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A case series of children with treatment resistant epilepsy from the UK Medical Cannabis Registry has been analysed and published in Neuropediatrics in January 2023, providing evidence of the efficacy and safety of cannabis-based medicinal products in the treatment of treatment resistant epilepsy.

This was an observational study including 35 children who on average had tried 7 anti-seizure medications and were experiencing an average of 120 seizures a month prior to starting medical cannabis. Within this sample at the point of analysis, 4 children were being administered CBD isolate therapy, 14 were receiving broad spectrum CBD therapy and 17 were receiving medical cannabis products containing low concentrations of THC in addition to CBD. The results from this study demonstrated that across the whole sample, 23 children experienced a more than 50% reduction in seizure frequency, 13 children experienced a more than 90% reduction in seizure frequency and 4 children no longer experienced seizures following the initiation of medical cannabis.

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Looking specifically at the 17 children who received THC and CBD medication, 16 (94.1%) experienced more than a 50% seizure reduction, this was a statistically significant reduction compared to CBD isolate therapy and broad spectrum CBD therapy. Additionally, 9 (52.9%) experienced a more than 90% seizure reduction and 3 (17.6%) were in remission and not experiencing any seizures.

Across the 35 children included within this sample, 16 children experienced one or more adverse events from the medical cannabis. In total, they experienced 26 adverse events with the most common adverse event being reported as fatigue. Within this, 22 of the reported adverse events were mild or moderate. This demonstrates that cannabis based medicinal products can be well tolerated with few serious side effects.

At present, there are no randomised controlled trials of the combined use of THC and CBD in treatment resistant epilepsy. However, an observational study based in Colorado found improvement in seizure frequency when using a broad spectrum of cannabis based medical products. Additionally, an Israeli case series also demonstrated a significant reduction in seizure frequency in children treated with CBD and THC medicinal cannabis products. The recently published case series discussed here adds to a growing body of evidence that provides positive evidence to support the use of medical cannabis in treatment resistant epilepsy.

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