Efficacy and safety of cannabidiol for the treatment of pediatric epilepsy
Main Article Content
Keywords
cannabidiol, pediatric, epilepsy, Dravet and Lennox-Gastaut syndromes
Abstract
Drug-resistant epilepsy affects one-third of patients, requiring new medications for efficacy. Interest in new antiepileptic properties, targeting novel receptors, is high.
Objectives: Determine which studies have examined the usage of cannabis & products derived from cannabis as a therapy of pediatric epilepsy.
Patients and methods: NRSs and RCTs examining the usage of cannabis as a therapy for any form of epilepsy in kids (eighteen years old or less) have been involved into our analysis. The interventions involved a wide range of cannabis-derived products, such as THC, cannabinol, CBD, or combinations, delivered through various routes (such as inhalation, oral). Pharmacologic (such as analgesics) & nonpharmacologic (such as vagus nerve stimulation, resective brain surgery ,diet therapy) therapies, in addition to placebo, standard care, or no treatment, were eligible comparators.
Results, Conclusion: The administration of CBD resulted in a significant improvement of seizure load. Most kids reported a reduction in the incidence of their seizures. kids with drug-resistant Dravet & Lennox-Gastaut syndromes can benefit from CBD in terms of reduced seizure burden (moderate certainty); nonetheless, few of these children were completely seizure free. Children with other DRE syndromes may also benefit, albeit the evidence is currently limited. It is not appropriate to apply these results to all cannabis-based products, particularly ones whose exact makeup is unknown.
References
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19. Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, Greenwood SM, Roberts C, Checketts D, VanLandingham KE, Zuberi SM. Effect of cannabidiol on drop seizures in the Lennox–Gastaut syndrome. New England Journal of Medicine. 2018 May 17;378(20):1888-97.
20. Thiele EA, Marsh ED, French JA, Mazurkiewicz-Beldzinska M, Benbadis SR, Joshi C, Lyons PD, Taylor A, Roberts C, Sommerville K, Gunning B. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2018 Mar 17;391(10125):1085-96.
21. Potnis VV, Albhar KG, Nanaware PA, Pote VS. A Review on Epilepsy and its Management. Journal of Drug Delivery and Therapeutics. 2020 May 15;10(3):273-9.
22. Goel D, Aggarwal P, Kandpal SD, Kakkar R, Negi D, Mittal N. Epidemiology of new onset seizures and epilepsy cases: a prospective cohort study. International Journal of Epilepsy. 2020 Apr;6(01):30-8.
23. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are the “common” neurologic disorders? Neurology. 2007;68:326–37.
24. Goel D, Aggarwal P, Kandpal SD, Kakkar R, Negi D, Mittal N. Epidemiology of new onset seizures and epilepsy cases: a prospective cohort study. International Journal of Epilepsy. 2020 Apr;6(01):30-8.
25. Neligan A, Sander JW. Epidemiology of seizures and epilepsy. Epilepsy. 2014 Feb 14:28-32.
26. Boleti AP, Frihling BE, e Silva PS, Cardoso PH, de Moraes LF, Rodrigues TA, Biembengute ME, Koolen HH, Migliolo L. Biochemical aspects and therapeutic mechanisms of cannabidiol in epilepsy. Neuroscience & Biobehavioral Reviews. 2022 Jan 1;132:1214-28.
27. Cross JH, Cock H. A perspective on cannabinoids for treating epilepsy: do they really change the landscape?. Neuropharmacology. 2020 Jun 15;170:107861.
28. Lattanzi S, Cagnetti C, Foschi N, Lorusso A, Provinciali L, Silvestrini M. Eslicarbazepine acetate as adjunctive treatment in partial-onset epilepsy. Acta Neurol Scand. 2018;137:29–32.
29. Stockings E, Zagic D, Campbell G, Weier M, Hall WD, Nielsen S, Herkes GK, Farrell M, Degenhardt L. Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. Journal of Neurology, Neurosurgery & Psychiatry. 2018 Jul 1;89(7):741-53.
30. Suraev, A. S., Todd, L., Bowen, M. T., Allsop, D. J., McGregor, I. S., Ireland, C., & Lintzeris, N. (2017). An Australian nationwide survey on medicinal cannabis use for epilepsy: history of antiepileptic drug treatment predicts medicinal cannabis use. Epilepsy & Behavior, 70, 334-340.
31. Press CA, Knupp KG, Chapman KE. Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy & Behavior. 2015 Apr 1;45:49-52.
32. Hussain SA, Zhou R, Jacobson C, Weng J, Cheng E, Lay J, Hung P, Lerner JT, Sankar R. Perceived efficacy of cannabidiol-enriched cannabis extracts for treatment of pediatric epilepsy: a potential role for infantile spasms and Lennox–Gastaut syndrome. Epilepsy & Behavior. 2015 Jun 1;47: 138-41.
2. Téllez-Zenteno JF, Hernández-Ronquillo L, Buckley S, Zahagun R, Rizvi S. A validation of the new definition of drug-resistant epilepsy by the International League Against Epilepsy. Epilepsia. 2014; 55: 829–34.
3. Kwan P, Arzimanoglou A, Berg AT, et al. Definition of drug resistant epilepsy: consensus proposal by the ad hoc Task Force of the ILAE commission on therapeutic strategies. Epilepsia. 2010; 51: 1069–77.
4. Howard MA, Baraban SC. Catastrophic epilepsies of childhood. Annu Rev Neurosci. 2017; 40: 149–66.
5. Begley CE, Durgin TL. The direct cost of epilepsy in the United States: a systematic review of estimates. Epilepsia. 2015;56: 1376–87.
6. Porter BE, Jacobson C. Report of a parent survey of cannabidiol-enriched cannabis use in pediatric treatment-resistant epilepsy. Epilepsy Behav. 2013; 29: 574–7.
7. Perucca E. Cannabinoids in the treatment of epilepsy: hard evidence at last? J Epilepsy Res. 2017; 7: 61–76.
8. O’Connell BK, Gloss D, Devinsk O. Cannabinoids in treatment-resistant epilepsy: a review. Epilepsy Behav. 2016; 70: 341–8.
9. Mathern GW, Beninsig L, Nehlig A. Fewer specialists support using medical marijuana and CBD in treating epilepsy patients compared with other medical professionals and patients: result of Epilepsia’s survey. Epilepsia. 2015;56: 1–6.
10. Gloss D, Vickrey B. Cannabinoids for epilepsy. Cochrane Database Syst Rev. 2014;3: CD009270.
11. Aguirre-Velazquez CG. Report from a survey of parents regarding the use of cannabidiol (medicinal cannabis) in Mexican children with refractory epilepsy. Neurol Res Int. 2017; 2017: 1–5.
12. Ibeas Bih C, Chen T, Nunn AV, Bazelot M, Dallas M, Whalley BJ. Molecular targets of cannabidiol in neurological disorders. Neurotherapeutics. 2015;12:699–730.
13. Devinsky O, Marsh E, Friedman D, Thiele E, Laux L, Sullivan J, Miller I, Flamini R, Wilfong A, Filloux F, Wong M. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet Neurology. 2016 Mar 1;15(3):270-8.
14. Hausman-Kedem M, Menascu S, Kramer U. Efficacy of CBD-enriched medical cannabis for treatment of refractory epilepsy in children and adolescents—an observational, longitudinal study. Brain Dev. 2018; 40: 544–51.
15. Tzadok M, Uliel-Siboni S, Linder I, Kramer U, Epstein O, Menascu S, Nissenkorn A, Yosef OB, Hyman E, Granot D, Dor M. CBD-enriched medical cannabis for intractable pediatric epilepsy: the current Israeli experience. Seizure. 2016 Feb 1;35:41-4.
16. US Food and Drug Administration. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. 2018. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm. Accessed June 27, 2018…..
17. Devinsky O, Patel AD, Thiele EA, Wong MH, Appleton R, Harden CL, Greenwood S, Morrison G, Sommerville K, GWPCARE1 Part A Study Group, GWPCARE1 Part A Study Group. Randomized, dose-ranging safety trial of cannabidiol in Dravet syndrome. Neurology. 2018 Apr 3;90(14):e1204-11.
18. Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, Scheffer IE, Thiele EA, Wright S. Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. New England Journal of Medicine. 2017 May 25;376(21):2011-20.
19. Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, Greenwood SM, Roberts C, Checketts D, VanLandingham KE, Zuberi SM. Effect of cannabidiol on drop seizures in the Lennox–Gastaut syndrome. New England Journal of Medicine. 2018 May 17;378(20):1888-97.
20. Thiele EA, Marsh ED, French JA, Mazurkiewicz-Beldzinska M, Benbadis SR, Joshi C, Lyons PD, Taylor A, Roberts C, Sommerville K, Gunning B. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. The Lancet. 2018 Mar 17;391(10125):1085-96.
21. Potnis VV, Albhar KG, Nanaware PA, Pote VS. A Review on Epilepsy and its Management. Journal of Drug Delivery and Therapeutics. 2020 May 15;10(3):273-9.
22. Goel D, Aggarwal P, Kandpal SD, Kakkar R, Negi D, Mittal N. Epidemiology of new onset seizures and epilepsy cases: a prospective cohort study. International Journal of Epilepsy. 2020 Apr;6(01):30-8.
23. Hirtz D, Thurman DJ, Gwinn-Hardy K, Mohamed M, Chaudhuri AR, Zalutsky R. How common are the “common” neurologic disorders? Neurology. 2007;68:326–37.
24. Goel D, Aggarwal P, Kandpal SD, Kakkar R, Negi D, Mittal N. Epidemiology of new onset seizures and epilepsy cases: a prospective cohort study. International Journal of Epilepsy. 2020 Apr;6(01):30-8.
25. Neligan A, Sander JW. Epidemiology of seizures and epilepsy. Epilepsy. 2014 Feb 14:28-32.
26. Boleti AP, Frihling BE, e Silva PS, Cardoso PH, de Moraes LF, Rodrigues TA, Biembengute ME, Koolen HH, Migliolo L. Biochemical aspects and therapeutic mechanisms of cannabidiol in epilepsy. Neuroscience & Biobehavioral Reviews. 2022 Jan 1;132:1214-28.
27. Cross JH, Cock H. A perspective on cannabinoids for treating epilepsy: do they really change the landscape?. Neuropharmacology. 2020 Jun 15;170:107861.
28. Lattanzi S, Cagnetti C, Foschi N, Lorusso A, Provinciali L, Silvestrini M. Eslicarbazepine acetate as adjunctive treatment in partial-onset epilepsy. Acta Neurol Scand. 2018;137:29–32.
29. Stockings E, Zagic D, Campbell G, Weier M, Hall WD, Nielsen S, Herkes GK, Farrell M, Degenhardt L. Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. Journal of Neurology, Neurosurgery & Psychiatry. 2018 Jul 1;89(7):741-53.
30. Suraev, A. S., Todd, L., Bowen, M. T., Allsop, D. J., McGregor, I. S., Ireland, C., & Lintzeris, N. (2017). An Australian nationwide survey on medicinal cannabis use for epilepsy: history of antiepileptic drug treatment predicts medicinal cannabis use. Epilepsy & Behavior, 70, 334-340.
31. Press CA, Knupp KG, Chapman KE. Parental reporting of response to oral cannabis extracts for treatment of refractory epilepsy. Epilepsy & Behavior. 2015 Apr 1;45:49-52.
32. Hussain SA, Zhou R, Jacobson C, Weng J, Cheng E, Lay J, Hung P, Lerner JT, Sankar R. Perceived efficacy of cannabidiol-enriched cannabis extracts for treatment of pediatric epilepsy: a potential role for infantile spasms and Lennox–Gastaut syndrome. Epilepsy & Behavior. 2015 Jun 1;47: 138-41.
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Published
May 20, 2022
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How to Cite
ABDULAZIZ ALRABAT1, BADER MOHAMMAD ALMALKI2, Alghamdi, Raid Hassan D3, Naif Abdulrahman alotibi4, omar owaydhah salem almotairi1, Wedad musleh sarazid1, Rayid Hassan Ahmed Alzahrani5. (2022). Efficacy and safety of cannabidiol for the treatment of pediatric epilepsy. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 1173-1180. https://doi.org/10.53555/jptcp.v29i04.5707
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All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
ABDULAZIZ ALRABAT1, BADER MOHAMMAD ALMALKI2, Alghamdi, Raid Hassan D3, Naif Abdulrahman alotibi4, omar owaydhah salem almotairi1, Wedad musleh sarazid1, Rayid Hassan Ahmed Alzahrani5. (2022). Efficacy and safety of cannabidiol for the treatment of pediatric epilepsy. Journal of Population Therapeutics and Clinical Pharmacology, 29(04), 1173-1180. https://doi.org/10.53555/jptcp.v29i04.5707