Two Pediatric Tertiary Care Centers Evaluate Efficacy of CBD on Refractory, Intractable Epilepsy

New studies on the therapeutic impact of cannabidiol (CBD) in pediatric patients with genetic and other etiologies of epilepsy are emerging after recent FDA approval of CBD for other forms of illness and epilepsy, according to abstracts presented at the AES annual meeting that took place December 2-6 in Nashville, Tenessee.

Most patients with non-genetic causes of Lennox-Gastaut syndrome who experienced no improvement with CBD possessed a structural etiology for their epilepsy. CBD administration at the therapeutic dose appeared to be well tolerated with few side effects in the pediatric demographic.¹

Researchers at Children’s Hospital and Medical Center in Omaha, Nebraska, carried out a retrospective review of 32 patients younger than 19 years who received a prescription of CBD for epilepsy in a pediatric tertiary care center to see how they responded to the drug.

CBD therapy efficacy was based on a record of seizure frequency and compared between genetic and non-genetic etiologies evaluated statistically with a 2-tailed t-test.

The researchers found after CBD administration that 23% of patients had no improvement, 30% had mild improvement, and 46.1% had great improvement; however, 61.6% patients without genetic etiology experienced no improvement, 5.2% experienced mild improvement, and 63.1% had great improvement.

Most patients with non-genetic epilepsy etiology without improvement from CBD treatment were 83.3% were structural and 16.7% unknown, and of those who had great improvement, 50% were unknown, 41.67% were structural, and 8.3% were metabolic.

These results help illustrate the possible benefits of CBD treatment for pediatric patients with epilepsy.

A second abstract measuring clinical response from a study conducted at Korea University Guro Hospital found that CBD may be used to control intractable epilepsy with precise adjustment of antiseizure medications (ASMs) in relation to clinical response, though more study is needed in this area.²

As a fairly new treatment for people with epilepsy, the effectiveness of CBD needs to be tested in pediatric patients with intractable epilepsy under various clinical circumstances, the researchers noted.

A study conducted prior to April 2022 with a cohort of 28 patients ranging from 4 to 20 years old evaluated responses to oral CBD through record of seizure frequency and volume.

Dosage administration included a cocktail of CBD, clobazam, and valproate, and seizures were reduced by half for 85.7% of patients, with 42.9% of patients exhibiting a reduction rate of 76% to 99%, and 3.6% of patients had no seizures.

Beneficial development in the areas of cognition, language, sleep, and control of saliva were also logged, and conversely sleepiness, ataxia, and transient liver enzyme or ammonia elevation were found, but these were rectified with ASM or CBD adjustment.

Other notable outcomes of this study include the need for a patient to stop CBD because of recurrent pneumonia, two patients that showed no change, and one patient who experienced more seizures with SCN2A-related epilepsy.

“CBD is worth attempting to control intractable epilepsy with meticulous adjustment of ASMs according to the clinical response,” the authors concluded. “A larger cohort and a long-term follow-up are needed to verify this study.”

References

1. Fahad I, Rathore G, Cameron K, Dennis E, Zhou D. Real-world outcomes of cannabidiol for the treatment of refractory epilepsy in pediatric patients: a pediatric tertiary care center experience. Abstract presented at: American Epilepsy Society Annual Meeting; December 2-6, 2022; Nashville, TN. Abstract 3.307.

2. Shim Y, Byeon JH, Eun B. Clinical efficacy and adverse events of cannabidiol with concomitant anti-seizure medications in intractable pediatric epilepsy: a tertiary hospital experience. Abstract presented at: American Epilepsy Society Annual Meeting; December 2-6, 2022; Nashville, TN. Abstract 3.219.