The effectiveness of cannabidiol as a clinical management tool in children and adolescents aged 1 to 18 years with epileptic syndromes and its impact on quality of life: a systematic review
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Abstract
Introduction: Epilepsy is a common neurological condition that impacts the quality of life of patients and their families. Cannabidiol (CBD) appears as a promising therapeutic alternative for the treatment of epilepsy, especially in children. Objective: This study reviews recent evidence on the effectiveness of CBD in reducing epileptic seizures in children aged 1 to 18 years and evaluates its impact on health and quality of life. Data Source: A systematic review was carried out in databases such as PubMed, Scielo and LILACS, resulting in 534 articles, of which 6 were selected following strict inclusion criteria, such as the type of cannabidiol used, the age of study participants and the need to evaluate quality of life outcomes during and after treatment. Data Synthesis: The results show that CBD is effective in reducing the frequency of epileptic seizures, with more than 75.0% of patients resistant to conventional treatments showing a reduction in seizures. Additionally, 11.9% of patients achieved seizure freedom after an average follow-up of 20 months, with improvements in sleep quality observed. Conclusion: Evidence suggests that CBD may be a valuable therapeutic option for pediatric epilepsy. However, more research is needed to understand the mechanisms of action, safety and clinical implications of cannabidiol in the treatment of children with epilepsy.
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References
1. Devinsky O, Marsh E, Friedman D, Thiele E, Laux L, Sullivan J, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. The Lancet Neurology [Internet]. 2016; 15(3):270-8. doi:10.1016/S1474-4422(15)00379-8.
2. Wang S, Zhang X, Wang Y, Zhou J. Medication compliance of children with epilepsy: a cross-sectional survey. Ital J Pediatr. 2023 Nov 16;49(1):153. doi:10.1186/s13052-023-01525-5.
3. Lima M, Silva A, Oliveira R, et al. Prevalência de epilepsia em crianças e adolescentes: um estudo multicêntrico no Brasil. Arq Neuropsiquiat. 2021 Mar 79(3):234-42.
4. Fine A, Wirrell EC. Seizures in Children. Pediatr Rev. 2020;41(7):321-347. doi:10.1542/pir.2019-0134.
5. Vicente AG, Dieguez AC, Amarante BT, Hortolam IM, Brito MG. Perfil epidemiológico das internações pediátricas por epilepsia no Brasil no período entre 2012 e 2022. Research, Society and Development. 2024;13(3):e3413345203.
6. Fisher RS, Acevedo C, Arzimanoglou A, Bogacz A, Cross JH, Elger CE, et al. ILAE Official Report: A practical clinical definition of epilepsy. Epilepsia. 2014;55(4):475-82. doi:10.1111/epi.12550.
7. Santana BR, Henrique G, Cruz M, Monteiro SG, Gonçalves IM. A eficácia do canabidiol no tratamento de pacientes pediátricos com a síndrome de Lennox-Gastaut: uma revisão integrativa. Brazilian Journal of Health Review. 2023;6(3):9948-58.
8. Szaflarski JP, Bebin EM, Comi AM, Patel AD, Joshi C, Checketts D, et al. Long-term safety and treatment effects of cannabidiol in children and adults with treatment-resistant epilepsies: Expanded access program results. Epilepsia. 2018 Jul 12;59(8):1540-8.
9. Devinsky O, Patel AD, Cross JH, Villanueva V, Wirrell EC, Privitera M, et al. Effect of Cannabidiol on Drop Seizures in the Lennox–Gastaut Syndrome. N Engl J Med. 2018; 378(20):1888-97. doi:10.1056/NEJMoa1714631.
10. Devinsky O, Cross JH, Laux L, Marsh E, Miller I, Nabbout R, et al. Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome. N Engl J Med. 2017;376(21):2011-2020. doi:10.1056/NEJMoa1611618.
11. Medeiros FC, Soares PB, Jesus RA de, Teixeira DG, Alexandre MM, Zardeto-Sabec G. Uso medicinal da Cannabis sativa (Cannabaceae) como alternativa no tratamento da epilepsia. Brazilian Journal of Development. 2020;6(6):41510-23.
12. Gouveia LDG, Sousa MNA de, Nogueira RB de S de S, Nogueira TB de S de S. Uso e eficácia de cannabidiol em pacientes com epilepsia: uma revisão sistemática / Cannabidiol use and effectiveness in patients with epilepsy: a systematic review. Brazilian Journal of Health Review. 2021;4(2):5209-20. doi:10.34119/bjhrv4n2-095.
13. Scheffer IE, Hulihan J, Messenheimer J, Ali S, Keenan N, Griesser J, et al. Safety and Tolerability of Transdermal Cannabidiol Gel in Children with Developmental and Epileptic Encephalopathies: A Nonrandomized Controlled Trial. JAMA Network Open. 2021;4(9):e2123930. doi:10.1001/jamanetworkopen.2021.23930.
14. Klotz KA, Grob D, Schönberger J, Nakamura L, Metternich B, Schulze-Bonhage A, et al. Effect of Cannabidiol on Interictal Epileptiform Activity and Sleep Architecture in Children with Intractable Epilepsy: A Prospective Open-Label Study. CNS Drugs. 2021 Nov;35(11):1207-1215. doi:10.1007/s40263-021-00867-0.
15. Caraballo R, Reyes Valenzuela R, Dermijian G. Uso del cannabis medicinal en niños con encefalopatías epilépticas farmacorresistentes. Experiencia en Hospital Garrahan. Med infant [Internet]. 2022 [cited 2024 Aug 31];205-11. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1399593?src=similardocs
16. Park YD, Linder DF, Pope J, Flamini JR, Moretz K, Diamond MP, et al. Long-term efficacy and safety of cannabidiol (CBD) in children with treatment-resistant epilepsy: Results from a state-based expanded access program. Epilepsy Behav. 2020;112:107474. doi:10.1016/j.yebeh.2020.107474.
17. Mitelpunkt A, Kramer U, Hausman Kedem M, Zilbershot Fink E, Orbach R, Chernuha V, et al. The safety, tolerability, and effectiveness of PTL-101, an oral cannabidiol formulation, in pediatric intractable epilepsy: A phase II, open-label, single-center study. Epilepsy Behav. 2019;98(Pt A):233-237. doi:10.1016/j.yebeh.2019.07.007.
18. Michel Marcos Dalmedico, Eduarda Sansigolo Bocchi, Ramos K, Miranda S. Evidências sobre a eficácia e segurança do canabidiol no tratamento da epilepsia infantil fármaco-resistente. Rev Ped SOPERJ. 2023;23(3)87-95. doi: http://dx.doi.org/10.31365/issn.2595-1769.v23i3p87-95.
19. Aderinto N, Olatunji G, Kokori E, Ajayi YI, Akinmoju O, Ayedun AS, et al. The efficacy and safety of cannabidiol (CBD) in pediatric patients with Dravet Syndrome: a narrative review of clinical trials. Eur J Med Res. 2024;29(1):182. doi:10.1186/s40001-024-01788-6.
20. Pereira PG, Pugliese FS, Silva MS, Andrade LG, Rinaldi Neto S. O uso do canabidiol em paciente com epilepsia. Revista Ibero-Americana de Humanidades, Ciências e Educação. 2021;7(9):424-433. https://doi.org/10.51891/rease.v7i9.2225
21. Mimura PMP, Ferreira LS, Pereira CL. Canabinoides no tratamento do autismo e epilepsia infantil. BrJP. São Paulo. 2023;6(2):S139-41.
22. Carvalho LAN, Cruz MDM, Oliveira PHF, Carvalho NO, Peres FM, Mendonça IS, et al. Revisão sistemática sobre os efeitos do canabidiol na epilepsia infantile. Brazilian Journal of Development. 2021;7(6):63347-61. doi:10.34117/bjdv7n6-625.
23. Vasconcelos TCL. Atividade terapêutica do canabidiol no tratamento da síndrome de Dravet. Research Development. 2023;12(5), e29712541792. doi:http://dx.doi.org/10.33448/rsd-v12i5.41792.
24. Júnior WSP, Farias MR. A eficácia terapêutica da Cannabis no tratamento da epilepsia: uma revisão sistemática. Brazilian Journal of Development. 2021 Jul 13;7(7):70956-63. doi:https://doi.org/10.34117/bjdv7n7-324.
25. Caldas NDBS, Batista FL. Uso do canabidiol no tratamento de crianças com epilepsia. Saúde & Ciência em Ação. [Internet]. 2022 [cited 2024 Aug 31];8(1):56-66. Disponível em: https://revistas.unifan.edu.br/index.php/RevistaICS/article/view/974
26. Júnior AMR, Paixão CS, Figueira LBS, Amâncio LJ, Almeida ACG. Uso do canabidiol como terapia alternativa para tratamento de epilepsia: revisão sistemática. Brazilian Journal of Development. 2022;8(5):40580-97. doi:https://doi.org/10.34117/bjdv8n5-509
27. Luiza M, Costa L, Garcia VF. Canabidiol para o tratamento de epilepsia em crianças: uma revisão crítica da literatura. Journal Archives of Health. 2024;5(3):e2205-5. doi: https://doi.org/10.46919/archv5n3espec-514
28. Teixeira CCC, Inácio GB, Lima JL, Freitas AJO, Costa MIV, Dias LHR, et al. O efeito do uso do Canabidiol em crianças com Epilepsia Refratária. Brazilian Journal of Development, 2022;8(7), 54307–27. https://doi.org/10.34117/bjdv8n7-347.
29. Sousa TMN, Rodrigues BCSP, Colaço PMC, Remígio AN, Fernandes CMJ, Silva SRM, et al. O impacto do canabidiol na qualidade de vida de crianças com epilepsia. Resid Pediatr. 2023;13(1). doi:10.25060/residpediatr-2023.v13n1-601.
30. Mendonça IS, Magalhães JD, Sousa GOS, Aragão AJV, França LG. O potencial terapêutico do Canabidiol no tratamento de epilepsias na infância. Rev. Est. Multidisc. UNDB [Internet]. 28 dez 2023 [citado 31 ago 2024];3(3). Disponível em: https://periodicos.undb.edu.br/index.php/rem/article/view/183
31. Dahmer DSV, Bonfati JW, Camargo EB, Elias FTS. O uso do canabidiol em crianças com epilepsia resistente a medicamento e a diminuição na frequência das crises: revisão rápida. Rev Cient Esc Estadual Saúde Pública de Goiás Cândido Santiago [Internet]. 2023 [cited 2024 Aug 31];9f1-EE3. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1524805
32. Sociedade Brasileira de Pediatria. Indicações para uso da Cannabis em pacientes pediátricos: uma revisão baseada em evidências. Documento científico da Sociedade Brasileira de Pediatria [Internet]. São Paulo: SBP; 2019 Dec [cited 2024 Aug 31]. Available from: https://www.sbp.com.br/fileadmin/user_upload/_22241c-DocCient_-_IndicUso_Cannabis_pacientes_pediat.pdf