Authors :
Presenting Author: Katarzyna Mieszczanek, MD – Danish Epilepsy Centre "Filadelfia", Dianalund, Denmark
Kern Olofsson, MD – Neuropaediatric Department – Danish Epilepsy Centre “Filadelfia” Dianalund, Denmark; Guido Rubboli, MD, PhD, Prof. – Neurological Department – Danish Epilepsy Centre “Filadelfia” Dianalund, Denmark
Rationale:
In our Center, Cannabidiol is used from 2017, primary for treatment epilepsy associated with Dravet syndrom, Lennox-Gastaut syndrome or Tuberous Sclerosis Complex (TSC). Cannabidiol was also applied in treatment of other epileptic encephalopathies (EE) and developmental epileptic encephalopathies (DEE) for example in a course of Rett syndrome or Angelmann syndrome. The study was conducted to evaluate the effect of Cannabidiol on serum levels of antiepileptic drugs.
Methods:
We reviewed a single-center retrospective series of 68 patients in treatment with Cannabidiol between 2017 and 2023. A total of 11 patients were excluded from the study due to luck of antiepileptic drug serum levels before or after Cannabidiol adding. Blood tests were made at the same time and drugs were taken by patients at the same time. Serum Cannabidiol levels were not performed.
Results:
A total of 27 men and 30 women at the age between eight and fifty one years were treated in our Center with diagnosis: Lennox-Gastaut syndrome, Dravet syndrome,TSC or other epileptic or developmental epileptic encephalopathies.
In polytherapy with Cannabidiol with or without clobazam were used: valproic acid (17 case), topiramat (11), perampanel (8), lacosamide (8), rufinamide (8), levetiracetam (7), zonisamid (7), lamotrigine (5), bivaracetam (4), ethosuximide (4), stiripentol (4), eslicarbazepin (2), oxcarbazepine (2), pregabalin (2) and sultiame (1).
In most cases, valproic acid serum level was slightly or significantly increased after Cannabidiol addition (11 patients). Topiramate level in all cases was the same or only slightly increased or decreased. Perampanel level was slightly or significant increased in all cases and lacosamid was significantly increased in four cases (50% of patients). Zonisamid serum level was slightly increased in most cases (six of seven patients). All four patients treated with brivaracetam and one of four patients with rufinamide had significantly increased serum level. Levetiracetam and lamotrigin serum level was stable or only slightly increased.
Conclusions:
There seems to be no simple relationship between Cannabidiol and most antiepileptic drugs. Cannabidiol politherapy with antiepileptic drugs requires control of serum antiepileptic drug levels especially in polytherapy in such medicine as valproic acid, brivaracetam, lacosamide, and perampanel but also rufinamide.
Funding: No funding