Summary:
Epilepsy is a chronic disease characterized by recurrent unprovoked seizures. Up to 30% of children with
epilepsy will be refractory to standard anticonvulsant therapy, and those with epileptic encephalopathy can be particularly challenging to treat. The endocannabinoid system can modulate the physiologic processes underlying epileptogenesis. The anticonvulsant properties of several cannabinoids, namely Δ
9-
tetrahydrocannabinol and
cannabidiol (CBD), have been demonstrated in both
in vitro and
in vivo studies.
Cannabis-based therapies have been used for millennia to treat a variety of diseases including
epilepsy. Several studies have shown that CBD, both in isolation as a pharmaceutical-grade preparation or as part of a CBD-enriched
cannabis herbal extract, is beneficial in decreasing seizure frequency in children with treatment-resistant
epilepsy. Overall,
cannabis herbal extracts appear to provide greater efficacy in decreasing seizure frequency, but the studies assessing
cannabis herbal extract are either retrospective or small-scale observational studies. The two large randomized controlled studies assessing the efficacy of pharmaceutical-grade CBD in children with Dravet and Lennox–Gastaut syndromes showed similar efficacy to other anticonvulsants. Lack of data regarding appropriate dosing and
pediatric pharmacokinetics continues to make authorization of
cannabis-based therapies to children with treatment-resistant
epilepsy challenging.
