For some children with epilepsy, seizures cannot be adequately controlled despite several anti-epileptic drugs. This so-called drug-resistant epilepsy is a great burden for the whole family.
In recent years, CBD has moved into the focus of epilepsy research, especially in the form of the prescription medicine Epidiolex. But what exactly is known, and how does this differ from freely available CBD oils?
Epilepsy in childhood
Epilepsy is a collective term for various disorders in which recurrent epileptic seizures occur. In childhood, rare genetic epilepsy syndromes are also seen, such as Dravet syndrome or Lennox–Gastaut syndrome.
The aim of treatment is to reduce the frequency and severity of seizures and to support development as well as possible. Standard therapy uses antiepileptic drugs; in some cases, diets or surgical procedures are also used.
How CBD acts in epilepsy
CBD acts on different signalling pathways in the brain that are involved in neuronal excitability and inflammation. These include:
- Modulation of endocannabinoid receptors,
- influence on calcium and sodium channels,
- anti-inflammatory and neuroprotective effects.
Through this complex interaction, CBD can reduce the tendency to seizures in some patients.
Epidiolex: the approved CBD drug
Epidiolex is a purified CBD solution that has been approved in the EU and many other countries for two severe childhood epilepsies: Dravet syndrome and Lennox–Gastaut syndrome.
In several large clinical trials, Epidiolex, in combination with existing antiepileptic drugs, led to a significant reduction in seizure frequency compared with placebo. Some children experienced more than a 50% reduction in seizures.
At the same time, side effects such as fatigue, diarrhoea and elevated liver enzymes were observed more frequently. Regular medical monitoring is therefore essential.
Freely available CBD oils vs. medicinal products
Non-prescription CBD oils differ from Epidiolex in several key respects:
- They are not approved as medicines and are not subject to the same strict quality controls.
- The exact CBD content and purity can vary and are not always reliably declared.
- They are usually taken in lower doses than those used in studies on epilepsy.
For children with severe epilepsy, self-treatment with over-the-counter CBD products is therefore strongly discouraged. Therapy should always be carried out within a specialist medical setting.
Interactions and safety aspects
CBD can interact with various antiepileptic drugs via liver metabolism, for example valproic acid or clobazam. This may alter drug levels and side-effect profiles.
Possible side effects of CBD in epilepsy treatment include:
- Fatigue and drowsiness
- Loss of appetite and weight loss
- Gastrointestinal complaints
- Elevated liver enzymes
Therefore, children who receive CBD for epilepsy should be closely monitored, and blood tests should be performed regularly.
Conclusion: Important option, but only under specialist supervision
CBD, in the form of the approved medicinal product Epidiolex, represents an important therapeutic option for certain severe childhood epilepsies. For some affected children, seizure frequency can be significantly reduced.
At the same time, CBD is not a miracle cure and is associated with possible side effects and interactions. Over-the-counter CBD oils are not a substitute for medically supervised therapy.
Parents who are considering CBD for their child’s epilepsy should always do so together with a paediatric neurologist and on the basis of current treatment guidelines.
References
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