Medical Marijuana Could Mitigate Medically Refractory Epilepsy

WASHINGTON, DC—Medical marijuana may be an effective therapy for patients with medically refractory epilepsy, according to research presented at the 71st Annual Meeting of the American Epilepsy Society. When combined with current antiepileptic drugs, medical marijuna appears to improve epilepsy, overall quality of life, mood, quality of sleep, and appetite. Most patients report that medical marijuana treatment is more expensive and more inconvenient than antiepileptic drugs, however.

Approximately one-third of patients with epilepsy have medically refractory epilepsy, which is characterized by frequent seizures, neurodevelopmental delays, and impaired quality of life. These patients often have multiple comorbidities that significantly affect their quality of life. New developments in antiepileptic drugs have not significantly reduced the number of patients with medically refractory epilepsy, nor significantly improved quality of life.

Evaluating Efficacy of the New York Medical Marijuana Program

Studies have suggested that cannabidiol (CBD) is effective and well tolerated in patients with medically refractory epilepsy. Juliann M. Paolicchi, MD, Codirector of Pediatric Epilepsy Research for the Northeast Regional Epilepsy Group in New York, and Aidan Papalia, Behavioral Economics Research Assistant at Binghamton University in Rochester, New York, sought to evaluate the potential benefits and disadvantages of the New York Medical Marijuana Program.

Juliann M. Paolicchi, MD

The investigators included in their study 27 patients between ages 3 and 48 who had registered for the New York Medical Marijuana Program in the previous year. Participants were required to have used medical marijuana for at least one month.

The average number of previously used antiepileptic drugs was 5.43 in this cohort, and patients were registered to use a 20:1 ratio of CBD to tetrahydrocannabinol.

Patients completed a questionnaire that asked about the effect of marijuana on overall quality of life, epilepsy, and comorbidities (eg, mood, sleep, appetite, stress, sedation, anxiety, and aggression). Patients were also asked to compare the cost and convenience of obtaining medical marijuana with those of previously used antiepileptic medications. Respondents used a scale of 1 (indicating a significant negative impact) to 5 (indicating a significant positive impact).

In all, 17 patients reported medical marijuana use for more than one month, four patients were unable to afford treatment, four participants declined to answer the survey, and two patients were exempt from the study because their contact information had changed or because they had used medical marijuana for less than a month. One patient discontinued therapy for lack of efficacy.

Treatment Improved Quality of Life

Overall, most patients (ie, 70% or more) reported that medical marijuana improved their overall quality of life, epilepsy, mood, quality of sleep, and appetite. Less than half of patients reported improvement in stress, sedation, anxiety, and aggression. In addition, high out-of-pocket costs and lack of insurance coverage of medical marijuana presented major concerns for these patients, said Dr. Paolicchi and Mr. Papalia.

“Although this study lacks controls and is based on self-reporting, it serves as a pilot study for a larger follow-up study to quantify the effects of medical marijuana treatment on medically refractory epilepsy and its associated comorbidities,” they concluded.

—Erica Tricarico