CBD for Epilepsy Types Beyond Its Approved Indications
Among 108 patients with various refractory epilepsies treated off-label with CBD, 38.9% achieved at least 50% seizure reduction at three months.
Quick Facts
What This Study Found
Add-on CBD showed meaningful seizure reduction across epilepsy types beyond its approved indications (Lennox-Gastaut, Dravet, TSC). At three months, 38.9% of 108 patients achieved at least 50% seizure reduction. Among those with tonic-clonic seizures, 45.8% were 50% responders and 16.7% became tonic-clonic seizure-free. Response was not predicted by sex, age, epilepsy type, or clobazam use.
Key Numbers
108 patients (mean age 27.3, range 1.4-68 years). 38.9% achieved at least 50% seizure reduction at 3 months. 25.9% had 50-74% reduction, 13% had 75-99% reduction. Mean seizure days dropped from 16.8 to 14.5 per month (p=0.002). Retention: 85.2% at 3 months, 73.5% at 6 months, 61.1% at 12 months. 63% rated improved on CGI-C. Adverse events in 38%: diarrhea (15), sedation (13), nausea/vomiting (7).
How They Did This
Retrospective cohort study of 108 patients who started off-label CBD between 2019 and 2023 at six German epilepsy centers. Follow-up included seizure frequency, retention rates, Clinical Global Impression of Change (CGI-C), and adverse events.
Why This Research Matters
CBD is only approved for a few rare epilepsy syndromes. This real-world data suggests it may benefit a broader range of patients with treatment-resistant epilepsy, which could support expanded indications.
The Bigger Picture
The 50% responder rate of 38.9% is comparable to what other anti-seizure medications achieve in registration trials for focal epilepsies, suggesting CBD deserves consideration as a mainstream treatment option rather than a last resort.
What This Study Doesn't Tell Us
Retrospective design without a control group. Open-label treatment allows for placebo effects and observer bias. Retention was better in children/adolescents, potentially confounding age-related results. Six centers in one country limits generalizability.
Questions This Raises
- ?Would a randomized controlled trial in focal epilepsy confirm these responder rates?
- ?Why do children and adolescents have better retention on CBD than adults?
Trust & Context
- Key Stat:
- 38.9% of patients with refractory epilepsy achieved 50%+ seizure reduction with off-label CBD
- Evidence Grade:
- Multi-center real-world cohort with meaningful sample size, but retrospective, uncontrolled, and open-label design limits causal conclusions.
- Study Age:
- 2025 publication with data from 2019-2023 across six German epilepsy centers.
- Original Title:
- Use of cannabidiol for off-label treatment of patients with refractory focal, genetic generalised and other epilepsies.
- Published In:
- Neurological research and practice, 7(1), 49 (2025)
- Authors:
- Hollander, Marie, Mayer, Thomas(3), Klotz, Kerstin Alexandra(3), Knake, Susanne, von Podewils, Felix, Kurlemann, Gerhard, Immisch, Ilka, Rosenow, Felix, Schubert-Bast, Susanne, Strzelczyk, Adam
- Database ID:
- RTHC-06675
Evidence Hierarchy
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Cite This Study
https://rethinkthc.com/research/RTHC-06675APA
Hollander, Marie; Mayer, Thomas; Klotz, Kerstin Alexandra; Knake, Susanne; von Podewils, Felix; Kurlemann, Gerhard; Immisch, Ilka; Rosenow, Felix; Schubert-Bast, Susanne; Strzelczyk, Adam. (2025). Use of cannabidiol for off-label treatment of patients with refractory focal, genetic generalised and other epilepsies.. Neurological research and practice, 7(1), 49. https://doi.org/10.1186/s42466-025-00408-w
MLA
Hollander, Marie, et al. "Use of cannabidiol for off-label treatment of patients with refractory focal, genetic generalised and other epilepsies.." Neurological research and practice, 2025. https://doi.org/10.1186/s42466-025-00408-w
RethinkTHC
RethinkTHC Research Database. "Use of cannabidiol for off-label treatment of patients with ..." RTHC-06675. Retrieved from https://rethinkthc.com/research/hollander-2025-use-of-cannabidiol-for
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.