Early research shows whole-plant cannabis is linked to a significant reduction in seizures in children with severe treatment-resistant epilepsy.
In a small series of cases, children with severe treatment-resistant epilepsy treated with a range of cannabis-based medicinal products (CBMP) made from whole plant extracts reported an 86% reduction in monthly seizures.
All participants had no improvement with traditional antiepileptic drugs (AEDs).
The study adds to a small but growing body of research looking at whole herbal cannabis medicines containing tetrahydrocannabinol (THC) in pediatric epilepsies.
“Although we have already noted the superior efficacy of whole herbal medical cannabis in a previous group of children, it is remarkable that the treatment effect resulted in an average 86% reduction in seizures. epilepsy and demonstrates the obvious clinical value of this product. intervention, “said lead author Rayyan Raja Zafar, a doctoral candidate at the Center for Psychedelic Research and Neuropsychopharmacology at Imperial College London, UK. Medscape Medical News.
The results were published online Dec. 14 in BMJ Paediatrics Open.
Superior to CBD?
The retrospective case series included 10 children under the age of 18 who were recruited by MedCann Support and End Our Pain, charities that represent children who use medical cannabis to treat incurable epilepsies. The data was collected from the parents or caregivers of the patients between January and May 2021.
Patients had a range of epilepsy etiologies and reported a mean of 7 (± 4.58) AED before the onset of CBMP. Two patients showed no improvement in their symptoms after taking Epidyolex, a purified cannabidiol (CBD) approved by the European Commission in 2019 for the treatment of rare forms of epilepsy. The formulation was approved by the United States Food and Drug Administration in 2018 as Epidiolex.
All participants received CBMPs including Bedrolite (
Patients consumed an average of 5.15 (± 6.8) mg of THC per day and an average of 171.8 (± 153.3) mg of CBD per day.
All patients reported fewer seizures, ranging from a decrease in monthly seizure activity from 62.5% to 100%. The average drop was 86%.
“It appears that whole plant cannabis is superior to CBD alone, and the reasons are speculative,” Zafar said.
“We know that THC has independent antiepileptic activity; however, much less is known about the role that other cannabinoids and minor terpenes play in the cannabis plant, ”Zafar added.
“There have been preclinical tests to suggest that they also have anti-epileptic activity, and therefore the combined effects of the whole plant products appear to work better than a single isolate.”
Commenting on the findings of Medscape Medical News, Tyler Allison, MD, associate professor of pediatrics at Children’s Mercy Kansas City, Missouri, noted that researchers chose patients based on their long-standing use of whole herbal medicinal cannabis oils, introducing a bias in selection.
“The answer is always interesting, and I think it needs to be investigated further with better parameters in place to reduce bias, but I don’t think it is fair to assess the magnitude of the decrease in seizure frequency when the study population consisted only of patients who responded to treatment, ”said Allison, who was not involved in the research.
“How many patients have tried whole plant cannabis oil and found it not to be effective or at least more effective than their other anti-epileptic drugs?” ” He asked. “This information is missing and could have a significant impact on the importance of the study.”
Selection bias and the small study group also make it difficult to compare the results with previous studies of isolated CBD involving larger patient populations, Allison added.
An intention-to-treat randomized study comparing a control group treated with one form of isolated CBD product and a second group given whole plant cannabis oils would eliminate this bias, he noted. “Then they could analyze seizure frequency the same way they did and compare between groups to see if whole plant cannabis oil shows a reduction in seizure frequency compared to a drug. similar, ”he said.
It’s a design that Zafar noted that he and his colleagues are interested in pursuing.
“We are starting research to better understand the role of cannabinoids and minor terpenes in the treatment of this disease because we want to better understand why we are seeing a superior clinical effect in whole herbal medicines,” he said. declared.
He added that they also plan to partner with academic and business collaborators for additional retrospective and forward-looking studies on these issues.
The study was not funded. Zafar did not report any relevant financial relationships. Disclosures for other authors are listed in the original article. Allison does not report any relevant conflict of interest.
BMJ Paediatr Open. Published online December 14, 2021. Full text
For more information on Medscape Neurology, join us on Facebook and Twitter.