CBD: Effective Treatment for Epilepsy or Health Gimmick?

By: Nick Parekh

With sweeping changes in cannabis policy over the last decade, the market for
cannabidiol (CBD), a non-psychoactive compound found in both hemp and cannabis,
has increased exponentially. Places ranging from restaurants to gas stations now
peddle CBD and CBD-infused products, selling consumers the idea that CBD is a natural
remedy for a variety of ailments and diseases. Most of the claims people make about
CBD’s potential to treat disease are unsupported by scientific data and may be entirely

Despite the deceptive marketing of CBD, the compound has drawn a lot of
attention in the epilepsy community due to empirical evidence supporting its ability to
treat some forms of epilepsy. In 2018, the Food and Drug Administration (FDA) of the
United States approved Epidiolex, a highly purified form of CBD produced by GW
Pharmaceuticals, to treat 2 rare forms of epilepsy: Lennox-Gastaut syndrome and
Dravet syndrome. Tuberous sclerosis was also added to the list of conditions treated by
the drug in 2020. In double-blind, randomized, placebo-controlled clinical trials, patients
treated with Epidiolex had reduced seizure frequency when compared to patients in the
control group.

For epileptic patients without these specific forms of epilepsy, Epidiolex cannot
be prescribed to them and there is much less data available to support CBD as a
potential anti-epileptic drug (AED). A new study published in Epilepsy and Behavior
shows that while it is not clear that CBD usage reduces seizure frequency in other types
of epilepsy, it does have a significant positive impact on patients’ quality of life in
numerous areas, including sleep and mental health. Patients in the study who used
artisanal, or non-prescribed, CBD alongside other AEDs reported better sleep quality and
lower rates of anxiety and depression (19% and 17% lower, respectively) than those who
did not.

The exact mechanisms of how CBD produces these effects are not
well-understood. Unlike THC which activates the cannabinoid receptor CB1 in the brain
and affects the release of other neurotransmitters, CBD binds to the receptor but does
not activate it. The structure of CBD also does not look like that of any current
anti-epileptic drug. CBD is thought to prevent seizure formation through multiple
mechanisms, including promoting the release of inhibitory neurotransmitters like GABA
and reducing inflammation in the brain.

Although scientists have slowly gained a greater understanding of CBD, there are
still many unresolved questions that make doctors hesitant to prescribe it. While CBD is
known to cause short-term side effects such as drowsiness, fatigue, and loss of
appetite, its long-term effects on the brain and body are generally unknown. Clinical
research has shown that CBD may cause liver damage when used in combination with
some AEDs such as valproate and may raise the concentration of other AEDs in the
blood, increasing the risk of side effects. Moreover, the optimal dose of CBD for patients
has not been determined and has been shown to differ heavily from patient to patient. It
also appears to have a bell-shaped response curve, so too little or too much CBD may
be ineffective. These are all reasons why it is important to first consult your neurologist
before medicating with CBD.

When purchasing CBD, consumers must be wary of the source. In one study from
the Journal of the American Medical Association (JAMA) that looked at 84 CBD products
(vapes, oils, and tinctures) from 31 different companies, 26% of the products contained
less CBD than was advertised. Additionally, THC was detected in roughly 21% of the
sampled products. CBD oils seemed to be the most accurately labeled out of the
product types considered, but 55% of the oils were still inaccurately labeled. Although
this was not looked at in the study, CBD products may also be contaminated with heavy
metals and harmful chemicals such as pesticides and purifying solvents. Due to the
lack of consistency and specificity in testing standards at the state level, patients with
epilepsy must look for CBD products that have been tested and are from reputable

CBD’s explosive growth in popularity has led to many false claims about its
benefits – and people profiting from those claims. Despite this, CBD has a genuine ability
to treat certain types of epilepsy and may have the ability to treat others as more
research is done. In the meantime, it is important for epilepsy patients seeking CBD to
understand the risks of using it as not much is understood about its physiological
effects, and many artisanal products are not properly tested and labeled.


Bonn-Miller MO, Loflin MJE, Thomas BF, Marcu JP, Hyke T, Vandrey R. Labeling Accuracy
of Cannabidiol Extracts Sold Online. JAMA. 2017;318(17):1708–1709.

Eisenstein, M. (2019, August 28). The reality behind cannabidiol’s medical hype. Nature.

GW Pharmaceuticals. (n.d.). CBD mechanism of action. Retrieved October 7, 2021, from

Johns Hopkins Medicine. (2021, August 11). CBD products may help people with
epilepsy better tolerate Anti-Seizure medications. Johns Hopkins Medicine

Silva, G. D., del Guerra, F. B., de Oliveira Lelis, M., & Pinto, L. F. (2020). Cannabidiol in the
treatment of epilepsy: A focused review of evidence and gaps. Frontiers in
Neurology, 11. https://doi.org/10.3389/fneur.2020.531939

U.S. Food and Drug Administration. (2018, June 26). FDA approves first drug comprised
of an active ingredient derived from marijuana to treat rare, severe forms of

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