The value of using whole-plant medicinal cannabis to treat children with intractable epileptic seizures has been known from anecdotal sources for more than 150 years. In 1843, an Irish physician noted that cannabis tinctures cured an infant, and the doctor proclaimed that medicine had found a useful anticonvulsant mediation.
However, the recreational and medicinal use of cannabis was made illegal in the U.K. in 1971. Research into the efficacy of cannabis for treating epileptic seizures ceased.
More recently, however, the U.K.’s National Institute for Health and Clinical Excellence (NICE), which provides guidance on which treatments and therapies the health service in England should adopt, has reviewed this situation. They have decided to accept as valid the testimonies of parents and carers who report that children respond well to whole-plant medicinal cannabis in instances where other, conventional antiepileptic drugs or purified cannabidiol (CBD oil) have not brought relief.
In 2018, medicinal whole-plant cannabis was designated a prescription medicine for the treatment of severe childhood epilepsy in the U.K. However, doctors have been very hesitant to prescribe this medication due to the absence of clinical trial data.
Whole plant cannabis includes tetrahydrocannabinol (THC), the molecular component responsible for the characteristic ‘high’ associated with recreational use, along with cannabidiol, other neuroactive cannabinoids, and molecules such as terpenes.
In a study published today in the open access journal BMJ Paediatrics Open, scientists report on the cases of ten severely epileptic children whose seizures had not responded to conventional treatment. Two of these children had also not responded to treatment with the only pharmaceutical grade, purified CBD oil licensed in the U.K. for treating the condition in children (Epidyolex). The scientists were interested in whether the use of whole-plant medicinal cannabis had reduced frequency of seizures in these children.
The researchers, from DrugScience (the UK-based drugs advisory committee), the Imperial College London, and the London School of Economics and Political Science, recruited participants from two charities representing children using medicinal cannabis to treat their severe epilepsy. The children’s average age was 6, but ranged from 1 to 13 years, and they all suffered from intractable forms of epilepsy.
Parents and carers reported their experiences to the researchers by means of phone or video calls between January and May 2021. The data relied on the subjective memories and evaluations of parents and carers, who assessed how children had responded while being treated with medicinal cannabis.
The results indicated an overall decrease of 86 percent in the frequency of seizures experienced by the ten children. In addition, while taking medicinal cannabis the children were able to dispense with the use of other, conventional epilepsy drugs. Whereas before treatment with medicinal cannabis the children used an average of seven different epilepsy drugs, afterwards they used an average of only one other drug. Furthermore, seven of the children were able to stop the use of all other drugs completely.
Parents and carers also reported significant and sustained improvements in the health and wellbeing of their children, including in sleep, eating, behavior and cognition, after they started to take whole-plant medicinal cannabis products. Only a few minor side effects, such as tiredness, were reported.
Combining the data from all ten children, the researchers calculated that the children used an average of 5.15 mg THC and 171.8 mg CBD every day. In addition, the average monthly cost of the medicinal cannabis products was £874. One child had obtained a prescription for free on the NHS.
The researchers acknowledge the small sample size for this research and the fact that it was an observational study that relied on parental recall and had no control group. They also recognize the possibility that only parents and carers whose children had responded positively to medicinal cannabis may have decided to take part in the study.
At the same time, the experts state their findings support several other observational and controlled interventional studies that show significant reductions in seizure frequency after treatment with medicinal cannabis.
Full chemical analysis of whole-plant medicinal cannabis products is ongoing, and research still needs to elucidate the mechanisms by which the constituents work to achieve the reported effects. In addition, the potential long-term negative effects of taking medicinal cannabis need to be weighed up against the effects of using other antiepileptic drugs, some of which have severe consequences for normal childhood development.
“We believe that our data on whole-plant medical cannabis in childhood-onset severe treatment-resistant epilepsy, provides evidence to support its introduction into the NHS within current NICE prescribing guidelines,” concluded the researchers.
“Such a move would be hugely beneficial to the families, who in addition to having the psychological distress of looking after their chronically ill children, have also to cover the crippling financial burden of their medication.”