Seizures

#010: Role of Cannabinoids in Seizure Disorder — Part 2

In the second episode of this two-part series on epilepsy and seizure disorder, I focus on epilepsy and seizure disorders in women and children. I talk about current treatments, drug side effects, and current FDA approved cannabis-based products for epilepsy in children.

Anytime you have drugs that cause a great deal of side effects, you will have a population that will not be compliant when taking their medicine. I talk about the different side effects, from mild headaches to more serious bone loss, and how that affects a patient’s compliance.

For women, treating epilepsy and seizure disorders is especially difficult. Estrogen has been shown to have a seizure activating effect, and I share what that might mean for women with this condition. Enzyme inducers and enzyme inhibitors can also have an impact on the level of estrogen in a woman’s body, so this effect must be carefully considered by a doctor before prescribing.

Pregnancy can present its own challenges. Up to 25 or 30 percent of women experience an increase or decrease in seizures during pregnancy. So while a doctor is trying to manage their seizure disorder, they are also having to consider the effect on the unborn baby. This can be difficult because simply not treating the seizure disorder is not possible.

Seizure disorder is one of the few diseases where cannabis-based drugs are FDA approved for its management, but so far it is only approved for children. We have studies that show how well it works for children, so it might work well for adults, but we don’t know yet. I talk about the proper dosage and application of cannabinoid products that currently work and are federally approved.

Cannabinoids aren’t a wonder drug; they have side effects just like every other drug. I really think that it’s important that we understand them, and that’s why my focus is on education. If the time comes that the powers-that-be approve cannabinoids for widespread use, I think it’s really important for providers to understand its benefits and limitations.

What’s Inside:​

  • One-third of the epileptic population cannot tolerate the side effects of the drugs currently used to treat it.
  • I discuss the difference between acute and chronic effects.
  • The unexpected effect of birth control pills and seizure medication.
  • Drug side effects during pregnancy can be especially challenging.
  • Vitamins, minerals, and food can all play a role in the management of epilepsy and seizure disorders.
  • Current approved cannabis-based products for epileptic children.

Mentioned In This Episode:

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Transcription:

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TRANSCRIPT

This show is for educational purposes and should not be taken for a doctor’s advice. Welcome to Let’s Talk About Medical Cannabis with Doctor O. A clinical pharmacist certified in medical cannabis. Every week, you’ll learn about alternative ways to improve your health and well-being, using the powers of healing botanicals.

Hi, guys. Welcome to another episode of Let’s Talk About Medical Cannabis with Doctor O. Thank you so much for joining me today. My name is Lola Ohonba. I’m a clinical pharmacist certified in medical cannabis.

Glad you could join me today. Thank you. Today’s episode is the concluding part of our episode on the role of cannabinoids in the management of epilepsy is seizure. This is the part two of the role of cannabinoids in the management of seizure disorder. Guess what? This is the tenth episode.

Thank you guys so much for your support. I can’t believe we are already on the tenth episode. This is amazing. I am very glad, grateful to you guys, our listeners. Without you, I can’t even do this. This was me stepping out of my comfort zone. And so, so grateful that you guys could join me on this ride. Thank you, guys so much. So on today’s show, we’ll be looking at the role of the women in epilepsy seizure the way we manage the female population. We are also going to be looking at the role of cannabis and what cannabis is being used to treat, how it is being used in the management of seizure disorder.

We’re going to look at the FDA approved to FDA approval. Medication that is cannabis-based dye that is being used in the management of seizure disorder. So glad that you guys could join me. Before going on into the details of today’s show, I would like to request a favor from you guys. I want you guys to please go on your list named platform if you are using Apple. If you are using Spotify, if you are using the platform to listen, please go on your listening perform and leave us a review. We need a review. The review is what will put us on the chart. So please go on the list platform and leave a review. Thank you. Apart from that, if you have not yet subscribed to the show, please do so. Yes. I know people can listen, but when you’re subscribed, it also helps with our rating on the platform community. So please go ahead and subscribe to the show. We have links on our web site wci-health.com.

There are links to where you can subscribe to any platform that you like to use. And also, if you would like to support the show. We have a link, a Patreon link on our web site. We are very appreciative of any support, nothing is too small. Thank you guys so much.

So on our last episode, we talked about what is a seizure disorder. We’ve talked about the Greek history behind the diseases, how it was said in the Greek of old that diseases where due to the many spells cast by the gods when they are angry. But Hippocrates of Kos, the father of medicine, was the first one who came out and said, No that’s hocus-pocus. Diseases are not due to curses from god. In fact diseases are a result environmental factors among other things. In fact, the hocus pocus they said goddess of the moon Seline, anytime she’s mad and you don’t give R-E-S-P-E-C-T. She just splashed the curse on people. So we were able to look into that on our last episode.

We also looked into the different types of seizure disorder, partial seizure, generalized seizure. Tonic, clonic, others. We will look we looked into it. If you have not listened to the episode, please go ahead and do so. And we have all the episodes. Like I said, this is our episode 10.

So we have lot of material out there where you guys can really learn about this things. Apart from other types of seizure disorder, we also look into the non-pharmacological ways of managing the disease. Because if it’s not managed, it can lead to what we call SUDEP, which is sudden death that’s a result of complication from epilepsy or seizure. So we’re looked into non-pharmacological way with the word diet is being used in the management. We also looked into the surgery and did a Vegas simulator is the one type of surgery that is being used. After that, we looked into the pharmacological means of managing the disease.

And like I said, most physicians, in fact all the physician managing the disease. They always follow a specific guideline that’s been outlined by the association responsible for for this management of the disease. So that’s why we did it in our episode 1 this episode in this episode, we will be looking at the how we manage female population on epilepsy. We also gonna look into the role of cannabis. The cannabinoid in the management. We are look in to the FDA, approve medication. The cannabis based medication that is being used now in the management of the disease.

So like I said in our episode, part one of this series. There is no cure for seizure disorder; epilepsy and we don’t have a cure for it. So if we don’t have a cure for it, how do we manage it? We address the pharmacological ways of managing the disease in the previous episode. But unfortunately, when we use this medicine, pharmacological therapy to manage it, some people, they cannot tolerate the side effects of the drugs and about a third of the population suffering from this disorder. The drugs are not effective for about one third of the population. So where do we go from here? How do we deal with this situation of noncompliance and all of it not even working? And part of some of the side effects that people have when they are on anti-seizure medication or some of the side effects are dizziness, drowsiness, insomnia, nausea.

They have a headache, fatigue, low vision. These are acute side effects. The acute means is for a short time. So when you have a headache, you for a short time, it will pass. That’s acute. But the chronic condition, the chronic side effect is what normally makes people to not want to use the medicine.

So when we talk about chronic, it depends on the drug. Different drugs, they have different side effect. So for some of the drugs, the chronic side effects include loss of bone density, that’s osteoporosis. So for elderly population or even just the elderly population, as we grow or die, we lose bone density.

So if you already get into that stage whereby your bone, you have you are susceptible to loss of bone density. So some of this medication, when you use it, also speed up the rate that bone is lost. Some people experience weight gain. Some people experience behavioral changes. Some people experience memory loss in some of the medication. Also, kidney stone. And for female population, some people can have menstrual cycle irregularities. There is a folic acid deficiency. When people use fentatone is being implicated. There is a reduction in the folic acid deficiency in that drug, which is very important, especially in female of childbearing age. Also there is a rash. I know people will be like rash is no big deal. No, there are some rashes that are not a big deal. When we have this rash and we’ve called Steven Jones syndrome. Steven Jones syndrome, a type of rash. It’s a medical emergency. If that is going on, want has to get to the hospital immediately. So based on all this chronic side effects. People might not be compliant with your drug.

The next subtopic I’m going to be looking at is the anti-seizure drug, and female population. Like I said, the way we manage female is different from male. Women, we have our estrogen, which has been shown to have seizure activating affect. When I say seizure activating effect, basically what I’m saying is that the estrogen is being shown to trigger seizure episode. It increases the ability of drugs to have ability of somebody to have seizure disorder. So estrogen, which is also found in many of many female being higher in quantity. In women, we have more estrogen than progesterone. For progesterone has also been shown to have seizure, protective effect. So seizure, protective effect for progesterone and seizure triggering effect for estrogen. Drugs such as topiramate, topamas, as the case may be or ascarbamazepine. These are called enzyme inducer. They may cause treatment failure in female on oral contraceptives.

So basically, enzyme inducers what they do is they causes the drug to metabolize fast. Basically what that means is when you take enzyme inducer your or your estrogen which is in your birth control pills will be getting rid of out of your body fast. It will be metabolized faster than normal for, say, somebody that is on the pill. And you take this seizure disorder. Not all of them. The drug, your estrogen, your birth control pills will be getting rid of from your body faster than normal. So in this situation a person using this drug will have to use a secondary sub birth control. You’ll have to use our second line birth control to put a few are trained. I mean, when you use birth control, your reasoning is maybe somebody did not want or have be pregnant at that particular time. I know. People also use birth control for other reasons. But the main reason why most of us use it is pregnancy prevention. So if one is trying to have pregnancy prevention and you use this set of seizure medication, that is gonna speed up the metabolism of the birth control. If you don’t have a backup, a secondary backup, then one can get pregnant. For those on the enzyme inducers like the topiramate or the oscarbamazepine. So when we talk about the enzyme inducers, that would be the effect that we see.

But what about an enzyme inhibitors? So when we have drugs that inhibit the enzymes, then the estrogen is going to stay more in the body instead of it matter being metabolized out of your body, then it this longer because the drug the seizure drug is preventing the estrogen from being broken down. So in that situation you can have excess drug estrogen in the body and that will have its own side effects.

So one has to be able to talk to the doctor and your provider will choose the best agent and they will know how to manage the effects or decide the effect that might be resulting from that. Up to about 25 to 30 percent of women are said to have increase or decrease in seizure frequency during pregnancy. Providers would need to factor that into consideration when they are using, when they are choosing drugs or therapy to manage pregnant females because up to 25 to 30 percent have, can either have increasing seizure activity or decrease in seizure activities during pregnancy.

According to clinical studies, there is a higher incidence of adverse or adverse pregnancy outcome in female with epilepsy or seizure. So basically people that are pregnant and are on medication for management of seizure disorder has been studied and find out that this female in this population, there’s a tendency for higher seizure episode. There is a frequency in higher episode of seizure in this population. The risk of for congenital birth defect is said to be between 4 to 6 percent, twice as high compared to a non-epileptic women.

So women that have a seizure medicine, the risk of them having children, kids with congenital birth defects is about 4 to 6 percent higher when you compare it to female, a pregnant female without are not on seizure medication by the same time.

Does that mean they shouldn’t take the medicine? No, that’s not what we are saying. Like we said, if this disease is not managed, it can result in SUDEP, sudden death due to epilepsy episode. So we just have to balance the risk and the benefits of the drug. And that is why it’s very important to look for a safer alternatives whereby desired effect to patients will be minimized. There is no drug that doesn’t have its own side effect, including cannabis. Cannabinoids products, they all have side effects, but we just have to balance the risk and the benefit of this side effect.

Drugs such as fenatone and barbiturate have been linked to congenital heart defect or facial cleft. Roy Carskadon Carbamazepine have been linked to spina bifida, so these drugs, phenytoin barbiturate phenobarbital, those have been linked to congenital heart defect or physcial cleft. And varproicicin and kabam exhibit, which are really, really one of our common long that being used.

They have been linked to spine bifida. It’s not in everybody. So when we talk about this side, it doesn’t mean everybody that is on the drug are going to experience. Is it just clinical studies. When they do they have to report everything that is seen during the clinical trial, even if this episode is one person or one mice, that shows that symptoms, it has to be reported. Prevention of pregnancy related adverse effect for anti-seizure drug. That’s the next one. We’re going to be looking less into the prevention of pregnancy related side effects due to the drugs. Some of the listed side effects I mentioned earlier, some of them can be managed.

They can be reduced by adequate folic acid intake. That’s why part of the reason why children of females of childbearing age are asked to take folic acid because some of this, especially the birth defect, the cleft palate dose can be reduced by intake increase in the folic acid intake. So female of childbearing age were on anti-seizure medication, did need to be on prenatal vitamins, approximately up to 0.5 to 5 mg per day which will have folic acid in it. For females that have the history of neural tube birth defect.

They have recommended higher folic acid dosage should be considered in those females. both all these individual patients, they have to consult with the primary physician to choose the right dosage or the right medication to manage this situation. Because every situation is different, every pregnancy is different.

So do not take any medication, including over-the-counter supplement without consulting your physicians. So the other element has been used is Vitamin K. Approximately ten milligrams per day of vitamin K is said to help reduce or neonatal hemorrhagic disorder if given to a mother during last month before delivery. So during the last trimester of pregnancy, if a pregnant female is given a vitamin K, approximately around 10 mg per day is being shown in clinical studies to reduce the risk of neonatal hemorrhagic disorder.

So apart from minerals and vitamins to manage some of the birth defect, food is essential not just for growth but for general well-being. So food is also part of the management that people are employing to control frequencies of seizure disorder.

So apart from the surgery, the medication keto diet, like I said in our previous episode, is being shown to reduce the frequencies of seizure episode. So what is the Keto Diet? Keto diet is made off of approximately seventy five percent fat, twenty percent protein and 5 percent of carbohydrates. So basically keto diets the emphasis is on the protein. I mean, sorry, the emphasis is on fat. It’s a high fat, low carbohydrate diet, high fat, low carbohydrate diet.

These is variation here in what people are doing. Yeah. Like I said, the emphasis is on the high fat, low diet. Basically what’s going on in keto diet is that instead of using your body using the carbohydrate, most of our food, a lot of what most of our food is carb based. So instead of your body using carb, your body is going to be using the energy diet derived from the fat. The oil based, fat-based food. Your body is burning the fat instead of the carbohydrates. So you are getting your energy from the fat burning. And that is why you are able to lose weight by burning out the fat. That is the basics behind keto diet.

Well, after we have tried non-pharmacological way, we have tried diets, we have tried pharmacological way and people are still having problem. What do we do? Do we go from there? And like I said earlier, about a third of the population is suffering from seizure. They are even non-responsive to conventional therapy. The medication that we have is not effective for about a third of the population. So how do we deal with that? How do we deal with the situation of people not taking medication because they are not able to tolerate this side effect?

So in this population, cannabis based product might be a safer alternative to consider. Seizure disorder is one of the very few disease states where cannabis-based drugs is FDA approved for the management. I know cannabis is not federally legal yet, but some medications out there the FDA approved for the management of seizure and seizure is the only disease state right now where we have federal FDA approved drugs to manage this disorder.

You’ll think, okay, if we can be using it to manage seizures, why can’t we do more studies on these drugs to use it to manage other disease? This always comes down for me, I feel like it still comes down to the big pharma. They just don’t want people to have access to these plants that is not as dangerous as they claim it to be.

Studies have shown effectiveness of cannabinoid in control of seizure, especially in children. Example you send a child lost? Well, I don’t know. Many people have heard the story of child loss from Colorado, where the day management of this uncontrollable seizure, they use a different kind of strain of CBD reach cannabinoid-based products and the child’s seizure was effectively manage using a cannabis based product. A high CBD low THC product is being shown to be effective in the management for seizure disorder.

Clinical trials have shown reduction of seizure episode in experimental animals that are in cannabis-based therapy. Cannabis based therapy is being shown to help reduce episodes of seizure in experimental animals like mice. Also, people using cannabis products have testified of its effectiveness in control of uncontrollable seizure episode. It helps to improve sleep and it also helps with the behavioral disorder.

The behavioral side effect of the disease. CBD based drug epidalis is approved by the FDA for the management of seizure disorder in children having Lennox-Gestaut Syndrome. Lennox-Gestaut Syndrome is common in children. And children that are suffering from this disorder, there is a new FDA approved medication call epidalis. This is CBD based cannabis-based product. So that’s FDA legal. It’s legal in the United States to use this medication.

Also, a very rare seizure disorder called Dravet Syndrome, where a seizure is said to be caused by fever or high temperature. Did Dravet syndrome the seizure caused by fever and is seen in children is very rare. So there’s also CBD approved FDA approved medication that is being used in this.

So I’m sure people are wondering. So how do your dose this product, how do you dose CBD from history has always been difficult to know what dose to give. In the case of children, oil or tincture are the two main dosage form that is being used, and I’m sure the adults can also use that because this makes sense. It’s a lot easier to be able to measure the quantity of oil or to be able to use droplets or put the tincture under the tongue.

So you can know what dose is working and what dose is, you need to add. So one can easily measure the oil, or one can easily measure the tincture. So these are two main dosage form that is being used, especially in children. So since we are already using epidalis for this management of seizure disorder in children, for those populations are responsive to the traditional answer of seizure medication or unable to tolerate the adverse effect of the traditional medicine cannabis based product might be a safer alternative.

Cannabis has been shown to be safe and effective in the management of seizure in children. So if we are using it for the children, then the adults should be able to use it too.  And many studies have shown there hasn’t been any documentation of people overdosing on cannabis based product on CBD. People have not overdose on that compared to all the other medication where people get overdose on. When you look at this situation with female on anti-epilepsy and anti-seizure medication, then you have a birth defect.

You have all kinds of diseases that is possibly passed down to the kids, to the babies. Cannabis was used by the Rastafarian female even during childbirth, during pregnancies. They used it to help them with nausea, to help them with eat. So we still feel like the power that be needs to do more research. Of course more research is needed, but cannabis based product is really, really we need to look into it. It could be a life saver for many patients suffering not just for a seizure, not just for food, for that, for other kinds of diseases or other kinds of disorder going on there. If we can give it to our cancer patients or help; if we can use it in HIV for ways for weight loss, dueto HIV AIDS and is a synthetic product. Okay. The epidalis is this manufactured synthetic product, this synthetic product. The dranabanol, the Marinol. If we can give those two or vulnerable population, why can’t we do more research? I guess the question is for the powers that be.

But my own portion, the reason why I do this to give education, to educate the community, to learn about it. To learn about it now, you need to know about it now, so now when it is finally approved for use nationwide or worldwide, you will have the information that you need to make an informed decision not just for yourself, but for your family. So that is our show today. I am glad you guys are able to join me. Like I said, this is our tenth episode. So I am hoping we can continue to do this and we appreciate your financial support. Please go on WCI-health and sign up to be one of our patreon to support this show. Nothing is too small. Also, please leave us a review. Like I said, the review is very essential for us to be rated and to keep moving. Give us a review for those that are yet to subscribe, please do so. Subscribe to this show. And we have products. We have hemp. We are carrying hemp Fusion brands of our CBD product. We have products for energy. We have products for sleep. We have the balm. We have the cream for those that do not want the tincture or peel the one or use that kind of product. If you just one to use a topical, topically is not absorb it into your blood stream. It is localized. So if you have pain, if you have stiffness on your knee topical products, we have all those on the web sites. Do check this out. And until next time. Remember Health equals wealth. Thank you guys. Have a wonderful week.

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