Cannabidiol in Adults With Lennox-Gastaut Syndrome: Real-World Experience

We report a single centre experience of cannabidiol use as adjunctive treatment in adults with Lennox-Gastaut Syndrome (LGS).

Retrospective review of adults with LGS treated with cannabidiol with clinical data collected from electronic records and caregiver standardised seizure diaries with seizure-related outcomes assessed at baseline, 6 months, and last follow-up.

Seventy-nine adults (median age 29 years; 40 male) were included. Median follow-up was 41 months. Four patients died unrelated to cannabidiol treatment. Sixty-seven (86%) remained on treatment at last follow-up. Across all seizure types, 59.5% achieved ≥ 50% reduction at 6 months and 67.1% at last follow-up. Among those with 'Drop Seizures' (n = 78), 50% achieved > 50% reduction at 6 months and 61.5% at last follow-up. 'Drop Seizure' responder rates were numerically higher with clobazam > 5 mg/day, but with no statistically significant dose-response relationship seen. Seizure-free days increased (baseline 5.7/month; last follow-up 12.5/month). Seizure-related hospital admissions and injuries declined. Cognitive or behavioural improvements were reported in 48 patients (60.8%); there was no statistically significant association with achieving ≥ 50% seizure reduction. Drowsiness (n = 33) was the most frequent adverse event often related to drug-drug interactions. Diarrhoea (n = 24) was more common than previously reported. Side-effects necessitated ASM adjustments in 51 patients. Fourteen were able to withdraw one or more ASMs.

CBD was associated with sustained effectiveness and good tolerability in adults with LGS, with high retention and improvement in seizure and other clinically meaningful outcomes. Adverse effects, mainly interaction-related, were usually managed with concomitant medication adjustments.