Cannabidiol (CBD), the non-intoxicating component of cannabis, is emerging as a meaningful option for older adults managing epilepsy alongside multiple other health conditions. A recent analysis comparing 280 people using commercial CBD products with 138 who hadn't started revealed that CBD users experienced better tolerability of seizure medications, lower anxiety and depression, improved sleep, and fewer emergency room visits.

Why Is Epilepsy in Seniors Being Overlooked?

Most people think of epilepsy as a childhood condition, but the reality is starkly different. Epilepsy follows what researchers call a "U-shaped curve," meaning it's common in early life, then rises sharply again after age 65. A recent analysis of Medicare claims found 20,545 new epilepsy cases in 2019 alone among older Americans.

The financial burden is substantial. Institutionalized Medicare beneficiaries with epilepsy face average monthly healthcare costs of $3,479 compared to $2,381 for those without the condition. Annual costs averaged $41,749 versus $28,569. Researchers project the total burden for this population could nearly double, from $6.82 billion in 2017 to $11.75 billion by 2027.

Beyond seizures themselves, older patients with epilepsy contend with medication complications, falls, anxiety, depression, sleep disruption, caregiver strain, and frequent emergency and hospital visits. This complexity makes treatment tolerability, not just seizure control, a critical clinical outcome.

What Did the CBD and Epilepsy Study Actually Show?

Researchers from the Realm of Caring Foundation and Johns Hopkins School of Medicine conducted a comparison study using validated assessments across multiple health domains. The findings paint a compelling picture of how CBD might fit into comprehensive epilepsy care for older adults.

Compared with the control group, CBD users reported measurable improvements across several key areas:

• Medication Tolerability: CBD users experienced better tolerance of their seizure medications, meaning fewer unwanted side effects from their prescribed treatments.
• Mental Health: Users reported lower anxiety and depression scores, which are common comorbidities in older adults with epilepsy.
• Sleep Quality: Adults using CBD reported better sleep, a significant factor in seizure management and overall quality of life.
• Specific Side Effect Reduction: CBD users reported less dizziness, sleepiness, unsteadiness, memory difficulty, and impaired concentration, precisely the effects that carry outsized risk for older adults prone to falls and cognitive decline.
• Healthcare Utilization: Users had lower odds of emergency room visits and reported less caregiver strain.
• Quality of Life: CBD users reported higher psychological quality of life scores overall.

Importantly, this was not a story of patients abandoning conventional treatment. Eighty-eight percent of CBD users were still taking prescription seizure medications. CBD was largely used alongside standard care, not as a replacement.

How Should Physicians Integrate CBD Into Epilepsy Care?

The real question facing the medical system isn't whether CBD belongs in epilepsy care, but how to bring it out of the shadows and into clinical practice with proper oversight. Patients are already buying commercial CBD products whether or not their doctors know about it. The choice is between continued unmonitored use or physician-guided therapy with evidence-based protocols.

• Assessment and Selection: Physicians should evaluate whether CBD fits a patient's specific epilepsy type and individual health goals, considering their full medical history and other conditions.
• Drug Interaction Monitoring: Doctors need training to check for potential interactions between CBD and antiseizure medications, ensuring safe concurrent use.
• Comprehensive Tracking: Rather than leaving patients to manage complex changes alone, clinicians should systematically monitor seizures, mood, sleep, falls, and cognition over time to document real-world outcomes.

"Physician-guided CBD should be studied not only for seizure reduction, but for the broader outcomes that patients, caregivers, and health systems experience every day," stated Sasha Kalcheff-Korn, executive director of Realm of Caring.

Sasha Kalcheff-Korn, Executive Director, Realm of Caring

What's Blocking Progress on CBD Research and Access?

The FDA has approved a pharmaceutical CBD formulation called Epidiolex for a narrow set of epilepsy diagnoses, but many patients use commercial CBD products outside that regulatory pathway, largely unmonitored and undocumented in their medical records. Further criminalizing cannabis only pushes this care deeper into the shadows.

For Medicare, the central question is whether appropriately selected and monitored cannabinoid therapy can help reduce the higher-cost consequences of epilepsy, such as emergency visits, hospital admissions, medication intolerance, and preventable declines in daily functioning. Given the scale of Medicare's exposure to this problem and the fact that patients are using these products regardless of whether their doctors know about it, the case for funding rigorous research is compelling.

The path forward requires policymakers and voters to guide policy by science rather than outdated myths. As epilepsy becomes more common among older Americans, maintaining the status quo will carry its own costs, both financial and in terms of patient quality of life.