Cannabidiol in Adults With Lennox–Gastaut Syndrome: Real‐World Experience

BACKGROUND: We report a single centre experience of cannabidiol use as adjunctive treatment in adults with Lennox-Gastaut Syndrome (LGS). METHODS: Retrospective review of adults with LGS treated with cannabidiol with clinical data collected from electronic records and caregiver standardised seizure diaries with seizure-related outcomes assessed at baseline, 6 months, and last follow-up. RESULTS: Seventy-nine adults (median age 29 years; 40 male) were included. Median follow-up was 41 months. Four patients died unrelated to cannabidiol treatment. Sixty-seven (86%) remained on treatment at last follow-up. Across all seizure types, 59.5% achieved ≥ 50% reduction at 6 months and 67.1% at last follow-up. Among those with 'Drop Seizures' (n = 78), 50% achieved > 50% reduction at 6 months and 61.5% at last follow-up. 'Drop Seizure' responder rates were numerically higher with clobazam > 5 mg/day, but with no statistically significant dose-response relationship seen. Seizure-free days increased (baseline 5.7/month; last follow-up 12.5/month). Seizure-related hospital admissions and injuries declined. Cognitive or behavioural improvements were reported in 48 patients (60.8%); there was no statistically significant association with achieving ≥ 50% seizure reduction. Drowsiness (n = 33) was the most frequent adverse event often related to drug-drug interactions. Diarrhoea (n = 24) was more common than previously reported. Side-effects necessitated ASM adjustments in 51 patients. Fourteen were able to withdraw one or more ASMs. CONCLUSIONS: CBD was associated with sustained effectiveness and good tolerability in adults with LGS, with high retention and improvement in seizure and other clinically meaningful outcomes. Adverse effects, mainly interaction-related, were usually managed with concomitant medication adjustments.