Annual Meeting Abstracts: View
(Abst. 1.326), 2014
PARENTAL REPORTING OF RESPONSE TO ORAL CANNABIS EXTRACTS AS ADJUNCTIVE TREATMENT FOR MEDICALLY REFRACTORY EPILEPSY
Authors: Craig Press, Kelly Knupp and Kevin Chapman
Content: Rationale: Oral cannabis extracts (OCE) are emerging treatment options recently available for legal use in Colorado (CO). Although there are anecdotal reports suggesting potential benefit, no definitive studies demonstrate clear efficacy for the use of OCE or its derivatives for epilepsy. There is also evidence that chronic marijuana use leads to a decline in cognitive function that may not be reversible. After recent media and news exposure, CO has seen a dramatic rise in the interest in using OCE for pediatric epilepsy. The experience of a large group of pediatric epilepsy patients given OCE and followed in a single tertiary epilepsy center is reported. Methods: A retrospective chart review of patients with epilepsy who were treated with OCE at Children's Hospital Colorado was performed. Data was analyzed with descriptive statistics, χ2 or Fisher's exact test. Results: Fifty-eight patients were identified. 28 were male (48.3%), 23 had moved to CO to obtain OCE (39.7%). The average age was 7 years (6 months to 23 years) when starting OCE. Of the 58 patients, 28 (48.3%) reported any improvement in seizures and 18 (31.0%) reported a >50% reduction in seizures and were considered treatment responders. If the family had moved to CO for OCE this increased the responder rate to 52% vs. 17% if the family had established care in CO (p<0.01). Treatment responder rate varied, though not achieving statistical significance, based on epilepsy syndrome: Dravet 27%, Doose 0%, LGS 80% and other 30% (Table 1). Of the 16 patients with an electroencephalogram (EEG) prior to and during OCE treatment, only 2 (12.5%) had an improvement in their interictal EEG background. None of the 4 responders with EEG data had any improvement in their interictal EEG. When comparing various reported strains of OCE (i.e. Cannabidiol, Tetrahydrocannabinol) there was no difference in response rate. Many of the families reported benefits outside of seizure frequency including improved behavior/alertness (29%) and improved language (i.e. now using three words) (10%). Adverse events (AEs) occurred in 47% of patients with increased seizures (transient or persistent) or new seizures in 21% with somnolence/fatigue in 14% and rare adverse events of developmental regression (2), new choreiform movements (2), transient hemiparesis (1), status requiring intubation (1), and death (1). Conclusions: In this retrospective cohort, less than 1/3 of patients had a >50% reduction in seizure frequency in response to OCE by parental report, and these responses were not associated with a change in interictal EEG. Notably, families who moved to CO for OCE were 3 times as likely to report a >50% seizure reduction than families with established care in CO. Additionally, many of the families reported improvements in behavior, level of alertness, and language. AEs were generally mild; however, rare severe AEs did occur. These findings highlight the need for controlled studies to evaluate the efficacy and safety of OCE for treatment of pediatric epilepsies.