Potential of cannabinoid for epilepsy confirmed

UK and US researchers have shown that cannabidiol is effective in controlling seizures in a range of animal models with ‘a potential disease‐modifying effect… on reducing both seizure burden and associated comorbidities well after the onset of symptomatic seizures’ (Epilepsia 2018. First published: 26 December 2018. https://doi.org/10.1111/epi.14629).

The announcement follows a Government climb down, following advice from the Advisory Council on the Misuse of Drugs, over the role of medicinal cannabis in the management of epilepsy to allow specialist prescribing from November 21st 2018 with no legal restriction on indication (www.gov.uk/government/news/government-announces-that-medicinal-cannabis-is-legal).

Guidance from the Association of British Neurologists published in December 2018 (www.theabn.org/media/Documents/ABN%20publications/ABN%20guidelines%20Use%20of%20cannabis-based%20products%20in%20neurology%20December%202018%20v2.pdf) states there is sufficient clinical evidence for cannabis-based products in the treatment of Dravet’s syndrome and Lennox Gastaut syndrome.

Effectiveness in the long term treatment of Dravet’s syndrome was recently confirmed by a non-blinded 48-week extension study involving 264 patients who received cannabidiol 2.5 – 30 mg/kg/day in addition to other medication (Epilepsia 2018. First published: 23 December. https://doi.org/10.1111/epi.14628). The median reduction in monthly seizure frequency was 38% – 44% for convulsive seizures and 39% – 51% for total seizures; 85% of patients/caregivers reported improvement in the patient’s overall condition. Adverse effects included diarrhoea (35%), pyrexia (27%), decreased appetite (25%) and somnolence (25%). Elevated liver transaminases occurred in 17% of patients, all of whom were also taking valproic acid. Adverse effects resulted in discontinuation of treatment in 6% of patients.

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