Highlights
- •The efficacy and safety of CBD has been demonstrated in Lennox-Gastaut and Darvet Syndromes.
- •A growing body of evidence is supporting the utilization of CBD in refractory status epilepticus, including NORSE and FIRES.
- •The majority of patients who received CBD did so after multiple other medications failed to provide seizure cessation.
Abstract
Objective
To summarize and evaluate clinical experiences with refractory status epilepticus
in which cannabidiol (CBD) was utilized for cessation of seizure activity.
Methods
A comprehensive literature review was performed on PubMED, MEDLINE, Scopus, and CINAHL
between May - June 2022 with the assistance of a medical reference librarian using
the following search terms: “Cannabidiol” [MAJR], “Status Epilepticus” [MAJR], “New-Onset
Refractory Status Epilepticus”, and “cannabidiol.” Reports that provided dosing regimens
and patient outcomes were included.
Results
Thirty-two articles were screened. Five articles were selected for inclusion in this
review and detailed the clinical courses of 11 patients. Five of the 11 patients received
CBD during the chronic epilepsy stage, while the remaining 6 received it during a
period of acute status epilepticus. Patients were trialed on an average of 9 anti-epileptic
drugs prior to CBD administration, after which 9 of the 11 patients experienced a
reduction of seizure activity. Dosing of CBD ranged between 5-25 mg/kg/day and was
titrated based on patient response to therapy. Adverse effects were relatively benign
and were generally limited to gastrointestinal discomfort, reported after seizure
cessation.
Conclusions
CBD may provide a potentially efficacious and safe management strategy in refractory
status epilepticus, including patients with new-onset refractory status epilepticus
and febrile infection-related epilepsy syndrome. A potential for drug-drug interactions
between CBD and anti-epileptic drugs warrants judicious monitoring. Additional research
is necessary to determine a definitive dosing strategy for this agent.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seizure - European Journal of EpilepsyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Proposed consensus definitions for new-onset refractory status epilepticus (NORSE), febrile infection-related epilepsy syndrome (FIRES), and related conditions.Epilepsia. 2018; 59: 739-744
- Danbury: National Organization for Rare Diseases. c 2022. NORSE (New Onset Refractory Status Epilepticus) and FIRES (Febrile Infection-Related Epilepsy Syndrome).2020 (Available from)
- New-onset refractory status epilepticus and febrile infection-related epilepsy syndrome.Dev Med Child Neurol. 2020; 62: 897-905
- Cannabidiol [package insert].Greenwich Biosciences, Inc, Carlsbad, CA2020 (Available from:)
- Cannabinoids: Therapeutic Use in Clinical Practice.Int J Mol Sci. 2022 Mar 19; 23: 3344
- Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial.Lancet Neurol. 2016; 15: 270-278
- Long-Term Safety, Tolerability, and Efficacy of Cannabidiol in Children with Refractory Epilepsy: Results from an Expanded Access Program in the US.CNS Drugs. 2019; 33: 47-60
- Cannabidiol as a potential treatment for febrile infection-related epilepsy syndrome (Fires) in the acute and chronic phases.J Child Neurol. 2017; 32: 35-40
- High dose cannabidiol (CBD) in the treatment of new-onset refractory status epilepticus (NORSE).Seizure. 2021; 94: 126-128
- Rare homozygous nonsense variant in AIMP1 causing Early Onset Epileptic Encephalopathy with Burst Suppression (EOEE-BS). 2020; 63103970
- Cannabidiol oil in the treatment of super refractory status epilepticus. A case report.Seizure. 2016; 35: 56-58
- Successful use of pure cannabidiol for the treatment of super-refractory status epilepticus.Epilepsy Behav Case Rep. 2018; 10: 141-144
- A spicy status: Synthetic cannabinoid (spice) use and new-onset refractory status epilepticus-A case report and review of the literature.J Neurol. 2017; 264: 2506-2508
Article info
Publication history
Published online: November 12, 2022
Accepted:
November 10,
2022
Received in revised form:
September 21,
2022
Received:
July 5,
2022
Identification
Copyright
© 2022 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.
