Journal article
Evidence for cannabis and cannabinoids for epilepsy: A systematic review of controlled and observational evidence
Journal of Neurology, Neurosurgery and Psychiatry, Vol.89, pp.741-753
2018
PMID: 29511052
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.
Details
- Title
- Evidence for cannabis and cannabinoids for epilepsy: A systematic review of controlled and observational evidence
- Authors
- Emily Stockings (Author) - UNSW AustraliaDino Zagic (Author) - UNSW AustraliaGabrielle Campbell (Author) - UNSW AustraliaMegan Weier (Author) - UNSW AustraliaWayne D Hall (Author) - University of QueenslandSuzanne Nielsen (Author) - UNSW AustraliaGeoffrey K Herkes (Author) - Royal North Shore HospitalMichael Farrell (Author) - UNSW AustraliaLouisa Degenhardt (Author) - UNSW Australia
- Publication details
- Journal of Neurology, Neurosurgery and Psychiatry, Vol.89, pp.741-753
- Publisher
- B M J Group
- DOI
- 10.1136/jnnp-2017-317168
- ISSN
- 1468-330X
- PMID
- 29511052
- Organisation Unit
- School of Health and Behavioural Sciences - Legacy; University of the Sunshine Coast, Queensland; School of Health and Sport Sciences - Legacy
- Language
- English
- Record Identifier
- 99472500702621
- Output Type
- Journal article
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- Domestic collaboration
- International collaboration
- Web Of Science research areas
- Clinical Neurology
- Psychiatry
- Surgery
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Source: InCites