Slow CBD titration in children with severe epilepsy achieved comparable efficacy with better tolerance
In 125 children with drug-resistant epilepsy, a slower CBD titration protocol achieved 38% with 50%+ seizure reduction at 6 months while reducing side effects compared to faster titration in previous trials.
Quick Facts
What This Study Found
At 6 months, mean seizure frequency decreased 41% from baseline, and 37.8% had 50%+ seizure reduction. Adverse events occurred in 48.8%, mainly somnolence (21%), asthenia (16%), and behavioral changes (13%). Abnormal transaminases occurred in 11 patients receiving both valproate and clobazam. Concomitant clobazam did not increase efficacy rates.
Key Numbers
125 patients enrolled. Doses: 10 mg/kg/day at M1, 14 at M2, 15.5 at M6. 26 discontinued (19 for lack of efficacy). AEs in 48.8%. Somnolence 21%, asthenia 16%. 37.8% achieved 50%+ seizure reduction at M6. 1 SUDEP.
How They Did This
Prospective, open-label, multicenter study in 7 French reference centers. 125 patients (62 LGS, 48 Dravet, 15 other) with slow CBD titration to 10 mg/kg/day over at least 1 month, then gradual increase to max 20 mg/kg/day. Assessed at months 1, 2, and 6.
Why This Research Matters
Slow titration may allow clinicians to achieve similar seizure control with fewer side effects, improving the risk-benefit profile of CBD therapy for severe childhood epilepsy.
The Bigger Picture
This study offers practical guidance for clinicians prescribing CBD: slower dose escalation may deliver comparable seizure control with better tolerability, and clobazam co-administration may not add efficacy but does increase some adverse events.
What This Study Doesn't Tell Us
Open-label without control group; heterogeneous epilepsy types; variable follow-up; one SUDEP occurred (not necessarily related to CBD).
Questions This Raises
- ?Would even slower titration further improve tolerability?
- ?Can clinicians predict which patients will benefit without clobazam co-administration?
Trust & Context
- Key Stat:
- 37.8% achieved 50%+ seizure reduction; slow titration improved tolerability
- Evidence Grade:
- Multicenter prospective study but open-label without control group.
- Study Age:
- Published in 2020.
- Original Title:
- Slow Titration of Cannabidiol Add-On in Drug-Resistant Epilepsies Can Improve Safety With Maintained Efficacy in an Open-Label Study.
- Published In:
- Frontiers in neurology, 11, 829 (2020)
- Authors:
- D'Onofrio, Gianluca(2), Kuchenbuch, Mathieu(2), Hachon-Le Camus, Caroline, Desnous, Béatrice, Staath, Véronique, Napuri, Sylvia, Ville, Dorothée, Pedespan, Jean-Michel, Lépine, Anne, Cances, Claude, de Saint-Martin, Anne, Teng, Théo, Chemaly, Nicole, Milh, Mathieu, Villeneuve, Nathalie, Nabbout, Rima
- Database ID:
- RTHC-02489
Evidence Hierarchy
Enrolls participants and follows them forward in time.
What do these levels mean? →Frequently Asked Questions
Why does a slower titration help?
Gradually increasing the CBD dose gives the body time to adjust, reducing side effects like somnolence and fatigue. This study showed that seizure reduction was comparable to faster protocols in previous trials while side effects were more manageable.
Does adding clobazam to CBD improve results?
In this study, patients taking CBD with clobazam did not have better seizure outcomes than those without clobazam. However, the combination was associated with more side effects in some cases, particularly elevated liver enzymes when valproate was also present.
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Cite This Study
https://rethinkthc.com/research/RTHC-02489APA
D'Onofrio, Gianluca; Kuchenbuch, Mathieu; Hachon-Le Camus, Caroline; Desnous, Béatrice; Staath, Véronique; Napuri, Sylvia; Ville, Dorothée; Pedespan, Jean-Michel; Lépine, Anne; Cances, Claude; de Saint-Martin, Anne; Teng, Théo; Chemaly, Nicole; Milh, Mathieu; Villeneuve, Nathalie; Nabbout, Rima. (2020). Slow Titration of Cannabidiol Add-On in Drug-Resistant Epilepsies Can Improve Safety With Maintained Efficacy in an Open-Label Study.. Frontiers in neurology, 11, 829. https://doi.org/10.3389/fneur.2020.00829
MLA
D'Onofrio, Gianluca, et al. "Slow Titration of Cannabidiol Add-On in Drug-Resistant Epilepsies Can Improve Safety With Maintained Efficacy in an Open-Label Study.." Frontiers in neurology, 2020. https://doi.org/10.3389/fneur.2020.00829
RethinkTHC
RethinkTHC Research Database. "Slow Titration of Cannabidiol Add-On in Drug-Resistant Epile..." RTHC-02489. Retrieved from https://rethinkthc.com/research/d-onofrio-2020-slow-titration-of-cannabidiol
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.