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Home > Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence.

Stockings, Emily and Zagic, Dino and Campbell, Gabrielle and Weier, Megan and Hall, Wayne D and Nielsen, Suzanne and Herkes, Geoffery K and Farrell, Michael and Degenhardt, Louisa (2018) Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence. Journal of Neurology, Neurosurgery and Psychiatry , 89 , (7) . doi: 10.1136/jnnp-2017-317168.

URL: https://jnnp.bmj.com/content/89/7/741.long

Review evidence for cannabinoids as adjunctive treatments for treatment-resistant epilepsy. Systematic search of Medline, Embase and PsycINFO was conducted in October 2017. Outcomes were: 50%+ seizure reduction, complete seizure freedom; improved quality of life (QoL). Tolerability/safety were assessed by study withdrawals, adverse events (AEs) and serious adverse events (SAEs). Analyses were conducted in Stata V.15.0. 36 studies were identified: 6 randomised controlled trials (RCTs), 30 observational studies. Mean age of participants was 16.1 years (range 0.5–55 years). Cannabidiol (CBD) 20 mg/kg/day was more effective than placebo at reducing seizure frequency by 50%+(relative risk (RR) 1.74, 95% CI 1.24 to 2.43, 2 RCTs, 291 patients, low Grades of Recommendation, Assessment, Development and Evaluation (GRADE) rating). The number needed to treat for one person using CBD to experience 50%+ seizure reduction was 8. CBD was more effective than placebo at achieving complete seizure freedom, and improving QoL, however increased risk of AEs and SAEs.

Pooled across 17 observational studies, 48.5% of patients reported 50%+ reductions in seizures; in 14 observational studies 8.5% were seizure-free. Twelve observational studies reported improved QoL; 50.6% AEs and 2.2% SAEs. Pharmaceutical-grade CBD as adjuvant treatment in paediatric-onset drug-resistant epilepsy may reduce seizure frequency. Existing RCT evidence is mostly in paediatric samples with rare and severe epilepsy syndromes; RCTs examining other syndromes and cannabinoids are needed.


Item Type
Article
Publication Type
International, Open Access, Review, Article
Drug Type
Cannabis, Prescription/Over the counter
Intervention Type
Drug therapy
Source
Date
2018
Identification #
doi: 10.1136/jnnp-2017-317168
Publisher
BMJ Publishing
Volume
89
Number
7
EndNote

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