PMID- 29511052
OWN - NLM
STAT- MEDLINE
DCOM- 20191004
LR  - 20191007
IS  - 1468-330X (Electronic)
IS  - 0022-3050 (Linking)
VI  - 89
IP  - 7
DP  - 2018 Jul
TI  - Evidence for cannabis and cannabinoids for epilepsy: a systematic review of 
      controlled and observational evidence.
PG  - 741-753
LID - 10.1136/jnnp-2017-317168 [doi]
AB  - Review evidence for cannabinoids as adjunctive treatments for treatment-resistant 
      epilepsy. Systematic search of Medline, Embase and PsycINFO was conducted in 
      October 2017. Outcomes were: 50%+ seizure reduction, complete seizure freedom; 
      improved quality of life (QoL). Tolerability/safety were assessed by study 
      withdrawals, adverse events (AEs) and serious adverse events (SAEs). Analyses 
      were conducted in Stata V.15.0. 36 studies were identified: 6 randomised 
      controlled trials (RCTs), 30 observational studies. Mean age of participants was 
      16.1 years (range 0.5-55 years). Cannabidiol (CBD) 20 mg/kg/day was more 
      effective than placebo at reducing seizure frequency by 50%+(relative risk (RR) 
      1.74, 95% CI 1.24 to 2.43, 2 RCTs, 291 patients, low Grades of Recommendation, 
      Assessment, Development and Evaluation (GRADE) rating). The number needed to 
      treat for one person using CBD to experience 50%+ seizure reduction was 8 (95% CI 
      6 to 17). CBD was more effective than placebo at achieving complete seizure 
      freedom (RR 6.17, 95% CI 1.50 to 25.32, 3 RCTs, 306 patients, low GRADE rating), 
      and improving QoL (RR 1.73, 95% CI 1.33 to 2.26), however increased risk of AEs 
      (RR 1.24, 95% CI 1.13 to 1.36) and SAEs (RR 2.55, 95% CI 1.48 to 4.38). Pooled 
      across 17 observational studies, 48.5% (95% CI 39.0% to 58.1%) of patients 
      reported 50%+ reductions in seizures; in 14 observational studies 8.5% (95% CI 
      3.8% to 14.5%) were seizure-free. Twelve observational studies reported improved 
      QoL (55.8%, 95% CI 40.5 to 70.6); 50.6% (95% CI 31.7 to 69.4) AEs and 2.2% 
      (95% CI 0 to 7.9) SAEs. Pharmaceutical-grade CBD as adjuvant treatment in 
      paediatric-onset drug-resistant epilepsy may reduce seizure frequency. Existing 
      RCT evidence is mostly in paediatric samples with rare and severe epilepsy 
      syndromes; RCTs examining other syndromes and cannabinoids are needed. PROSPERO 
      REGISTRATION NUMBER: CRD42017055412.
CI  - (c) Article author(s) (or their employer(s) unless otherwise stated in the text of 
      the article) 2018. All rights reserved. No commercial use is permitted unless 
      otherwise expressly granted.
FAU - Stockings, Emily
AU  - Stockings E
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
FAU - Zagic, Dino
AU  - Zagic D
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
FAU - Campbell, Gabrielle
AU  - Campbell G
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
FAU - Weier, Megan
AU  - Weier M
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
FAU - Hall, Wayne D
AU  - Hall WD
AD  - Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, 
      Queensland, Australia.
AD  - National Addiction Centre, Kings College London, London, England.
FAU - Nielsen, Suzanne
AU  - Nielsen S
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
FAU - Herkes, Geoffrey K
AU  - Herkes GK
AD  - Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, 
      Australia.
FAU - Farrell, Michael
AU  - Farrell M
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
FAU - Degenhardt, Louisa
AU  - Degenhardt L
AD  - National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, New South Wales, 
      Australia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20180306
PL  - England
TA  - J Neurol Neurosurg Psychiatry
JT  - Journal of neurology, neurosurgery, and psychiatry
JID - 2985191R
RN  - 0 (Cannabinoids)
RN  - 0 (Medical Marijuana)
SB  - IM
MH  - Cannabinoids/*therapeutic use
MH  - *Cannabis
MH  - Epilepsy/*drug therapy
MH  - Humans
MH  - Medical Marijuana/*therapeutic use
OTO - NOTNLM
OT  - cannabidiol
OT  - cannabinoids
OT  - cannabis
OT  - dravet syndrome
OT  - epilepsy
OT  - lennox-gastaut syndrome
OT  - seizures
COIS- Competing interests: SN, MF and LD have all been investigators on untied 
      investigator-driven educational grants funded by Reckitt Benckiser. MF and LD 
      have received an untied educational grant from Mundipharma for postmarketing 
      surveillance studies of Reformulated OxyContin. SN, MF and LD have been 
      investigators on untied investigator-driven educational grants funded by 
      Indivior. WDH provided evidence to parliamentary committees on medical uses of 
      cannabis in Australia and the UK, and is on the Australian Advisory Council on 
      the Medicinal Use of Cannabis. MW, WDH, MF and LD have previously published 
      manuscripts on the topic of therapeutic use of cannabis.
EDAT- 2018/03/08 06:00
MHDA- 2019/10/08 06:00
CRDT- 2018/03/08 06:00
PHST- 2017/08/29 00:00 [received]
PHST- 2017/12/12 00:00 [revised]
PHST- 2017/12/16 00:00 [accepted]
PHST- 2018/03/08 06:00 [pubmed]
PHST- 2019/10/08 06:00 [medline]
PHST- 2018/03/08 06:00 [entrez]
AID - jnnp-2017-317168 [pii]
AID - 10.1136/jnnp-2017-317168 [doi]
PST - ppublish
SO  - J Neurol Neurosurg Psychiatry. 2018 Jul;89(7):741-753. doi: 
      10.1136/jnnp-2017-317168. Epub 2018 Mar 6.