By Amy Vaerewyck
(May 2104) Edward Maa, MD, noticed a trend when his epilepsy patients responded to a questionnaire about the use of complementary and alternative medicine: Many were using marijuana.
Maa, assistant professor of neurology at the CU School of Medicine and chief of the Denver Health Comprehensive Epilepsy Program, was hoping to gather evidence to support acupuncture as a popular complementary treatment for epilepsy. Instead, he learned that the No. 1 alternative medicine used by his epilepsy patients was marijuana
“Thirty-four percent of my patients, unbeknownst to me, were using or had used marijuana to treat their epilepsy,” Maa says. “I was surprised.”
With Colorado’s evolving marijuana laws and policy, Maa and other scientists at the Anschutz Medical Campus are attempting to determine the benefits and risks of marijuana for some patients.
“A lot of our patients are using, so as a physician, I consider it my responsibility to educate myself on this subject,” he says. “I need to know the science behind the claims and the interactions with my seizure medications. If you’re afraid to address it, you may miss potential bad effects."
Because university physicians are not directly involved with approving patients for the state registry of those allowed to purchase medical marijuana, Maa contacted Margaret Gedde, MD, a doctor affiliated with the Realm of Caring, a nonprofit organization in Colorado Springs, Colo. The organization is recently famous for its “Charlotte’s Web” strain of cannabis, which has been used for children with severe epilepsy — such as Dravet syndrome, Lennox-Gastaut syndrome and Doose syndrome — and sparked a mini-migration to Colorado of families struggling with epilepsy.
Maa and Gedde presented their findings at the American Epilepsy Society in December 2013. Due to its patient sample size and methodologies, the study and its results were not without controversy, Maa says.
“Given the conflict between federal and state views of marijuana, this was the best that could be done under the circumstances,” Maa says. “However, for some of these kids to have such a dramatic reduction of seizures is unbelievable. At the very least we need to get to the bottom of this reported effect. Maybe Charlotte’s Web is affecting the drug levels of the other medications, maybe it is a true effect, maybe it is wishful thinking on the part of the parent — either way, we should know.”
“It is unfortunate that marijuana has a Schedule I rating,” Maa says. “Cocaine doesn’t even have a Schedule I rating, because it is used in eye drops. Changing the rating for marijuana would do a lot to move things forward on people’s comfort level and trying to get more research.”
Maa says research related to medical marijuana’s impact on calming seizures is limited.
“It’s a fascinating question worthy of
There are, however, those who suggest caution and express considerable concern about other effects of marijuana use. Classifying marijuana as a Schedule I drug, which ranks it among the “most dangerous” substances alongside heroin, LSD
“We do know from basic science studies that marijuana derivatives can completely stop the cellular mechanisms of learning and memory,” says Brooks-Kayal, who is also vice president of the American Epilepsy Society. “And right now, I don’t know the benefits, I don’t know the likelihood it’s going to help, and I know nothing about the risks.”
The pediatric neurologists at
At the same time, they report seeing potentially serious side effects including changes in levels of other medications, sedation and worsening seizures in some patients in association with marijuana derivatives.
“We also have no information about the potential long-term adverse effects on learning and memory in young children treated with marijuana products, and studies of adolescents who use marijuana recreationally suggest that this may be a very substantial concern,” Brooks-Kayal says. “We thus critically need well-controlled studies to better understand if these products are safe and effective for use in children or adults with epilepsy.”