COMMENTARY

Marijuana for Epilepsy: Weighing the Evidence

Epilepsy Notes

Andrew N. Wilner, MD

Disclosures

March 25, 2014

In This Article

Mechanism of Action

Marijuana has psychoactive properties that result from tetrahydrocannabinol (THC) activation of the endogenous endocannabinoid system that includes cannabinoid receptor 1 and cannabinoid receptor 2. Cannabinoid receptor 1 is a prominent G-protein coupled receptor in the central nervous system, which is highly expressed in the neocortex, hippocampus, basal ganglia, and cerebellum, as well as the brainstem, spinal cord, and peripheral nerves.[3] Moreover, more than 100 aromatic hydrocarbons have been identified in cannabis resin.[3] Much more remains to be learned about marijuana's effects on the brain, immune system, blood cells, and other aspects of human physiology.

Charlotte's Web

The much-publicized case of Charlotte Figi, an unfortunate child with intractable epilepsy caused by Dravet syndrome, is profiled in the CNN documentary Weed. Charlotte's seizures numbered as many as 300 every week and were not controlled with conventional antiepileptic drugs. After trying a special marijuana extract high in cannabidiol and low in THC, her seizures magically stopped. This concoction has become known as "Charlotte's web." Cannabidiol is the principal nonpsychoactive cannabinoid in cannabis.[3] There have been other successful cases as well, such as that of Zaki, a 9-year-old boy whose seizures responded to Charlotte's web.[4]

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