Epilepsy and cannabidiol: a guide to treatment.

Alexis Arzimanoglou, Ulrich Brandl, J Helen Cross, Antonio Gil-Nagel, Lieven Lagae, Cecilie Johannessen Landmark, Nicola Specchio, Rima Nabbout, Elizabeth A Thiele, Oliver Gubbay

Journal: Epileptic disorders : international epilepsy journal with videotape 2020;22(1):1-14

PMID: 32096470

Abstract

The growing interest in cannabidiol (CBD), specifically a pure form of CBD, as a treatment for epilepsy, among other conditions, is reflected in recent changes in legislation in some countries. Although there has been much speculation about the therapeutic value of cannabis-based products as an anti-seizure treatment for some time, it is only within the last two years that Class I evidence has been available for a pure form of CBD, based on placebo-controlled RCTs for patients with Lennox-Gastaut syndrome and Dravet syndrome. However, just as we are beginning to understand the significance of CBD as a treatment for epilepsy, in recent years, a broad spectrum of products advertised to contain CBD has emerged on the market. The effects of these products are fundamentally dependent on the purity, preparation, and concentration of CBD and other components, and consensus and standardisation are severely lacking regarding their preparation, composition, usage and effectiveness. This review aims to provide information to neurologists and epileptologists on the therapeutic value of CBD products, principally a purified form, in routine practice for patients with intractable epilepsy.

Address: Paediatric Epilepsy Dpt., University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, and Inserm U1028/CNRS UMR5292, Lyon, France; Department of Neuropediatrics, University Hospital Jena, Jena, Germany; UCL NIHR BRC Great Ormond Street Institute of Child Health, Member of the ERN EpiCARE, London, UK; Hospital Ruber Internacional, Epilepsy program, Madrid, Spain; University Hospitals KULeuven, Department Development and Regeneration, Section Pediatric Neurology, Member of the ERN EpiCARE, Leuven Belgium; Program for Pharmacy, Oslo Metropolitan University and The National Center for Epilepsy and Dept of Pharmacology, Oslo University Hospital, Norway; Rare and Complex Epilepsy Unit, Department on Neuroscience, Bambino Gesu' Children's Hospital, IRCCS, Member of the ERN EpiCARE, Rome, Italy; Pediatric neurology department, Reference centre for rare epilepsies, Member of the ERN EpiCARE, Necker Enfants Malades University Hospital, APHP, Inserm UMR1163, Institut Imagine, Paris Descartes University, Paris, France; Department of Neurology, Massachusetts General Hospital, Boston, USA; Paediatric Epilepsy Dpt., University Hospitals of Lyon (HCL), Member of the ERN EpiCARE, and Inserm U1028 / CNRS UMR5292, Lyon, France; Université Paris Diderot, Sorbonne Paris Cité, INSERM UMR1141, Paris; AP-HP, Hôpital Robert Debré, Service de Neurologie Pédiatrique, Paris; Carreño Hospital Clínic - Epilepsy Unit, Department of Neurology; Member of the European Reference Network on Rare and Complex epilepsies, ERN EpiCARE, Barcelona, Spain; Muir Maxwell Epilepsy Centre, Centre for Clinical Brain Sciences and MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK; Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK; Department of Neurology, University of California, San Francisco, San Francisco, CA, United States; Department of Pediatrics, Catholic University of Leuven, Brussels, Belgium; Institute for Experimental and Clinical Research, Catholic University of Leuven, Brussels, Belgium; Endocannabinoid Research Group, Institute of Biomolecular Chemistry (ICB), National Research Council (CNR), Pozzuoli (NA) 80078 IT, Italy; Canada Excellence Research Chair on the Microbiome-Endocannabinoidome Axis in Metabolic Health, Institut Universitaire de Cardiologie et de Pneumologie de Québec and Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec City G1V 0A6, Canada; Hospital Sant Joan de Deu, Esplugues de Llobregat, Espana; Department of Paediatric Neurology, Evelina London Children's Hospital; Department of Child Neurology, Brain Center, University medical Center Utrecht, Member of the European Reference Network EpiCARE, The Netherlands; School of Medicine, University of Eastern Finland, Kuopio, Finland; Epilepsy Center/Neuro Center, Kuopio University Hospital, Kuopio, Finland; Pediatric Neurology Unit, Wolfson Medical Center, Holon and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Department of Developmental Neurology, Medical University of Gdansk, Gdansk, Poland; Rare and Complex Epilepsy Unit, Division of Neurology, Department of Neurosciences, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy; Department of Neuropediatrics, University Children's Hospital, Zürich, Switzerland; TIGER, Neuroscience Research Center of Lyon, INSERM U1028, CNRS 5292 Lyon, France; Clínica Universidad de Navarra, Pediatric Neurology Unit, Pio XII, 36, 31080, Pamplona, Spain; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto “G. Gaslini”, Genova; GW Research Ltd, Chivers Way, Histon, Cambridge, United Kingdom
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