Over recent years, there have been a number of positive findings concerning the anti-seizure effects of cannabidiol (CBD) in some forms of epilepsy. Most notably, the cannabis compound has been found, in numerous trials, to reduce seizure frequency and severity in treatment-resistant forms of the illness – namely, Dravet and Lennox-Gastaut syndromes.
Following these findings, the CBD-based medication, Epidyolex (or Epidiolex in the US) has now been approved for use in a number of countries, including the UK. Medical cannabis was effectively legalised in the UK in 2018, following the rescheduling of the drug. Epidyolex remains one of the only cannabis-based medicines recommended for use by the National Institute of Health and Care Excellence (NICE).
Measuring Quality of Life of Patients with Severe Epilepsy
Lennox-Gastaut and Dravet syndromes are rare forms of epilepsy which are often exceptionally difficult to treat. While these conditions can affect people of any age, symptoms usually begin in early childhood.
Severe forms of epilepsy often have a number of negative effects on the physical, mental, and social development of children. Low self-esteem, anxiety, depression, impaired memory and lack of attention, lack of independence, and social stigma, can all have a profound effect on the quality of life of child epilepsy patients.
Quality of Life questionnaires are often used to supplement physician assessments of how both symptoms and antiepileptic medications can have an impact on quality of life. The Quality of Life in Childhood Epilepsy (QOLCE) survey is often used in this context.
Potential Benefits of Medical Cannabis
Medical cannabis has been approved as a conjunctive therapy in treatment-resistant epilepsy, due to its anticonvulsant properties. While there is sufficient evidence that cannabis-derived medications can help to reduce seizure frequency and severity, a recent study aimed to assess its impact on quality of life.
A total of 60 paediatric epilepsy patients were enrolled in the open-label study, with 80% (48) completing both pre- and post-treatment QOLCE surveys. Patients were observed over a 12-week period. The QOLCE survey assessed multiple domains, including energy/fatigue; memory; other cognitive; control/helplessness; social interactions; and behaviour.
Results of the Study
At baseline (pre-treatment) the mean monthly motor seizure and total seizure frequency in participating patients were 27.5 and 33 seizures per month, respectively. A median dose of 25mg/kg (CBD) was achieved during the titration period.
In contrast, the median motor seizure frequency during the 12-week observation period was 13.9, representing a median per cent reduction of 39.4% from baseline. Twenty patients (41.7%) saw a reduction in seizure frequency of over 50%.
Quality of Life
The results of the pre-treatment QOLCE survey indicated a mean overall QOLCE score of 37.8. Post-treatment QOLCE results increased to a mean score of 45.7 – with a mean change of 8.1 from baseline.
The surveys also collected data of individual QOL control domains. The post-treatment QOLCE survey presented significant improvements in physical restrictions, energy/fatigue, memory, anxiety, self-esteem, social interactions, social activities and behaviour.
The researchers of this study concluded that treatment with CBD contributed to significant improvements in both seizure frequency and quality of life in participating paediatric epilepsy patients. These findings support the results of previous studies in this area and the continued use of cannabis-based medications in the treatment of treatment-resistant epilepsy.
However, the researchers conclude that it remains difficult to discern whether improvements in quality-of-life scores are linked directly to the effects of the medication, reduced seizures, or psychological effects of reduced seizures. Each of these factors undoubtedly contributes to improvements in quality of life and all “may be casually interrelated”.
Having said this, the researchers identified no correlations between improvements in QOLCE and adverse events or changes in seizure frequency with CBD. This may indicate that CBD may have the potential to improve health-related QOL, independently from its effects on seizure frequency and severity. The demonstrated improvements in QOL measures such as sleep, mood, and overall mental health may be linked to the anxiolytic or other effects of the cannabinoid.