Cannabis‐based products for pediatric epilepsy: A systematic review
Summary Objective To assess the benefits and harms of cannabis‐based products for pediatric epilepsy. Methods We identified in this living systematic review randomized controlled trials (RCTs) and nonrandomized studies (NRSs) involving children with epilepsy treated with cannabis‐based products. We...
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| Veröffentlicht in: | Epilepsia (Copenhagen) 2019-01, Vol.60 (1), p.6-19 |
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| creator | Elliott, Jesse DeJean, Deirdre Clifford, Tammy Coyle, Doug Potter, Beth K. Skidmore, Becky Alexander, Christine Repetski, Alexander E. Shukla, Vijay McCoy, Bláthnaid Wells, George A. |
| description | Summary
Objective
To assess the benefits and harms of cannabis‐based products for pediatric epilepsy.
Methods
We identified in this living systematic review randomized controlled trials (RCTs) and nonrandomized studies (NRSs) involving children with epilepsy treated with cannabis‐based products. We searched MEDLINE, Embase, PsycINFO, Cochrane Library, and gray literature (April 25, 2018). The primary outcome was seizure freedom; secondary outcomes were seizure frequency (total, ≥50% reduction), quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and visits to the emergency room. Data were pooled by random‐effects meta‐analysis. Risk of bias was assessed for each study, and GRADE was used to assess the quality of evidence for each outcome.
Results
Four RCTs and 19 NRSs were included, primarily involving cannabidiol. All RCTs were at low risk of bias, whereas all NRSs were at high risk. Among RCTs, there was no statistically significant difference between cannabidiol and placebo in seizure freedom (relative risk [RR] = 6.77, 95% confidence interval [CI] = 0.36‐128.38; 1 RCT), quality of life (mean difference = 0.6, 95% CI = −2.6 to 3.9; 3 RCTs), sleep disruption (mean difference = −0.3, 95% CI = −0.8 to 0.2; 3 RCTs), or vomiting (RR = 1.00, 95% CI = 0.51‐1.96; 4 RCTs). There was a statistically significant reduction in the median frequency of monthly seizures with cannabidiol compared with placebo (−19.8%, 95% CI = −27.0% to −12.6%; 3 RCTs) and an increase in the number of participants with at least a 50% reduction in seizures (RR = 1.76, 95% CI = 1.07‐2.88; 1 RCT) and diarrhea (RR = 2.25, 95% CI = 1.38‐3.68; 3 RCTs). Death and status epilepticus were infrequently reported.
Significance
Evidence from high‐quality RCTs suggests that cannabidiol probably reduces seizures among children with drug‐resistant epilepsy (moderate certainty). At this time, the evidence base is primarily limited to cannabidiol, and these findings should not be extended to all cannabis‐based products. |
| doi_str_mv | 10.1111/epi.14608 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2150532115</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2164134724</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3888-bb3d827944549d1aca799834b8537ed054b4473e1e5676d0c8924c3a8ab4dd203</originalsourceid><addsrcrecordid>eNp10MtKAzEUBuAgiq3VhS8gA250MW0ySSYZd6VULRR0oeuQW2HK3ExmLLPzEXxGn8ToVBeC2QTCx59zfgDOEZyicGa2yaeIpJAfgDGiCY8RStkhGEOIcJxRDkfgxPsthJClDB-DEYYUUZbSMVguZFVJlfuPt3clvTVR42rT6dZHm9pFjTW5bF2uo_BHYRvf30TzyPe-taVsw7Ozr7ndnYKjjSy8PdvfE_B8u3xa3Mfrh7vVYr6ONeacx0phwxOWEUJJZpDUkmUZx0Rxipk1kBJFCMMWWZqy1EDNs4RoLLlUxJgE4gm4GnLDkC-d9a0oc69tUcjK1p0XCaKQ4gQhGujlH7qtO1eF6YJKCcKEJSSo60FpV3vv7EY0Li-l6wWC4qtbEfYW390Ge7FP7FRpza_8KTOA2QB2oar-_ySxfFwNkZ_jOYIM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2164134724</pqid></control><display><type>article</type><title>Cannabis‐based products for pediatric epilepsy: A systematic review</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Access via Wiley Online Library</source><source>Wiley Free Content</source><source>Alma/SFX Local Collection</source><creator>Elliott, Jesse ; DeJean, Deirdre ; Clifford, Tammy ; Coyle, Doug ; Potter, Beth K. ; Skidmore, Becky ; Alexander, Christine ; Repetski, Alexander E. ; Shukla, Vijay ; McCoy, Bláthnaid ; Wells, George A.</creator><creatorcontrib>Elliott, Jesse ; DeJean, Deirdre ; Clifford, Tammy ; Coyle, Doug ; Potter, Beth K. ; Skidmore, Becky ; Alexander, Christine ; Repetski, Alexander E. ; Shukla, Vijay ; McCoy, Bláthnaid ; Wells, George A.</creatorcontrib><description>Summary
Objective
To assess the benefits and harms of cannabis‐based products for pediatric epilepsy.
Methods
We identified in this living systematic review randomized controlled trials (RCTs) and nonrandomized studies (NRSs) involving children with epilepsy treated with cannabis‐based products. We searched MEDLINE, Embase, PsycINFO, Cochrane Library, and gray literature (April 25, 2018). The primary outcome was seizure freedom; secondary outcomes were seizure frequency (total, ≥50% reduction), quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and visits to the emergency room. Data were pooled by random‐effects meta‐analysis. Risk of bias was assessed for each study, and GRADE was used to assess the quality of evidence for each outcome.
Results
Four RCTs and 19 NRSs were included, primarily involving cannabidiol. All RCTs were at low risk of bias, whereas all NRSs were at high risk. Among RCTs, there was no statistically significant difference between cannabidiol and placebo in seizure freedom (relative risk [RR] = 6.77, 95% confidence interval [CI] = 0.36‐128.38; 1 RCT), quality of life (mean difference = 0.6, 95% CI = −2.6 to 3.9; 3 RCTs), sleep disruption (mean difference = −0.3, 95% CI = −0.8 to 0.2; 3 RCTs), or vomiting (RR = 1.00, 95% CI = 0.51‐1.96; 4 RCTs). There was a statistically significant reduction in the median frequency of monthly seizures with cannabidiol compared with placebo (−19.8%, 95% CI = −27.0% to −12.6%; 3 RCTs) and an increase in the number of participants with at least a 50% reduction in seizures (RR = 1.76, 95% CI = 1.07‐2.88; 1 RCT) and diarrhea (RR = 2.25, 95% CI = 1.38‐3.68; 3 RCTs). Death and status epilepticus were infrequently reported.
Significance
Evidence from high‐quality RCTs suggests that cannabidiol probably reduces seizures among children with drug‐resistant epilepsy (moderate certainty). At this time, the evidence base is primarily limited to cannabidiol, and these findings should not be extended to all cannabis‐based products.</description><identifier>ISSN: 0013-9580</identifier><identifier>EISSN: 1528-1167</identifier><identifier>DOI: 10.1111/epi.14608</identifier><identifier>PMID: 30515765</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>cannabidiol ; Cannabis ; Child ; Children ; Clinical Trials as Topic - methods ; Convulsions & seizures ; Diarrhea ; Drug Resistant Epilepsy - diagnosis ; Drug Resistant Epilepsy - drug therapy ; efficacy ; Emergency medical care ; Epilepsy ; Humans ; Marijuana ; Medical Marijuana - therapeutic use ; pediatric drug‐resistant epilepsy ; Pediatrics ; Quality of life ; safety ; seizure ; Seizures ; Sleep ; Statistical analysis ; Systematic review ; Vomiting</subject><ispartof>Epilepsia (Copenhagen), 2019-01, Vol.60 (1), p.6-19</ispartof><rights>Wiley Periodicals, Inc. © 2018 International League Against Epilepsy</rights><rights>Wiley Periodicals, Inc. © 2018 International League Against Epilepsy.</rights><rights>Copyright © 2019 International League Against Epilepsy</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3888-bb3d827944549d1aca799834b8537ed054b4473e1e5676d0c8924c3a8ab4dd203</citedby><cites>FETCH-LOGICAL-c3888-bb3d827944549d1aca799834b8537ed054b4473e1e5676d0c8924c3a8ab4dd203</cites><orcidid>0000-0002-2501-1641</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fepi.14608$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fepi.14608$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,1434,27929,27930,45579,45580,46414,46838</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30515765$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Elliott, Jesse</creatorcontrib><creatorcontrib>DeJean, Deirdre</creatorcontrib><creatorcontrib>Clifford, Tammy</creatorcontrib><creatorcontrib>Coyle, Doug</creatorcontrib><creatorcontrib>Potter, Beth K.</creatorcontrib><creatorcontrib>Skidmore, Becky</creatorcontrib><creatorcontrib>Alexander, Christine</creatorcontrib><creatorcontrib>Repetski, Alexander E.</creatorcontrib><creatorcontrib>Shukla, Vijay</creatorcontrib><creatorcontrib>McCoy, Bláthnaid</creatorcontrib><creatorcontrib>Wells, George A.</creatorcontrib><title>Cannabis‐based products for pediatric epilepsy: A systematic review</title><title>Epilepsia (Copenhagen)</title><addtitle>Epilepsia</addtitle><description>Summary
Objective
To assess the benefits and harms of cannabis‐based products for pediatric epilepsy.
Methods
We identified in this living systematic review randomized controlled trials (RCTs) and nonrandomized studies (NRSs) involving children with epilepsy treated with cannabis‐based products. We searched MEDLINE, Embase, PsycINFO, Cochrane Library, and gray literature (April 25, 2018). The primary outcome was seizure freedom; secondary outcomes were seizure frequency (total, ≥50% reduction), quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and visits to the emergency room. Data were pooled by random‐effects meta‐analysis. Risk of bias was assessed for each study, and GRADE was used to assess the quality of evidence for each outcome.
Results
Four RCTs and 19 NRSs were included, primarily involving cannabidiol. All RCTs were at low risk of bias, whereas all NRSs were at high risk. Among RCTs, there was no statistically significant difference between cannabidiol and placebo in seizure freedom (relative risk [RR] = 6.77, 95% confidence interval [CI] = 0.36‐128.38; 1 RCT), quality of life (mean difference = 0.6, 95% CI = −2.6 to 3.9; 3 RCTs), sleep disruption (mean difference = −0.3, 95% CI = −0.8 to 0.2; 3 RCTs), or vomiting (RR = 1.00, 95% CI = 0.51‐1.96; 4 RCTs). There was a statistically significant reduction in the median frequency of monthly seizures with cannabidiol compared with placebo (−19.8%, 95% CI = −27.0% to −12.6%; 3 RCTs) and an increase in the number of participants with at least a 50% reduction in seizures (RR = 1.76, 95% CI = 1.07‐2.88; 1 RCT) and diarrhea (RR = 2.25, 95% CI = 1.38‐3.68; 3 RCTs). Death and status epilepticus were infrequently reported.
Significance
Evidence from high‐quality RCTs suggests that cannabidiol probably reduces seizures among children with drug‐resistant epilepsy (moderate certainty). At this time, the evidence base is primarily limited to cannabidiol, and these findings should not be extended to all cannabis‐based products.</description><subject>cannabidiol</subject><subject>Cannabis</subject><subject>Child</subject><subject>Children</subject><subject>Clinical Trials as Topic - methods</subject><subject>Convulsions & seizures</subject><subject>Diarrhea</subject><subject>Drug Resistant Epilepsy - diagnosis</subject><subject>Drug Resistant Epilepsy - drug therapy</subject><subject>efficacy</subject><subject>Emergency medical care</subject><subject>Epilepsy</subject><subject>Humans</subject><subject>Marijuana</subject><subject>Medical Marijuana - therapeutic use</subject><subject>pediatric drug‐resistant epilepsy</subject><subject>Pediatrics</subject><subject>Quality of life</subject><subject>safety</subject><subject>seizure</subject><subject>Seizures</subject><subject>Sleep</subject><subject>Statistical analysis</subject><subject>Systematic review</subject><subject>Vomiting</subject><issn>0013-9580</issn><issn>1528-1167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10MtKAzEUBuAgiq3VhS8gA250MW0ySSYZd6VULRR0oeuQW2HK3ExmLLPzEXxGn8ToVBeC2QTCx59zfgDOEZyicGa2yaeIpJAfgDGiCY8RStkhGEOIcJxRDkfgxPsthJClDB-DEYYUUZbSMVguZFVJlfuPt3clvTVR42rT6dZHm9pFjTW5bF2uo_BHYRvf30TzyPe-taVsw7Ozr7ndnYKjjSy8PdvfE_B8u3xa3Mfrh7vVYr6ONeacx0phwxOWEUJJZpDUkmUZx0Rxipk1kBJFCMMWWZqy1EDNs4RoLLlUxJgE4gm4GnLDkC-d9a0oc69tUcjK1p0XCaKQ4gQhGujlH7qtO1eF6YJKCcKEJSSo60FpV3vv7EY0Li-l6wWC4qtbEfYW390Ge7FP7FRpza_8KTOA2QB2oar-_ySxfFwNkZ_jOYIM</recordid><startdate>201901</startdate><enddate>201901</enddate><creator>Elliott, Jesse</creator><creator>DeJean, Deirdre</creator><creator>Clifford, Tammy</creator><creator>Coyle, Doug</creator><creator>Potter, Beth K.</creator><creator>Skidmore, Becky</creator><creator>Alexander, Christine</creator><creator>Repetski, Alexander E.</creator><creator>Shukla, Vijay</creator><creator>McCoy, Bláthnaid</creator><creator>Wells, George A.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2501-1641</orcidid></search><sort><creationdate>201901</creationdate><title>Cannabis‐based products for pediatric epilepsy: A systematic review</title><author>Elliott, Jesse ; DeJean, Deirdre ; Clifford, Tammy ; Coyle, Doug ; Potter, Beth K. ; Skidmore, Becky ; Alexander, Christine ; Repetski, Alexander E. ; Shukla, Vijay ; McCoy, Bláthnaid ; Wells, George A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3888-bb3d827944549d1aca799834b8537ed054b4473e1e5676d0c8924c3a8ab4dd203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>cannabidiol</topic><topic>Cannabis</topic><topic>Child</topic><topic>Children</topic><topic>Clinical Trials as Topic - methods</topic><topic>Convulsions & seizures</topic><topic>Diarrhea</topic><topic>Drug Resistant Epilepsy - diagnosis</topic><topic>Drug Resistant Epilepsy - drug therapy</topic><topic>efficacy</topic><topic>Emergency medical care</topic><topic>Epilepsy</topic><topic>Humans</topic><topic>Marijuana</topic><topic>Medical Marijuana - therapeutic use</topic><topic>pediatric drug‐resistant epilepsy</topic><topic>Pediatrics</topic><topic>Quality of life</topic><topic>safety</topic><topic>seizure</topic><topic>Seizures</topic><topic>Sleep</topic><topic>Statistical analysis</topic><topic>Systematic review</topic><topic>Vomiting</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Elliott, Jesse</creatorcontrib><creatorcontrib>DeJean, Deirdre</creatorcontrib><creatorcontrib>Clifford, Tammy</creatorcontrib><creatorcontrib>Coyle, Doug</creatorcontrib><creatorcontrib>Potter, Beth K.</creatorcontrib><creatorcontrib>Skidmore, Becky</creatorcontrib><creatorcontrib>Alexander, Christine</creatorcontrib><creatorcontrib>Repetski, Alexander E.</creatorcontrib><creatorcontrib>Shukla, Vijay</creatorcontrib><creatorcontrib>McCoy, Bláthnaid</creatorcontrib><creatorcontrib>Wells, George A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Epilepsia (Copenhagen)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Elliott, Jesse</au><au>DeJean, Deirdre</au><au>Clifford, Tammy</au><au>Coyle, Doug</au><au>Potter, Beth K.</au><au>Skidmore, Becky</au><au>Alexander, Christine</au><au>Repetski, Alexander E.</au><au>Shukla, Vijay</au><au>McCoy, Bláthnaid</au><au>Wells, George A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cannabis‐based products for pediatric epilepsy: A systematic review</atitle><jtitle>Epilepsia (Copenhagen)</jtitle><addtitle>Epilepsia</addtitle><date>2019-01</date><risdate>2019</risdate><volume>60</volume><issue>1</issue><spage>6</spage><epage>19</epage><pages>6-19</pages><issn>0013-9580</issn><eissn>1528-1167</eissn><abstract>Summary
Objective
To assess the benefits and harms of cannabis‐based products for pediatric epilepsy.
Methods
We identified in this living systematic review randomized controlled trials (RCTs) and nonrandomized studies (NRSs) involving children with epilepsy treated with cannabis‐based products. We searched MEDLINE, Embase, PsycINFO, Cochrane Library, and gray literature (April 25, 2018). The primary outcome was seizure freedom; secondary outcomes were seizure frequency (total, ≥50% reduction), quality of life, sleep, status epilepticus, death, gastrointestinal adverse events, and visits to the emergency room. Data were pooled by random‐effects meta‐analysis. Risk of bias was assessed for each study, and GRADE was used to assess the quality of evidence for each outcome.
Results
Four RCTs and 19 NRSs were included, primarily involving cannabidiol. All RCTs were at low risk of bias, whereas all NRSs were at high risk. Among RCTs, there was no statistically significant difference between cannabidiol and placebo in seizure freedom (relative risk [RR] = 6.77, 95% confidence interval [CI] = 0.36‐128.38; 1 RCT), quality of life (mean difference = 0.6, 95% CI = −2.6 to 3.9; 3 RCTs), sleep disruption (mean difference = −0.3, 95% CI = −0.8 to 0.2; 3 RCTs), or vomiting (RR = 1.00, 95% CI = 0.51‐1.96; 4 RCTs). There was a statistically significant reduction in the median frequency of monthly seizures with cannabidiol compared with placebo (−19.8%, 95% CI = −27.0% to −12.6%; 3 RCTs) and an increase in the number of participants with at least a 50% reduction in seizures (RR = 1.76, 95% CI = 1.07‐2.88; 1 RCT) and diarrhea (RR = 2.25, 95% CI = 1.38‐3.68; 3 RCTs). Death and status epilepticus were infrequently reported.
Significance
Evidence from high‐quality RCTs suggests that cannabidiol probably reduces seizures among children with drug‐resistant epilepsy (moderate certainty). At this time, the evidence base is primarily limited to cannabidiol, and these findings should not be extended to all cannabis‐based products.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>30515765</pmid><doi>10.1111/epi.14608</doi><tpages>14</tpages><orcidid>https://orcid.org/0000-0002-2501-1641</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | cannabidiol Cannabis Child Children Clinical Trials as Topic - methods Convulsions & seizures Diarrhea Drug Resistant Epilepsy - diagnosis Drug Resistant Epilepsy - drug therapy efficacy Emergency medical care Epilepsy Humans Marijuana Medical Marijuana - therapeutic use pediatric drug‐resistant epilepsy Pediatrics Quality of life safety seizure Seizures Sleep Statistical analysis Systematic review Vomiting |
| title | Cannabis‐based products for pediatric epilepsy: A systematic review |
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