In a multicenter Israeli study of 74 children with severe epilepsy resistant to more than 7 medications, 89% experienced seizure reduction with CBD-enriched cannabis oil, including 18% who had 75-100% fewer seizures.
Read this if your child has treatment-resistant epilepsy and you want to understand the evidence for CBD-based treatments.
89% of children with intractable epilepsy (failed 7+ drugs) had seizure reduction with CBD oil.
What the researchers found
Researchers reported the experience of five Israeli pediatric epilepsy centers treating 74 children and adolescents (ages 1-18) with intractable epilepsy using CBD-enriched medical cannabis oil (20:1 CBD to THC ratio dissolved in olive oil).
These children had severe, treatment-resistant epilepsy: all had failed more than 7 antiepileptic drugs, and 66% had also failed a ketogenic diet, vagal nerve stimulator, or both. They were treated for an average of 6 months with CBD at doses ranging from 1 to 20 mg/kg/day.
The results were striking: 89% (66 of 74) reported seizure reduction. Of these, 18% had 75-100% reduction, 34% had 50-75% reduction, 12% had 25-50% reduction, and 26% had less than 25% reduction. Five patients (7%) reported seizure worsening.
Beyond seizure control, improvements were observed in behavior, alertness, language, communication, motor skills, and sleep. Adverse effects included somnolence, fatigue, gastrointestinal issues, and irritability.
Why it matters
These children represented the most severe and treatment-resistant epilepsy cases. When more than 7 medications and even surgical/device interventions have failed, any seizure reduction is meaningful. The 89% response rate and the breadth of additional improvements are noteworthy for a population with almost no remaining treatment options.
The numbers in context
74 patients aged 1-18. All failed 7+ antiepileptic drugs. 66% also failed ketogenic diet or VNS. CBD dose: 1-20 mg/kg/day. 89% had seizure reduction: 18% at 75-100%, 34% at 50-75%, 12% at 25-50%, 26% at <25%. 7% had seizure worsening. 5 patients withdrew due to side effects.
How the study worked
Retrospective multicenter study across five Israeli pediatric epilepsy clinics. 74 patients aged 1-18 with intractable epilepsy (resistant to 7+ antiepileptic drugs) were treated with CBD-enriched cannabis oil (20:1 CBD:THC) at 1-20 mg/kg/day for at least 3 months (average 6 months). Seizure frequency was assessed by parental report during clinical visits.
What this study cannot tell us
Retrospective design with seizure frequency assessed by parental report rather than objective measurement. No control group, so placebo effects cannot be excluded. The CBD:THC ratio was 20:1, so some effects could be from the small amount of THC. Different patients received different doses. Open-label treatment introduces expectation bias.
How to read the evidence
Moderate evidence from a multicenter retrospective study with a meaningful sample size and clinically significant outcomes, though limited by the observational design and subjective seizure reporting.
When this study was published
Published in 2016, before the FDA approved Epidiolex (CBD) for pediatric epilepsy in 2018. This study was part of the evidence base supporting that approval.
The bigger picture
This study, along with similar reports from other countries, built the evidence base that led to the FDA's 2018 approval of Epidiolex (pharmaceutical CBD) for certain pediatric seizure disorders. The Israeli experience was part of a global wave of clinical data demonstrating CBD efficacy in treatment-resistant pediatric epilepsy.
Questions still open
- What is the optimal CBD dose for different epilepsy types? Do the benefits persist long-term, or does tolerance develop? Which specific epilepsy syndromes respond best to CBD? How much of the effect is from CBD versus the small amount of THC in the formulation?
Common questions
Does CBD help children with epilepsy?
Is CBD safe for children?
Read the original research
CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.
Seizure, 35, 41-4
Citation
Tzadok, Michal; Uliel-Siboni, Shimrit; Linder, Ilan; Kramer, Uri; Epstein, Orna; Menascu, Shay; Nissenkorn, Andrea; Yosef, Omer Bar; Hyman, Eli; Granot, Dorit; Dor, Michael; Lerman-Sagie, Tali; Ben-Zeev, Bruria. (2016). CBD-enriched medical cannabis for intractable pediatric epilepsy: The current Israeli experience.. Seizure, 35, 41-4. https://doi.org/10.1016/j.seizure.2016.01.004
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