Two patients with refractory and super-refractory status epilepticus, conditions with high mortality that had not responded to standard treatments, achieved seizure resolution after receiving highly purified CBD via nasogastric tube, with continued efficacy at 6-month follow-up.
Neurologists, intensivists, and families dealing with treatment-resistant epilepsy or status epilepticus.
Both refractory and super-refractory SE resolved with add-on CBD, with no adverse events
What the researchers found
Both patients achieved resolution of status epilepticus after adding highly purified CBD (hpCBD) as add-on therapy via nasogastric tube, without adverse events. At 6-month follow-up, both patients continued on hpCBD treatment, which remained effective for seizure management.
Why it matters
Refractory and super-refractory status epilepticus are medical emergencies with high mortality and very few effective treatments. While CBD is approved for specific epilepsy syndromes, this is among the first evidence of its potential in acute status epilepticus, a setting where new treatment options are desperately needed.
The numbers in context
Two patients treated. Both achieved SE resolution. Zero adverse events reported. Both continued on hpCBD at 6-month follow-up with continued efficacy. hpCBD is already approved for Lennox-Gastaut, Dravet syndrome, and Tuberous Sclerosis Complex.
How the study worked
Case series of two patients presenting with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). After standard antiseizure medications failed, hpCBD was administered via nasogastric tube as add-on therapy. Patients were followed for 6 months.
What this study cannot tell us
Only two cases, making it impossible to draw generalizable conclusions. Multiple other treatments were being given simultaneously, so the contribution of hpCBD alone is uncertain. No control group or comparison. Drug interactions with concurrent antiseizure medications were not fully characterized.
How to read the evidence
Case series of only two patients, providing initial clinical signal but no statistical power or controlled comparison.
When this study was published
Published in 2025.
The bigger picture
These cases expand the potential clinical applications of pharmaceutical-grade CBD beyond the chronic epilepsy syndromes for which it is already approved. The nasogastric delivery route is practical for ICU settings where patients cannot take oral medications. However, with only two cases, much more evidence is needed.
Questions still open
- What is the optimal dosing of hpCBD for status epilepticus? How does it interact with other ICU-level antiseizure medications? Would earlier administration of hpCBD improve outcomes? Is the effect specific to certain seizure types or etiologies?
Common questions
What is status epilepticus?
Is this the same CBD product used for other epilepsies?
Read the original research
Effectiveness of Highly Purified Cannabidiol in Refractory and Super-Refractory Status Epilepticus: A Case Series.
CNS & neurological disorders drug targets, 24(2), 158-163
Citation
Di Mauro, Giovanni; Vietri, Giovanni; Quaranta, Loreta; Placidi, Fabio; Izzi, Francesca; Castelli, Alessandro; Pagano, Andrea; Leonardis, Francesca; De Angelis, Viviana; Bianco, Ciro; Celeste, Maria Grazia; Mercuri, Nicola Biagio; Liguori, Claudio. (2025). Effectiveness of Highly Purified Cannabidiol in Refractory and Super-Refractory Status Epilepticus: A Case Series.. CNS & neurological disorders drug targets, 24(2), 158-163. https://doi.org/10.2174/0118715273304077240603115521
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