Adding Epidiolex, an oral cannabidiol medication, to other treatments successfully stopped epileptic seizures in a boy with Lennox-Gastaut syndrome (LGS), resulting in nearly normal electrical activity in the brain, a real-world case study reported.
The case study, “Effect of Cannabinoids on Electroencephalography of a Child with Lennox–Gastaut Syndrome,” was published in the Journal of Neurosciences in Rural Practice.
Developed by GW Pharmaceuticals, Epidiolex is a cannabidiol (CBD) solution, extracted from the cannabis plant, that is approved to treat seizures in patients with LGS, ages 1 and older. Clinical trials demonstrated that Epidiolex reduced the frequency of attacks in LGS, either alone or as an add-on treatment.
Now, an investigator at the Arnold Palmer Hospital, in Florida, described the case of a boy with LGS of unknown cause who was successfully treated with Epidiolex with dramatic results. As such, an electroencephalography or EEG scan — which detects electrical activity in the brain — was done to reveal the impact of Epidiolex on his brain’s electrical patterns.
“No studies have been published that document the effect of [Epidiolex] on electroencephalography (EEG) yet,” the researcher wrote. “It is not yet known whether [Epidiolex] changes EEG and how it improves as the seizures get better in those who respond to the treatment with reduction in seizures.”
At age 9, this boy had absence seizures, which presented as lapses in awareness. An EEG scan showed patterns typically seen in those with this type of seizure.
Instead of medications, his parents partially controlled the boy’s seizures with a self-formulated ketogenic diet — a high-fat, low-carbohydrate diet that alters energy metabolism in the brain.
The child had his first generalized tonic-clonic seizure (GTCS) at age 10, which was characterized by a loss of consciousness, muscle stiffening, and jerking movements. At that time, EEG scans showed a transition into a typical LGS pattern.
Along with the keto diet, the boy was started on the anticonvulsant therapy levetiracetam. Still, his seizures continued with daily absence seizures and infrequent GTCS, and he was twice hospitalized with multiple episodes.
He was given the anti-seizure medicine phenytoin along with levetiracetam, which controlled his GTCSs. He also received high-dose steroids for five days, and the ketogenic diet was stopped. Despite these measures controlling most seizures, the same LGS-like EEG pattern persisted.
Some remaining absence seizures were controlled with the addition of Epidiolex, at a daily dose of 5 mg/kg of body weight, while maintaining phenytoin.
However, at the age of 10.5, the boy started having drop attacks (atonic seizures), or sudden spontaneous falls while standing or walking. The Epidiolex dose was increased to 11 mg/kg per day (total 350 mg/day), and he continued phenytoin.
The boy eventually became seizure-free and did not experience further seizures while receiving Epidiolex and phenytoin. He retuned to regular school classes and is learning at an age-appropriate level.
An EEG assessment five months after starting Epidiolex showed a near-normal pattern that was sustained with only mild, infrequent, epileptic-type patterns. Further MRI scans also were normal, and a genetic screen did not detect any disease-causing mutations.
“In conclusion, [Epidiolex] improves EEG patterns besides improving seizure control as our case demonstrates,” the author wrote. “Early intervention besides age of onset of LGS might influence outcome.”
The researcher said further investigation was needed into Epidiolex’s impact on EEG patterns.
“Larger studies and analysis of EEG in patients with unknown/genetic [cause] of LGS will be needed to confirm the finding,” he added.