Study register · detailKohortenstudie · Epilepsy · 2017
The current status of artisanal cannabis for the treatment of epilepsy in the United States.
Sulak et al.·Epilepsy & behaviorImpact 2.4
Clear benefitGRADEModerate66 citations
Samplen = 272 Pat.
Durationunclear
EndpointSeizure reduction
Blindingn.a.
DesignKohortenstudie
Cannabinoidvollspektrum
Routeoral
”Key finding
72% of patients (210 of 272) experienced a reduction in seizures of at least 26%, with 28% in complete remission or near-complete seizure control (76-99% reduction).
Summary
Retrospective data on artisanal cannabis preparations in n=272 patients with treatment-refractory epilepsy (Washington, California, Maine); 14% found cannabis ineffective, 15% had 1-25% seizure reduction, 18% had 26-50% reduction, 17% had 51-75% reduction, 28% had 76-99% reduction, 10% achieved complete clinical remission. Side effects mild and rare; majority used CBD-enriched formulations, some with THC/THCA.
P
PopulationPatients with medication-refractory epilepsy of varying etiology (Washington State, California, Maine), n=272 (combined WA and CA)
I
InterventionArtisanal cannabis preparations (predominantly CBD-enriched, some with added THC and THCA), oral administration
O
Outcome14% with no response; 28% with 76–99% seizure reduction; 10% complete seizure freedom; mild and rare side effects
Confidence in the evidence
Very lowLowModerateHigh
Moderate
The third of four GRADE levels, the effect estimate is probably reliable.
The widespread patient use of artisanal cannabis preparations has preceded quality validation of cannabis use for epilepsy. Neurologists and cannabinoid specialists are increasingly in a position to monitor and guide the use of herbal cannabis in epilepsy patients. We report the retrospective data on efficacy and adverse effects of artisanal cannabis in Patients with medically refractory epilepsy with mixed etiologies in Washington State, California, and Maine. Clinical considerations, including potential risks and benefits, challenges related to artisanal preparations, and cannabinoid dosing, are discussed. RESULTS: Of 272 combined patients from Washington State and California, 37 (14%) found cannabis ineffective at reducing seizures, 29 (15%) experienced a 1-25% reduction in seizures, 60 (18%) experienced a 26-50% reduction in seizures, 45 (17%) experienced a 51-75% reduction in seizures, 75 (28%) experienced a 76-99% reduction in seizures, and 26 (10%) experienced a complete clinical response. Overall, adverse effects were mild and infrequent, and beneficial side effects such as increased alertness were reported. The majority of patients used cannabidiol (CBD)-enriched artisanal formulas, some with the addition of delta-9-tetrahydrocannabinol (THC) and tetrahydrocannabinolic acid (THCA). Four case reports are included that illustrate clinical responses at doses <0.1mg/kg/day, biphasic dose-response effects, the use of THCA for seizure prevention, the use of THC for seizure rescue, and the synergy of cannabinoids and terpenoids in artisanal preparations. This article is part of a Special Issue entitled "Cannabinoids and Epilepsy".