Scientists continue to analyze how cannabis-based treatments can alleviate the symptoms of epilepsy. Yet, one crucial factor is often overlooked: how genetics affect the way in which patients with epilepsy react to those treatments.
Studies already show that individuals’ unique genetic variations impact the way their bodies respond to cannabis. The next step, however, is determining how genetic variations in people with epilepsy impact the way their bodies respond to cannabis-based medications — and moreover, whether those epilepsy treatments provide a therapeutic benefit.
A 2017 study claimed that genetic predispositions may influence the speed at which seizure patients develop a tolerance to therapeutic CBD, adding that variations in specific genes “are responsible for both the therapeutic and side effects of medical marijuana and cannabinoid-based drugs.”
The term “epilepsy” encapsulates a number of different seizure disorders and, while it is partially driven by genetics, there are multiple factors that can influence the disease. For instance, while epilepsy diagnoses are statistically more common in people who have a direct family member with the condition, this increased risk is only a few percent higher than the risk for someone without a familial link to epilepsy.
A number of other causes, such as infection, fever, autoimmune disease, and traumatic brain injury, can induce what is known as “acquired epilepsy.” Sometimes epilepsy is epigenetic, meaning that it is inherited but not specifically “expressed”. In this case, an epigenetic effect might “turn on” or “turn off” an inherited gene, allowing it to be “expressed”. But sometimes, the reason why someone has epilepsy is unknown. In around 30% of patients, researchers fail to identify any cause of epilepsy.
But exciting new research has indicated a potential link between epilepsy and impairments in the endocannabinoid system. Because cannabinoids such as CBD and THC affect the body through their interactions with this system, there’s great hope that using cannabis-based medicines to treat epilepsy will fix those impairments, provided this link is real.
Studies on Genetics, Epilepsy and Cannabis-Based Treatments
So what does the research say?
In 2008, a study conducted on cadavers noted a severe absence of CB1 receptors in the hippocampus of brains with epilepsy compared to brains without epilepsy. This finding is significant for two reasons. First, CB1 receptors are fundamental components of the endocannabinoid system as they help regulate the nervous system’s response to stimuli. Secondly, it’s believed that the majority of seizures originate in the Medial Temporal Lobe (MTL) – the exact location of the hippocampus.
A theory developed in response to this research claims that cannabinoids such as CBD could be used to bombard the hippocampus of an epileptic brain, helping it to function more normally in spite of its shortage of CB1 receptors.
This logic is further supported by a 2006 animal study that found that its subjects underwent stronger seizures when the number of CB1 receptors in their brains were genetically reduced. More importantly, researchers noticed that certain endocannabinoids target hippocampal neurons and protect against acute epileptiform seizures.
More research in this field is required, but current findings are sufficient to suggest an important relationship between genes, epilepsy, and cannabinoids. With the influx of CBD in the hippocampus, people with epileptic brains will find the cannabinoid to be a therapeutic treatment because it will combat the genetically reduced number of CB1 receptors.
Cannabis as an Epilepsy Treatment: How Should the Industry Move Forward?
After accepting that genetics determine whether cannabis offers therapeutic benefits to people with epilepsy, the next step is to consider how the industry should move forward in using the remedy as an effective treatment.
Put simply, the process of using cannabis medicinally needs to be centered around treating patients as individuals and offering them more precise prescriptions. This approach has already been adopted in Germany — and to a lesser extent, Australia — where doctors are prescribing medical cannabis, with specific ratios of cannabinoids like CBD and THC, based upon the unique needs of their patients.
However, more education is required if this practice is to succeed. Most physicians hardly learn about the endocannabinoid system while studying medicine, even though it’s the second biggest neurotransmitter system in the body. On top of this, many cannabis users fail to understand that the results of consuming cannabis are not universal; two people with the same condition and same symptoms may not find relief from similar (but different) products. Different strains of cannabis — with different phenotypes — have different compositions and will yield different results.
These subtle variations matter. Consumers shouldn’t rely on anecdotal evidence and the assumption that a given product will work for them just because it’s cannabis. Patients and doctors alike must understand this concept if the industry is to move towards issuing precise, effective prescriptions of cannabis-based medications. Before physicians and patients can find epilepsy treatments that are founded on cannabis, they need to understand the endocannabinoid system and the genetic influences that impact the condition.
Increased Education on Cannabis Will Lead to Treatments for Epilepsy
The industry needs more education around cannabis and the endocannabinoid system. The education should offer a medicinal perspective, and physicians and consumers should receive the education though courses that are geared towards patient care.
Last year, the University of Maryland paved the way for a more established study of cannabis by launching a master’s degree in Medical Cannabis Science and Therapeutics. Many new opportunities to grow, process, prescribe and sell medical cannabis are being created as an increasing number of states legalize its use, yet expertise in the industry remains somewhat informal. Programs like the one offered by UMD are integral to formalizing knowledge and legitimizing the use of cannabis-based medicines.
Returning to the subject of cannabis as an epilepsy treatment, the emergence of academic certificates and degrees in cannabis is only a good thing. The medical profession needs more experts with an in-depth knowledge of cannabis.
After all, we know that cannabis can alleviate the symptoms of epilepsy, but we also know that genetic predispositions of individual patients can determine how effective cannabis is to them. People seeking medical cannabis as an epilepsy treatment require products that are tailored to their personal needs and prescribed by medical experts who understand the links between epilepsy, genetics and the endocannabinoid system.