Long-term cannabidiol treatment in canine refractory epilepsy, associated with situational anxiety: A case report

Idiopathic epilepsy is the most common neurological disorder affecting pets and can be characterized by seizure occurrence. Phenobarbital (PB) administration is the first-choice drug therapy, sometimes associated with potassium bromide (KBr), both approved in many countries, to synergize and improve seizure management in dogs unresponsive to monotherapy. However, up to 30% of patients are medically resistant, thus drawing clinicians' attention to the need to search for new therapeutic approaches. Here, a case of a 3-year-old Segugio Maremmano dog, diagnosed with idiopathic epilepsy refractory to maintenance polytherapy with PB (3 mg/kg BID) and KBr (15 mg/kg BID) and situational anxiety, treated with full-spectrum cannabidiol (CBD) oil as an add-on, is reported. The CBD oil administration followed a "start low and go slow" protocol, initiating at 0.5 mg/kg BID, and subsequently increasing to a maintenance dose of 1.5 mg/kg TID. One-month post-therapy at the maintenance dose, an improvement in situational anxiety has been noted, with no significant adverse effects, such as increased sleepiness, lethargy, ataxia, anorexia, or emesis. After three months of follow-up, the pet parents reported that the frequency of seizures had decreased by more than 50%, ranging from one every 20 days to one every 60–80 days (average ≈ 70 days). The impact of CBD as part of the integrated therapy was monitored on the patient throughout the follow-up period of 18 months, within a total clinical observation window of 37 months (from 12 to 49 months of age). The data demonstrated a substantial improvement in epileptic symptoms, accompanied by an overall improvement in well-being and a reduction in anxiety. Overall, our data shed light on the potential use of integrated therapy, based on the prescription of conventional and nutraceutical compounds, for the management of patients with emotional discomfort and refractory epilepsy.