Jerry J Shih: Medical Marijuana for the Treatment of Seizures

Shih:

The issue with CBD, cannabidiol or the layman's term is medical marijuana, is actually a really fascinating one because it's one of those substances in which the lay public actually was a head of the medical community. So by way of little historical context there are patients who have very bad seizures in which most of our common medications really don't do a great job of controlling, and a lot of these patients are actually younger children who have certain types of epileptic syndromes that are pretty devastating and catastrophic — they can have up to 30 40 50 seizures a day and become very developmentally challenged. It's just a really tragic type of epilepsy picture.

So sometime about maybe five, ten years ago, there was some thought that maybe marijuana may help reduce seizures, but because of, I think, the historical context of the laws in the United States basically prohibiting the use of marijuana, that has run into a little bit of a barrier.

And I don't know if you've heard of the term Charlotte's Web, but Charlotte's Web is actually CBD cannabidiol oil that was given to a young girl with Dravet syndrome, which is a syndrome that has a lot of bad seizures associated with it. She got this oil in Colorado. Her seizures went from 30 a day to 3 to 5 a month, and she started, you know, developing more normally, interacting with family. And so there was a big interest amongst the lay public that medical marijuana may be effective to treat patients with bad seizures.

But again because of sort of the, the legal environment, a lot of physicians where kind of reluctant to really try to use medical marijuana because it would put them in legal jeopardy. It was illegal to try to prescribe marijuana. So there are a group of people, researchers, epilepsy researchers who actually really sat down and I think did a great job of saying ‘let's try to design some studies to see if a medical marijuana is safe’ and B, ‘if medical marijuana is effective.’ And I think over the last couple of years we've actually had some new data that shows essentially both are true. And just in context, I think it's important to mention that in the year 2014 when the public was saying, ‘oh let's do medical marijuana for seizures,’ and stuff, the American Association of Neurology put out a statement that said we cannot condone the use of medical marijuana because we don't know if it's safe or effective. We're not saying it's not but we really need to have more studies to demonstrate that this is a safe and effective compound. That was 2014 I think.

One of the earliest studies, good studies that came out demonstrating that medical marijuana or cannabidiol is safe was a Lancet article published in December of 2015, and Lancet neurology is a very high-powered journal so they obviously did a great job in that respect. But this article showed that CBD was indeed safe in a large group of patients who were given that compound. And that led to further studies including one that was just recently published in May of 2017, so last month in the New England Journal of Medicine, that demonstrated in a population of patients with Dravet syndrome the very type of problem that Charlotte of Charlotte's Web had in patients with Dravet syndrome, that medical marijuana or CBD was effective in decreasing the amount of total seizures in that population.

So it's sort of, in a sense a landmark article, because it's the first to demonstrate that medical marijuana is indeed effective in reducing seizures in patients with epilepsy — at least that specific kind of epilepsy Dravet syndrome. And so the corollary to that is obviously, you know, there are people who have seizures due to a number of other causes and whether CBD would be effective for those other causes of epilepsy remains to be determined.