Real-world data on cannabidiol treatment of various epilepsy subtypes: A retrospective, multicenter study

OBJECTIVE

Cannabidiol (CBD) is approved for treatment of Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and tuberous sclerosis complex (TSC). Several studies suggest antiseizure effects also beyond these three epilepsy syndromes.

METHODS

In a retrospective multicenter study, we analyzed the efficacy and tolerability of CBD in patients with epilepsy at 16 epilepsy centers.

RESULTS

The study cohort comprised 311 patients with epilepsy with a median age of 11.3 (0-72) years (235 children and adolescents, 76 adults). Therapy with CBD was off-label in 91.3% of cases due to age, epilepsy subtype, lack of adjunct therapy with clobazam, and/or higher dose applied. CBD titration regimens were slower than recommended, with good tolerability of higher doses particularly in children. Of all patients, 36.9% experienced a reduction in seizure frequency of >50%, independent of their epilepsy subtype or clobazam co-medication. The median observation period was 15.8 months. About one third of all patients discontinued therapy within the observation period due to adverse effects or lack of efficacy. Adverse effects were reported frequently (46.9%).

SIGNIFICANCE

Our study highlights that CBD has an antiseizure effect comparable to other antiseizure medications with a positive safety profile independent of the epilepsy subtype. Comedication with clobazam was not associated with a better outcome. Higher doses to achieve seizure frequency reduction were safe, particularly in children. These findings call for further trials for an extended approval of CBD for other epilepsy subtypes and for children <2 years of age.

T- and B-areas in immune reactions. Volume changes in T and B cell compartments of the rat spleen following intravenous administration of a thymus-dependent (SRBC) and a thymus-independent (paratyphoid vaccin-endotoxin) antigen. A histometric study

In the white pulp of rat spleens cell numbers were studied in the different compartments following intravenous administration of comparable doses of paratyphoid vaccine (PTV, thymus-independent) and sheep red blood cells (SRBC, thymus-dependent). In the periarteriolar lymphatic sheaths (PALS) both cell concentration and volume were measured. For the follicles and the marginal zone only volume was recorded in the first 5 days following antigen administration. Additionally, histologic observations were made. In the thymus-dependent area PTV caused oedema 12-24 hours after administration. Following SRBC administration an increase in lymphocyte numbers occurred until the second day, probably representing an influx of T cells from the recirculating pool. Both antigens gave rise to a plasmacellular reaction in the peripheral PALS (2nd-4th day). In the bone marrow-dependent areas a massive shift of medium-sized lymphocytes from the marginal zone to the follicles took place in the first 24 hours following PTV administration. These cells subsequently transformed into blasts. After SRBC (6 and 12 hours) only a few marginal zone lymphocytes seemed to migrate into the follicles. It is aruged that the endotoxin present in PTV is responsible for the fact that, following administration of the antigen, all marginal zone (B) cells responded. Endotoxin stimulation might provide a model for the fate of marginal zone cells stimulated by other agents, such as antigen (stimulating antigen binding B cells) or antigen-antibody complexes (stimulating Fc-receptor B cells).