Medical cannabis for epilepsy

For three severe epilepsy syndromes, Dravet syndrome, Lennox-Gastaut syndrome and tuberous sclerosis, highly purified cannabidiol is approved as a finished medicine (Epidyolex) for add-on therapy, and its efficacy has been shown in high-quality comparative studies. Real-world data document average reductions in seizure frequency over six and twelve months. For other forms of epilepsy, cannabis may be an option as a complement in individual cases; the evidence here is weaker and use is outside the approved indication (off-label).

For the approved indications, Epidyolex (highly purified cannabidiol) is the medicine of choice. For off-label use, CBD-dominant medications also come first, because they are not psychoactive and are easy to adjust. THC-containing medications are used with great restraint in epilepsy and are only an option in individual cases, for example with accompanying muscle stiffness or certain types of pain. The choice is made individually in the initial consultation and in coordination with your neurologist.

There is no general strain recommendation for epilepsy. Therapy is dominated by CBD: for the approved indications, Epidyolex, a highly purified finished cannabidiol medicine, is the medicine of choice. For off-label use, CBD-dominant medications also come first. Which specific medication may be considered in the individual case is decided by the treating doctor in coordination with your neurologist.

With CBD-containing medications an initial response can usually be assessed after a few days to two weeks, and full adjustment generally takes four to six weeks. With Epidyolex the dose is increased gradually according to the summary of product characteristics. At the follow-up appointment after two to four weeks, the dose is adjusted on the basis of the seizure diary and laboratory values.

The dosage of CBD in epilepsy is adjusted individually by a doctor. Treatment starts following the principle of start low, go slow: begin with low doses and increase the amount step by step. With Epidyolex the dose is increased gradually according to the summary of product characteristics. Adjustments are guided by the seizure diary, laboratory values and individual tolerability. Specific doses cannot be given in general terms, as they depend on the individual case.

Cannabidiol can interact with several anti-seizure medicines. Particularly relevant are clobazam, whose effect can be intensified, and valproate, with which liver values can rise. Other anti-seizure medicines can also interact via the same metabolic pathway in the body. That is why treatment starts at a low dose, laboratory values are checked regularly and therapy is adjusted if needed.

For the approved indications, Dravet syndrome, Lennox-Gastaut syndrome and tuberous sclerosis, cost coverage by German statutory health insurance is the rule. For off-label use, the application is assessed case by case by the Medical Service of the health insurers. In the initial consultation we offer an assessment of the chances of success and support with the necessary documents.

In epilepsy, besides the question of cannabis, there is the question of fitness to drive with regard to seizures. Each type of seizure has its own waiting periods after a seizure. Anyone whose reaction time is additionally impaired by cannabis therapy must not take part in road traffic. Especially at the start of therapy and after dose adjustments, reaction time is often reduced. Recommendation: do not drive yourself during the first days of adjustment and, if in doubt, ask your neurologist.