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Evidence for cannabis and cannabinoids for epilepsy: a systematic review of controlled and observational evidence

Published on Jul 1, 2018in Journal of Neurology, Neurosurgery, and Psychiatry8.27
· DOI :10.1136/jnnp-2017-317168
Emily Stockings13
Estimated H-index: 13
(UNSW: University of New South Wales),
Dino Zagic3
Estimated H-index: 3
(UNSW: University of New South Wales)
+ 6 AuthorsLouisa Degenhardt89
Estimated H-index: 89
(UNSW: University of New South Wales)
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Abstract
Review evidence for cannabinoids as adjunctive treatments for treatment-resistant epilepsy. Systematic search of Medline, Embase and PsycINFO was conducted in October 2017. Outcomes were: 50%+ seizure reduction, complete seizure freedom; improved quality of life (QoL). Tolerability/safety were assessed by study withdrawals, adverse events (AEs) and serious adverse events (SAEs). Analyses were conducted in Stata V.15.0. 36 studies were identified: 6 randomised controlled trials (RCTs), 30 observational studies. Mean age of participants was 16.1 years (range 0.5–55 years). Cannabidiol (CBD) 20 mg/kg/day was more effective than placebo at reducing seizure frequency by 50%+(relative risk (RR) 1.74, 95% CI 1.24 to 2.43, 2 RCTs, 291 patients, low Grades of Recommendation, Assessment, Development and Evaluation (GRADE) rating). The number needed to treat for one person using CBD to experience 50%+ seizure reduction was 8 (95% CI 6 to 17). CBD was more effective than placebo at achieving complete seizure freedom (RR 6.17, 95% CI 1.50 to 25.32, 3 RCTs, 306 patients, low GRADE rating), and improving QoL (RR 1.73, 95% CI 1.33 to 2.26), however increased risk of AEs (RR 1.24, 95% CI 1.13 to 1.36) and SAEs (RR 2.55, 95% CI 1.48 to 4.38). Pooled across 17 observational studies, 48.5% (95% CI 39.0% to 58.1%) of patients reported 50%+ reductions in seizures; in 14 observational studies 8.5% (95% CI 3.8% to 14.5%) were seizure-free. Twelve observational studies reported improved QoL (55.8%, 95% CI 40.5 to 70.6); 50.6% (95% CI 31.7 to 69.4) AEs and 2.2% (95% CI 0 to 7.9) SAEs. Pharmaceutical-grade CBD as adjuvant treatment in paediatric-onset drug-resistant epilepsy may reduce seizure frequency. Existing RCT evidence is mostly in paediatric samples with rare and severe epilepsy syndromes; RCTs examining other syndromes and cannabinoids are needed. PROSPERO registration number CRD42017055412.
  • References (50)
  • Citations (15)
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References50
Newest
#1Evan C. Rosenberg (NYU: New York University)H-Index: 3
#2Jay Louik (NYU: New York University)H-Index: 3
Last.Daniel Freidman (NYU: New York University)H-Index: 25
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#2Jh Cross (UCL: University College London)H-Index: 45
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#1Jacqueline S. Gofshteyn (Children's Hospital of Philadelphia)H-Index: 4
#2Angus A. Wilfong (Boston Children's Hospital)H-Index: 19
Last.Eric D. Marsh (UPenn: University of Pennsylvania)H-Index: 24
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#1Lauren Treat (Anschutz Medical Campus)H-Index: 1
#2Kevin E. Chapman (Anschutz Medical Campus)H-Index: 18
Last.Kelly G. Knupp (Anschutz Medical Campus)H-Index: 12
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#2Emilio Perucca (UNIPV: University of Pavia)H-Index: 79
#1Ying Yu (UTHSC: University of Tennessee Health Science Center)
#2Davis T. Nguyen (UTHSC: University of Tennessee Health Science Center)
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#1Roy C. Martin (UAB: University of Alabama at Birmingham)H-Index: 43
#2Tyler E. Gaston (UAB: University of Alabama at Birmingham)H-Index: 6
Last.Jerzy P. Szaflarski (UAB: University of Alabama at Birmingham)H-Index: 49
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#1Richard J. Huntsman (U of S: University of Saskatchewan)H-Index: 4
#2Richard Tang-Wai (LLU: Loma Linda University)H-Index: 3
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