CBD for Epilepsy: From Dravet Syndrome to Lennox-Gastaut

## CBD and Epilepsy: An Ancient Connection

Cannabis has been used to treat epilepsy for thousands of years. Modern research was sparked by viral videos in the early 2010s showing Charlotte Figi, a child with Dravet syndrome, experiencing dramatic seizure reduction after CBD oil treatment.

## Dravet Syndrome and Lennox-Gastaut Syndrome

Both are severe childhood epilepsy syndromes resistant to most conventional antiepileptics. Dravet syndrome involves SCN1A mutations affecting sodium channels; Lennox-Gastaut syndrome involves multiple seizure types with intellectual disability.

## Epidiolex® – FDA and EMA Approved

Epidiolex® (EU: Epidyolex®) is a pharmaceutical-grade CBD solution (100 mg/ml). Phase III trials demonstrated: - CARE1 (Dravet): CBD reduced convulsive seizures by 39% vs 13% placebo - GWPCARE3/4 (LGS): Significant reduction in drop seizures

The FDA approved Epidiolex® in 2018 – the first FDA approval for a plant-derived cannabinoid medicine. EMA approval followed in 2019.

## How CBD Works Against Seizures

CBD acts through multiple mechanisms: inhibition of voltage-gated sodium and calcium channels, GPR55 antagonism, adenosine reuptake inhibition, and anti-inflammatory effects. This multi-target action may explain its efficacy in drug-resistant epilepsies.

## Key Drug Interaction: Clobazam

CBD inhibits CYP2C19, causing elevated levels of clobazam and its active metabolite. Dose adjustment of clobazam is often necessary when combining with Epidiolex®.

> Note: Treatment decisions in epilepsy are highly individual and must be discussed with an epileptology specialist.