produce authoritative, relevant,
and reliable evidence in the form of Cochrane
Reviews) of cannabinoids for epilepsy found no reliable conclusions
could be drawn regarding the efficacy of the studied doses of 200-300 mg daily
of cannabidiol component of the marijuana plant (the non-psychoactive component
of marijuana plants in contrast to the psychoactive tetrahydrocannabinol [THC]
component) 2. Further trials are needed in this area.
Another trial
led by Devinsky et al 3 concluded that of 137 patients with onset of
drug-resistant epilepsy beginning in childhood and currently experiencing at
least four seizures per month, thirty-nine percent enjoyed a fifty percent, or
greater, reduction in seizure frequency.
Regarding the
treatment of depression in epilepsy with botanicals a Chinese mushroom called Xylaria nigripes was studied in a
random, double-blind, placebo-controlled trial of one hundred four patients.
The mushroom-treated patients reported significantly improved depression and
quality of life scores compared with placebo 4.
One must
use caution in assuming that natural products are safe. Ephedra, St. John’s
wort and ginkgo biloba can cause seizures. Tetrahydrocannabinol [THC] may
impair memory and executive function and induce psychiatric symptoms. Other
unwanted side-effects in cannabis trials include worsening seizures, drowsiness,
fatigue, and gastrointestinal complaints.
Interactions
s between antiseizure drugs and botanicals can include altered blood levels of
the antiseizure drugs (cannabidiol increases concentrations of clobazam).
Dr. Eckstein
emphasizes that neurologists need to be well-educated and up-to-date regarding
botanical therapies.
1) Massot-Tamis A, McLachlan RS. Marijuana use
in adults admitted to a Canadian epilepsy monitoring unit. Epilepsy Behav. 2016; 63: 73-78.
2) Gloss
D, Vickrey B. Cannabinoids for epilepsy. Cochrane
Database of Systematic Reviews 2012, Issue 6. Art. No.: CD009270. DOI:
10.1002/14651858.CD009270.pub 2.
3) Devinsky
O, Marsh E, Friedman D, et al. Cannabidiol in patients with treatment resistant
epilepsy: an open-label interventional trial. Lancet Neurol. 2016; 15(3): 270-278.
4) Peng
WF, Wang X, Hong Z et al. The anti-depression effect of Xylaria nigripes in patients with epilepsy. A multicenter
randomized double-blind study. Seizure.
2015; 29: 26-33.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David
Geffen School of Medicine at UCLA. “DINGS” is his first novel. It is a
mother’s dramatic story that teaches
epilepsy, now available in eBook, audiobook and soft cover editions.
