Abstracts

Rationale: Efficacy of cannabidiol (CBD)(Epidiolex) in patients with Lennox-Gastaut syndrome and Dravet syndrome has been demonstrated. Data about efficacy in other seizure types is scant. We evaluate the seizure response in 6 children with predominantly refractory absence seizures being treated under the FDA and CNMC IRB approved protocol “Pilot Trial of Cannabidiol in Children with Intractable Epilepsy”. Methods: All children were treated with adjunctive open label CBD having failed at least 4 commercially available seizure medications (AED) and having been on stable seizure medications for at least 30 days.  Each child had a 4 hour video EEG pre-treatment. The rate of drug introduction was standardized. The target dose of CBD was 25 mg./kg/day.  Safety labs and EKG were monitored pre and during treatment. Serum levels of cannabidiol and concomitant AED were monitored at each visit. Seizure calendars were recorded by caregiver. Absence seizures were scored as: “none; 1-5/day; 6-10/day; 11-20/day; >20/day” with the obvious knowledge that many absence seizures are not seen. Other seizure types (drop seizures, myoclonic seizures, tonic seizures, focal seizures) were recorded daily. Results: The predominant disabling seizure in all subjects was absence seizures. All children had an EEG signature of 3-4 cps anterior dominant spike wave associated with the clinical seizure of interest. All children had refractory absence seizures: 1 with absence seizures only; 1 with absence and eyelid myoclonia; 1 with absence seizures, myoclonic and drop seizures; 3 with myoclonic-absence seizures. The mean age of subjects: 10.9 years (range 6.6-16.25 years). Duration of follow-up:  mean 4.6 months (range 1.7-7.5 months). Change in absence seizures: (6 subjects) 3 had >90% reduction; 2>50% reduction; 1: no change. Myoclonic seizures: (n=3):  2 > 90% reduction, 1: no change. Drop seizures: n=1, >90% reduction. Tonic seizures: the child with tonic seizures reduced from 3/day to none. The child with absence seizures and eyelid myoclonia had complete resolution of absence seizures and no change in eyelid myoclonia. Conclusions: Cannabidiol (Epidiolex) appears to have benefited these subjects. Limitations of this report are the short time of follow-up, and the fact that although each child had disabling absence seizures with similar EEG’s, they had different types of epilepsies. A larger study of Epidiolex in absence seizures with longer follow up is necessary. Funding: No funding was received in support of this abstract. Epidiolex was obtained from GW Pharmaceuticals. However GW Pharmaceuticals did not fund or support the study.