cbd and child seizures

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-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.

Rosenberg EC, Tsien RW, Whalley BJ, Devinsky O.
Cannabinoids and Epilepsy.
Neurotherapeutics. 2015;12(4):747-68. PubMed abstract / Full Text
This provides a review of current understanding of the endocannabinoid system, the pro- and anticonvulsive effects of cannabinoids [e.g., Δ9-tetrahydrocannabinol and cannabidiol (CBD)], and evidence from pre-clinical and clinical trials of cannabinoids in epilepsy.

Drug Enforcement Administration.
Epidiolex placed in schedule V of Controlled Substance Act.
US Department of Justice; (2018) https://www.dea.gov/press-releases/2018/09/27/fda-approved-drug-epidio. . September 27, 2018 Press Release. Accessed on 12/20/2018.

State Medical Marijuana Laws (NCSL)
State and federal laws about medical marijuana; National Conference of State Legislatures.

Monte AA, Zane RD, Heard KJ.
The implications of marijuana legalization in Colorado.
JAMA. 2015;313(3):241-2. PubMed abstract / Full Text

Helpful Articles

Maa E, Figi P.
The case for medical marijuana in epilepsy.
Epilepsia. 2014;55(6):783-6. PubMed abstract

Ammerman S, Ryan S, Adelman WP.
The impact of marijuana policies on youth: clinical, research, and legal update.
Pediatrics. 2015;135(3):e769-85. PubMed abstract
AAP Technical Report on the epidemiology of marijuana use, definitions and biology of marijuana compounds, side effects, and effects of use on adolescent brain development. Legal and safety issues concerning medical marijuana specifically are also addressed, including effects on youth of criminal penalties for marijuana use and possession.

Ammerman S, Ryan S, Adelman WP.
The impact of marijuana policies on youth: clinical, research, and legal update.
Pediatrics. 2015;135(3):e769-85. PubMed abstract
AAP Technical Report on the epidemiology of marijuana use, definitions and biology of marijuana compounds, side effects, and effects of use on adolescent brain development. Legal and safety issues concerning medical marijuana specifically are also addressed, including effects on youth of criminal penalties for marijuana use and possession.

Information & Support

Devinsky O, Marsh E, Friedman D, Thiele E, Laux L, Sullivan J, Miller I, Flamini R, Wilfong A, Filloux F, Wong M, Tilton N, Bruno P, Bluvstein J, Hedlund J, Kamens R, Maclean J, Nangia S, Singhal NS, Wilson CA, Patel A, Cilio MR.
Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial.
Lancet Neurol. 2016;15(3):270-8. PubMed abstract

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.
N Engl J Med. 2018;378(20):1888-1897. PubMed abstract