Cannabis Use in Epilepsy Management

Introduction to Cannabis-Based Therapies

The American Academy of Neurology recommends pharmaceutical-grade CBD (Epidiolex) for the treatment of specific rare epilepsy syndromes, including Dravet Syndrome, Lennox-Gastaut Syndrome, and tuberous sclerosis complex-associated seizures, due to its proven efficacy in controlled trials 1

The FDA has approved Epidiolex (pharmaceutical-grade CBD) for the treatment of Dravet Syndrome, Lennox-Gastaut Syndrome, and tuberous sclerosis complex-associated seizures, with a typical dosing of 5-25 mg/kg/day administered twice daily 1
The use of Epidiolex is associated with dose-related, reversible transaminase elevations in approximately 13% of patients, typically within the first 2 months, highlighting the need for liver function monitoring 2

The use of whole-plant cannabis can paradoxically contribute to and reduce seizures, and its use is not recommended due to the lack of standardization, quality control, and rigorous efficacy data 4
CBD can significantly interact with multiple antiepileptic drugs through CYP450 inhibition, requiring dose adjustments of other medications, particularly clobazam and valproate 2
Liver enzyme monitoring is essential when using CBD, as meta-analysis showed a 6-fold increase in liver enzyme elevation with CBD use, and the risk increases with concomitant valproate 2

The American Epilepsy Society recommends that cannabinoids should only be considered after failure of standard therapies and only in FDA-approved indications, and that patients should be closely monitored for adverse effects and drug interactions 5
The Intensive Care Medicine society recommends that seizures in other contexts, such as post-cardiac arrest, should be treated with standard antiepileptic drugs, and not cannabis products 6

Pregnant and breastfeeding individuals must avoid all cannabis products due to fetal neurodevelopmental risks and increased premature birth risk, as recommended by the American College of Obstetricians and Gynecologists 1, 3
Adolescents face elevated risks associated with cannabis use, including neurodevelopmental decline, psychotic disorders, depression, and suicidal ideation, and its use is not recommended in this population 1, 3