Clinical Efficacy and Adverse Events of Cannabidiol with Concomitant Anti-seizure Medications in Intractable Pediatric Epilepsy: A Tertiary Hospital Experience
Abstract number :
3.219
Submission category :
4. Clinical Epilepsy / 4C. Clinical Treatments
Year :
2022
Submission ID :
2204502
Source :
www.aesnet.org
Presentation date :
12/5/2022 12:00:00 PM
Published date :
Nov 22, 2022, 05:25 AM
Authors :
Youngkyu Shim, MD – Korea University College of Medicine; Jung Hye Byeon, MD, PhD – Korea University College of Medicine; Baik-Lin Eun, MD, PhD – Korea University College of Medicine
Rationale: Cannabidiol recently gained clinical attention after being proven its efficacy and safety for epilepsy patients. However, still intractable pediatric epilepsy requires more evidence of the usefulness of this drug in diverse clinical situations. Here we share the clinical experience of Cannabidiol use.
Methods: We retrospectively reviewed 28 patients who were treated with Cannabidiol oral solution (CBD) at Korea University Guro Hospital before April 2022. Patients’ demographics, characteristics, and clinical responses to CBD were analyzed.
Results: The median age and follow-up duration were 11 years old (4-20 years) and 7 months (1-32 months), respectively. Eleven patients were female. The identifiable causes of epilepsy were hypoxic injury (n=2), encephalitis (n=2), acute disseminated encephalomyelitis (n=1), Down syndrome (n=1), tuberous sclerosis (n=1), West syndrome (n=7), and genetic epileptic encephalopathy (SCN1A=2, SCN2A=1, GABRB3=1, KCNT1=1, COL4A1=1). Twenty-five patients (89.3%) were co-administrated with clobazam and valproate. Median dose of CBD, clobazam, and valproate was 14.3 (6.8-25.0), 0.3 (0.1-0.6), and 14.3 (10.2-31.8) mg/kg/day, respectively. Twenty-four patients (24/28, 85.7%) showed more than 50% of seizure reduction including 12 (12/28, 42.9%) achieving a seizure reduction rate of 76-99% and one (3.6%) with seizure-free. Improved cognition (n=5), language (n=2), sleep (n=2), and saliva control (=2) were also noted. Add-on (n=3), retry (n=2), or dose-up (n=2) of clobazam led to new or additional seizure reduction. Adverse events were sleepiness (n=6), ataxia (n=1), and transient liver enzyme or ammonia elevation (each, n=1), which were resolved with an adjustment of ASMs or of CBD itself. However, one patient had to quit CBD due to frequent pneumonia. Two patients did not show response, and one patient with SCN2A-related epilepsy resulted in increased seizure frequency.
Conclusions: CBD is worth attempting to control intractable epilepsy with meticulous adjustment of ASMs according to the clinical response. A larger cohort and a long-term follow-up are needed to verify this study.
Funding: None
Clinical Epilepsy