Department of Medical Services, Ministry of Public Health

CBD-Enriched Medical Cannabis Shows Promise for Pediatric Epilepsy Treatment in Thailand

A recent study conducted in Thailand has shed light on the potential efficacy and safety of CBD-enriched medical cannabis products (MCPs) in treating pediatric drug-resistant epilepsy (PDRE). This research comes in the wake of Thailand’s 2019 legalization of medical cannabis use under a special access scheme.

Study Overview

The retrospective descriptive study, carried out at the Neurological Institute of Thailand and Queen Sirikit National Institute of Child Health, focused on PDRE patients treated with CBD-enriched MCPs. The products used had a CBD to THC ratio of at least 20:1.

Patient Demographics and Treatment

• 14 PDRE patients (7 male, 7 female)
• Median age: 9 years (range: 3-27 years)
• Median seizure frequency: 300 times per month
• Median number of concurrent antiepileptic drugs: 4 (range: 2-6)
• Median dosage: 5.6 mg/kg/day CBD, 0.12 mg/kg/day THC

Key Findings

1. Treatment Duration: 9 out of 14 patients (64%) continued treatment for a median of 18 months.
2. Efficacy:

• 50% responder rate for convulsive seizures: 50%
• 50% responder rate for total seizures: 43%
• Median monthly seizure reduction after 12 months:
  • Convulsive seizures: 57.5%
  • Total seizures: 67%

1. Adverse Events:

• All patients experienced adverse drug events (ADEs), occurring in 47% of 138 visits
• Most common ADEs: somnolence (64%), seizure aggravation (43%), irritability (42%), decreased appetite (28%)
• Serious ADEs:
  • Seizure aggravations leading to treatment withdrawal (28%)
  • Hospital admissions due to seizure and drowsiness (14%)
  • Hepatitis (7%)

1. Dosage Impact:

• Higher initial CBD doses were associated with increased seizure aggravation and dropout during titration (p = 0.086)
• At 12 months, the higher dose group showed significantly greater seizure reduction (p = 0.027)

Conclusion and Recommendations

The study suggests that CBD-enriched MCPs have potential efficacy in treating PDRE and can be used continuously for over 12 months. While adverse events were common, they were mostly tolerable.

To optimize treatment, the researchers recommend:

1. Initiating treatment with low doses
2. Titrating the dosage slowly
3. Closely monitoring for serious adverse events, especially during the first three months of treatment

This research provides valuable insights into the use of medical cannabis for treating drug-resistant epilepsy in pediatric patients within the Thai healthcare system. Further studies with larger sample sizes and longer follow-up periods may be warranted to confirm these findings and establish more comprehensive treatment guidelines.

This study represents a significant milestone in Thailand’s medical cannabis program. It’s one of the first to explore CBD-enriched medical cannabis for pediatric epilepsy in Southeast Asia, paving the way for further research and treatment options in the region.

The results are genuinely encouraging. A 50% responder rate for convulsive seizures is remarkable, especially considering these patients had drug-resistant epilepsy. For many families, this level of seizure reduction could be life-changing.