Alcohol and Marijuana: Effects on Epilepsy and Use by Patients with Epilepsy

Abstract

We review the safety of alcohol or marijuana use by patients with epilepsy. Alcohol intake in small amounts (one to two drinks per day) usually does not increase seizure frequency or significantly affect serum levels of antiepileptic drugs (AEDs). Adult patients with epilepsy should therefore be allowed to consume alcohol in limited amounts. However, exceptions may include patients with a history of alcohol or substance abuse, or those with a history of alcohol-related seizures. The most serious risk of seizures in connection with alcohol use is withdrawal. Alcohol withdrawal lowers the seizure threshold, an effect that may be related to alcohol dose, rapidity of withdrawal, and chronicity of exposure. Individuals who chronically abuse alcohol are at significantly increased risk of developing seizures, which can occur during withdrawal or intoxication. Alcohol abuse predisposes to medical and metabolic disorders that can lower the seizure threshold or cause symptoms that mimic seizures. Therefore, in evaluating a seizure in a patient who is inebriated or has abused alcohol, one must carefully investigate to determine the cause. Animal and human research on the effects of marijuana on seizure activity are inconclusive. There are currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency. Some evidence suggests that marijuana and its active cannabinoids have antiepileptic effects, but these may be specific to partial or tonic-clonic seizures. In some animal models, marijuana or its constituents can lower the seizure threshold. Preliminary, uncontrolled clinical studies suggest that cannabidiol may have antiepileptic effects in humans. Marijuana use can transiently impair short-term memory, and like alcohol use, may increase noncompliance with AEDs. Marijuana use or withdrawal could potentially trigger seizures in susceptible patients.

Cannabinoids and Epilepsy

“…In another study, a 45-year-old man with cerebral palsy and treatment-resistant focal epilepsy experienced a marked reduction in focal and secondary generalized seizures on daily marijuana [249]. Other recent cases also support the observation that cannabis use can reduce seizures in some patients [250,251]. These studies suggest that cannabis can not only reduce seizure susceptibility, but also trigger rebound seizures during withdrawal.…”

Convulsions Associated with the Use of a Synthetic Cannabinoid Product

“…Another report, in which there was laboratory confirmation for metabolites of the synthetic cannabinoid JWH-018, a patient was interpreted by the authors as having had a possible convulsion [6]. Convulsions associated with recreational use of Cannabis sativa (marijuana) use appear to be exceptionally unusual [11][12][13]. We describe a patient who had two witnessed generalized convulsions soon after smoking a "spice" product that we later confirmed to have four different synthetic cannabinoids.…”

“…Despite how prevalent the recreational use of marijuana is both currently and historically in various societies, convulsions associated with use have only been described very rarely [11][12][13]. Convulsions have occasionally been described in children after accidental ingestions [14,15].…”

“…The phytocannabinoids in marijuana include the major psychoactive component, Δ-9-THC [18], and various non-psychoactive cannabinoids including cannabinol, cannibidiol, and Δ-9-tetrahydrocannabivarin (THCV) [19,20]. Although animal studies have provided conflicting results (proconvulsant and anticonvulsant) on the effect of Δ-9-THC depending on the model used [12], cannabidiol and its derivatives has been found to be consistently anticonvulsant in animal models [12,21,22] and in limited human trials [23,24]. Δ-9-THCV was also recently demonstrated to exert anticonvulsant properties [20].…”

Cannabinoids in Health and Disease

“…189 There are currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency. 190 In one case report, marijuana smoking was proposed to induce seizures. 191 In another study, patients suffering from secondary generalized epilepsy with temporal focus treated with CBD remained almost free of convulsive crises throughout the experiment; other patients demonstrated partial improvement in their clinical condition.…”