Abstracts

Rationale: Epilepsy is prevalent in about 1% of US population. Out of that, 30% will develop refractory epilepsy. While certain interventions such as surgery, neurostimulation and some diets can help some patients remain intractable. Cannabidiol (CBD) is considered a possible treatment option, and is now approved for compassionate use in Florida (Compassionate Medical Cannabis Act of 2014). The aim of our study is to evaluate the experience of our patients with its use, efficacy and adverse events. Methods: A chart review was performed on patients who started CBD under our supervision. We identified 10 patients. Data included age, duration of epilepsy, anti-epileptic medications used, non-pharmacologic treatment including surgery, VNS and various diets. We also included the source of the CBD, CBD:THC ratio, and cost, since the sources varied. We focused on efficacy and adverse events collected via chart review and phone interview. Efficacy was evaluated by asking patients or their caregivers to quantify decrease in seizure frequency or change in seizure severity. Results: Average age was 22.4 year old (range: 10-46) with an average of 13.5 years (range: 3-23) of medically refractory epilepsy prior to starting CBD. There were 7 males and 3 females. One of our patients was diagnosed with Dravet syndrome. All patients continued their current anti-epileptic drugs with the initiation of CBD. All had tried at least 1 other AED in addition to their current regimen. Eight patients had tried non-pharmacologic treatments prior to CBD initiation. The most common CBD purchased was Charlotte's Web; one patient was also taking CBD tablets that were purchased from outside the country. The average monthly cost was $512.50 (range: $35-1,250). 30% of patients saw less than 25% improvement, 20 % saw 25-50% improvement and 10% saw 50-75% improvement in seizure frequency and severity. 30% of patients did not note significant change. 1 patient's seizure frequency worsened significantly with the addition of CBD which was later discontinued; this represents 10% of patients. Only 2 patients reported side effects that included dizziness, insomnia and changes in mood. Conclusions: In patients with medically refractory epilepsy, CBD may be useful adjunctive treatment option. While we did not see seizure freedom in any of our patients, 60% had reduction in seizure frequency or intensity. For our group of non-responders, 2 of the patients were using CBD only. It is unclear if the THC component is necessary for efficacy of this agent. In addition, there were several patients that initially had some benefit that for unknown reasons stopped responding or had decreased benefit. Several patients could not afford to further titrate to higher dose due to financial restraints. As CBD becomes more readily available at a lower price point, this area of research will become important in management for refractory epilepsy patient and needs to be further explored. Funding: none