Summary

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• This summary is based on the review of 21 systematic review(s)/meta-analysis(es). ^[1-21]
• Seizure Reduction in Dravet Syndrome (DS): Cannabidiol (CBD) reduced seizure frequency by 33%, with a 20% increase in the number of patients achieving a ≥50% reduction in seizures and a 3% increase in seizure freedom. However, CBD was less effective than stiripentol, fenfluramine, and soticlestat in reducing seizure frequency by ≥50%.
• Seizure Reduction in Lennox-Gastaut Syndrome (LGS): High-dose CBD significantly reduced drop seizure frequency in patients with LGS and drug-resistant epilepsy, showing a ≥50% reduction in seizure frequency compared to placebo. CBD was effective in LGS both with and without concomitant clobazam (CLB).
• Seizure Reduction in Other Conditions: CBD demonstrated effectiveness in reducing seizures in patients with tuberous sclerosis complex (TSC) and pediatric epilepsy. It also showed therapeutic benefits for epilepsy and Parkinsonism.
• Comparative Effectiveness: Stiripentol, fenfluramine, and soticlestat were more effective than CBD in reducing convulsive seizures in DS, with higher seizure response rates and a greater probability of achieving a ≥50% reduction in seizure frequency.
• CBD was associated with an increase in adverse events (AEs) by 12%, serious AEs by 16%, and a 15% increase in transaminase elevations, particularly in patients using concomitant valproate. Common AEs included somnolence and sedation, especially when used with CLB.
• CBD had a lower proportion of participants experiencing AEs compared to fenfluramine, but a higher risk of AEs than stiripentol. High-dose CBD had significantly higher odds of treatment-emergent adverse events (TEAEs) compared to placebo.
• Adverse events specific to CBD use included decreased appetite, rash, pneumonia, and aggression, with higher incidences of somnolence and sedation reported in patients taking CBD with CLB.
• CBD has demonstrated effectiveness in reducing seizures in pediatric patients with DS, children and adults with LGS, and patients with tuberous sclerosis complex (TSC) and drug-resistant epilepsy. In subgroups, CBD's efficacy was observed both with and without concomitant CLB, with notable differences in safety profiles when used alongside CLB, particularly higher rates of somnolence and sedation.