Chen Frank Yizhao, Duckman Joshua Myles, Rabinovitch Brenden Samuel, Hannesson Katrin Julia, Lewis Evan Cole
North Toronto Neurology, Toronto, ON, Canada.
Department of Research, JMCC Group, Toronto, ON, Canada.
Front Neurosci. 2025 May 19;19:1570531. doi: 10.3389/fnins.2025.1570531. eCollection 2025.
Seizure freedom (SF) is the primary goal of epilepsy treatment. More treatments that produce SF in drug-resistant epilepsy (DRE) are needed. Cannabis-based products for medicinal use (CBPMs) containing cannabidiol (CBD) and Δ9-tetrahydrocannabinol (THC), administered as oils, have been shown to induce SF in DRE. However, there remains a paucity of published real-world evidence in both pediatrics and adults on SF resulting from CBPM therapy.
This is a retrospective case series at an outpatient neurology clinic in Toronto, Canada, on patients with DRE who experienced significant SF during CBPM treatment. All patients were treated via the clinic's stepwise treatment protocol with CBPM oils only. The study describes clinical features of patients and their CBPM-related SF.
We report 19 DRE cases that experienced SF; 15 pediatric, 4 adults. The median cumulative SF duration was 245 days, split between continuous SF periods lasting at least 90 days. Five patients had continuous SF periods lasting ≥ 1 year. Most patients used CBD+THC regimens. Three patients weaned all concomitant ASMs. Adverse events (AEs) were reported by half of the patients.
The results of the study support prioritizing CBPMs in cases of DRE. It also supports research into identifying clinical and biological biomarkers for DRE cases that may achieve SF under CBPM treatment. Lastly, the study supports improving the accessibility of CBPMs, using SF as a primary outcome in future CBPM epilepsy trials, and assessing the role of THC in reducing seizures.
癫痫发作缓解（SF）是癫痫治疗的主要目标。需要更多能使药物难治性癫痫（DRE）实现发作缓解的治疗方法。含大麻二酚（CBD）和Δ9-四氢大麻酚（THC）的药用大麻产品（CBPMs）以油剂形式给药，已被证明可使药物难治性癫痫实现发作缓解。然而，关于CBPM治疗在儿科和成人中实现发作缓解的真实世界证据仍然匮乏。
这是一项在加拿大多伦多一家门诊神经科诊所进行的回顾性病例系列研究，研究对象为在CBPM治疗期间实现显著发作缓解的药物难治性癫痫患者。所有患者均仅通过该诊所的逐步治疗方案接受CBPM油剂治疗。该研究描述了患者的临床特征及其与CBPM相关的发作缓解情况。
我们报告了19例实现发作缓解的药物难治性癫痫病例；15例儿科患者，4例成人患者。发作缓解的中位累积持续时间为245天，分布在持续至少90天的连续发作缓解期之间。5例患者的连续发作缓解期持续≥1年。大多数患者使用CBD+THC方案。3例患者停用了所有伴随的抗癫痫药物（ASMs）。一半的患者报告了不良事件（AEs）。
该研究结果支持在药物难治性癫痫病例中优先使用CBPMs。它还支持开展研究，以确定可能在CBPM治疗下实现发作缓解的药物难治性癫痫病例的临床和生物学生物标志物。最后，该研究支持提高CBPMs的可及性，在未来的CBPM癫痫试验中将发作缓解作为主要结局，并评估THC在减少癫痫发作中的作用。
