Rising potential of cannabidiol in epilepsy treatment: addressing efficacy and challenges

Cannabidiol (CBD), a major component of Cannabis sativa, has gained significant attention for its potential in treating epilepsy, particularly drug-resistant forms such as Dravet syndrome (DS), Lennox-Gastaut syndrome (LGS), and tuberous sclerosis complex (TSC). Although the use of CBD in epilepsy began anecdotally, randomized controlled trials have since confirmed its efficacy. Studies using pharmaceutical-grade CBD have demonstrated significant reductions in seizure frequency, especially in patients with DS and LGS, where reductions of 37-49% were observed. Despite these successes, its effectiveness across all forms of epilepsy remains under investigation.

The exact mechanism of CBD's anticonvulsant effects is not fully understood, though it is believed to involve the modulation of intracellular calcium signaling and adenosine pathways. Notably, CBD has proven effective at reducing various seizure types, with a particularly notable impact on motor seizures. Additionally, long-term studies have shown sustained seizure control, with reductions of up to 50% over prolonged periods. However, CBD is not without side effects; patients commonly report somnolence, diarrhea, decreased appetite, and elevated liver enzymes, particularly when combined with other antiepileptic drugs like clobazam.

Challenges with CBD include its high cost, drug interactions, and the variability in product quality across non-pharmaceutical preparations. The growing demand for CBD has led to self-medication, often fueled by high patient expectations and unregulated products. As research continues, the focus remains on confirming the broader efficacy of CBD while addressing the economic and safety concerns tied to its use in epilepsy management.