Cannabidiol in the Treatment of Epilepsy: A Focused Review of Evidence and Gaps.

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Review

. 2020 Oct 19;11:531939.

doi: 10.3389/fneur.2020.531939. eCollection 2020.

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Guilherme Diogo Silva et al. Front Neurol. .

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Abstract

Approximately one third of epilepsy patients do not become seizure free with antiseizure medications. This treatment gap motivates research for new therapeutic options, such as cannabidiol (CBD). CBD differs from other cannabis derivatives because of its consistent efficacy and lack of a psychoactive effect. CBD can be recommended as adjunctive therapy in patients with Dravet and Lennox-Gastaut syndromes. The most common adverse effects (AEs) are drowsiness, reduced appetite, diarrhea, and vomiting. Transaminase elevation is the most common AE that leads to CBD discontinuation. Coadministration with valproate may increase the risk of hepatotoxicity. The combination of CBD and clobazam may increase both the effectiveness and the risk of AEs associated with these drugs. The most striking gaps in knowledge are the efficacy and optimal dose of CBD for adults with focal epilepsies, the long-term safety of CBD use, and strategies to improve access to CBD for people living with epilepsy.

Keywords: cannabidiol; efficacy; epilepsy; evidence; gaps; review; safety.

Figures

Figure 1

Figure 1

Comparison of efficacy in the main studies. TRE, treatment-resistant epilepsy; OL, open label; LG, Lennox-Gastaut; RCT, randomized controlled trial. Adapted from (12).

Figure 2

Figure 2

Total and serious adverse effects and discontinuation rates observed with CDB. TRE, treatment-resistant epilepsy; OL, open label; LG, Lennox-Gastaut; RCT, randomized controlled trial. Adapted from (12).

Figure 3

Figure 3

Most common adverse effects observed with CBD. TRE, treatment-resistant epilepsy; OL, open label; LG, Lennox-Gastaut; RCT, randomized controlled trial. Adapted from (12).

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