In the first Thai multicenter study, CBD-enriched oil as add-on treatment achieved consistent seizure reduction in children with drug-resistant epilepsy over 12+ months, with most adverse events being mild.
Parents of children with drug-resistant epilepsy and neurologists considering CBD as add-on therapy.
Sustained seizure reduction over 12+ months in children who had failed an average of 7 antiseizure medications
What the researchers found
Among 101 pediatric patients who had failed an average of 7 antiseizure medications, CBD-enriched oil at a median dose of 6 mg/kg/day produced consistent improvements in 50%+ seizure reduction rates at 3, 6, 9, 12 months and latest follow-up. Most seizure types responded positively except complex motor seizures. While 92% experienced adverse events, 95% were mild (somnolence, elevated liver enzymes, anorexia, irritability).
Why it matters
This is the first multicenter evidence for CBD-enriched oil in pediatric epilepsy from Thailand, demonstrating that medical-grade CBD products developed outside Western pharmaceutical markets can be effective and tolerable for treatment-resistant cases.
The numbers in context
101 patients, 42% male, median age 10 years. Median seizure frequency: 75/month at baseline. Failed average of 7 antiseizure medications. Median CBD dose: 6 mg/kg/day (range 1-15). Median follow-up: 15 months. Adverse events in 92%, mild in 95%. 33 discontinued (57% intolerable adverse events, 30% ineffectiveness, 12% noncompliance).
How the study worked
Prospective observational study across 19 Thai government hospitals (2021-2023). Enrolled 101 pediatric patients with drug-resistant epilepsy of various etiologies. Median follow-up: 15 months. Assessed seizure reduction, adverse events, and treatment discontinuation.
What this study cannot tell us
No randomized control group. Open-label design means placebo effects cannot be excluded. Variable etiologies make interpretation complex. 33 of 101 discontinued treatment. Adverse event rate was high (92%), though most were mild.
How to read the evidence
Moderate: multicenter prospective design with 15-month follow-up, but open-label without control group limits certainty.
When this study was published
2025 study (2021-2023 enrollment).
The bigger picture
With Epidiolex setting the standard for CBD in epilepsy, this study shows that nationally developed CBD products can achieve similar outcomes at potentially lower costs, which matters for healthcare systems in developing countries.
Questions still open
- How does the Thai CBD oil compare to Epidiolex in terms of purity and efficacy? Could the 33% discontinuation rate be reduced with better dosing protocols? Are the liver enzyme elevations clinically significant long-term?
Common questions
How severe was the epilepsy in these children?
Were there safety concerns?
Read the original research
National Multicenter Cohort Study: Adjunctive Cannabidiol-Enriched Cannabis Oil for Pediatric Drug-Resistant Epilepsy Treatment in Thailand.
Pediatric neurology, 169, 59-68
Citation
Lusawat, Apasri; Khongkhatithum, Chaiyos; Suwannachote, Sirorat; Katanyuwong, Kamornwan; Fangsa-Ad, Thitiporn; Anurat, Kingthong; Pattharathitikul, Siriporn; Thongmak, Tipaporn; Thewamit, Rapeepat; Sudachan, Panisra; Rojanawatsirivej, Apimid; Thampratankul, Lunliya; Sattaporn, Chanikhan; Bunyatumma, Puangtong; Auvichayapat, Narong; Laohasaran, Salin; Anuroj, Krittawit; Kontun, Sineenart; Cheawcharnprapan, Krit; Paticheep, Sudathip; Paibool, Watuhatai; Thirapote, Pat; Sanguansermsri, Chinnuwat; Suwanpakdee, Piradee; Woravimolvanich, Ornpreeya; Watcharakuldilok, Piangor; Visudtibhan, Anannit. (2025). National Multicenter Cohort Study: Adjunctive Cannabidiol-Enriched Cannabis Oil for Pediatric Drug-Resistant Epilepsy Treatment in Thailand.. Pediatric neurology, 169, 59-68. https://doi.org/10.1016/j.pediatrneurol.2025.04.015
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