Gloss David, Vickrey Barbara
Neurology MC14-05, 100 N Academy Ave, Geisinger Medical Center, Danville, USA, PA 17821.
Cochrane Database Syst Rev. 2014 Mar 5;2014(3):CD009270. doi: 10.1002/14651858.CD009270.pub3.
Marijuana appears to have anti-epileptic effects in animals. It is not currently known if it is effective in patients with epilepsy. Some states in the United States of America have explicitly approved its use for epilepsy.
To assess the efficacy and safety of cannabinoids when used as monotherapy or add-on treatment for people with epilepsy.
We searched the Cochrane Epilepsy Group Specialized Register (9 September 2013), Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (2013, Issue 8), MEDLINE (Ovid) (9 September 2013), ISI Web of Knowledge (9 September 2013), CINAHL (EBSCOhost) (9 September 2013), and ClinicalTrials.gov (9 September 2013). In addition, we included studies we personally knew about that were not found by the searches, as well as searched the references in the identified studies.
Randomized controlled trials (RCTs) whether blinded or not.
Two authors independently selected trials for inclusion and extracted the data. The primary outcome investigated was seizure freedom at one year or more, or three times the longest interseizure interval. Secondary outcomes included responder rate at six months or more, objective quality of life data, and adverse events.
We found four randomized trial reports that included a total of 48 patients, each of which used cannabidiol as the treatment agent. One report was an abstract and another was a letter to the editor. Anti-epileptic drugs were continued in all studies. Details of randomisation were not included in any study report. There was no investigation of whether the control and treatment participant groups were the same or different. All the reports were low quality.The four reports only answered the secondary outcome about adverse effects. None of the patients in the treatment groups suffered adverse effects.
AUTHORS' CONCLUSIONS: No reliable conclusions can be drawn at present regarding the efficacy of cannabinoids as a treatment for epilepsy. The dose of 200 to 300 mg daily of cannabidiol was safely administered to small numbers of patients generally for short periods of time, and so the safety of long term cannabidiol treatment cannot be reliably assessed.
大麻在动物身上似乎具有抗癫痫作用。目前尚不清楚其对癫痫患者是否有效。美利坚合众国的一些州已明确批准将其用于癫痫治疗。
评估大麻素作为单一疗法或辅助治疗用于癫痫患者的疗效和安全性。
我们检索了Cochrane癫痫专业组专门注册库（2013年9月9日）、Cochrane图书馆中的Cochrane对照试验中心注册库（CENTRAL）（2013年第8期）、MEDLINE（Ovid）（2013年9月9日）、ISI Web of Knowledge（2013年9月9日）、CINAHL（EBSCOhost）（2013年9月9日）以及ClinicalTrials.gov（2013年9月9日）。此外，我们纳入了我们个人知晓但检索未找到的研究，并检索了已识别研究中的参考文献。
随机对照试验（RCT），无论是否设盲。
两位作者独立选择纳入试验并提取数据。所研究的主要结局是一年或更长时间无癫痫发作，或最长发作间期的三倍。次要结局包括六个月或更长时间的缓解率、客观生活质量数据以及不良事件。
我们找到4份随机试验报告，共纳入48例患者，每份报告均使用大麻二酚作为治疗药物。一份报告是摘要，另一份是给编辑的信。所有研究中均继续使用抗癫痫药物。任何研究报告均未包含随机化细节。未调查对照组和治疗组参与者是否相同或不同。所有报告质量均较低。这4份报告仅回答了关于不良事件的次要结局。治疗组中无一例患者出现不良反应。
目前关于大麻素治疗癫痫的疗效无法得出可靠结论。每日200至300毫克的大麻二酚剂量通常在短时间内安全用于少数患者，因此无法可靠评估长期使用大麻二酚治疗的安全性。
