Report of a 6-month-old Asian infant with early infantile epileptic encephalopathy whose seizures were eliminated by cannabidiol.

Case Reports

. 2020 Jun 8;14:100373.

doi: 10.1016/j.ebr.2020.100373. eCollection 2020.

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Case Reports

Yuji Masataka et al. Epilepsy Behav Rep. .

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Abstract

We observed that cannabidiol supplements were highly effective in treating an infant boy with drug-resistant early infantile epileptic encephalopathy, eliminating his intractable tonic seizures. The infant began suffering clusters of brief tonic seizures from birth at 39 weeks gestation. EEG showed burst-suppression and seizures could not be controlled by trials of phenobarbital, zonisamide, vitamin B6, clobazam, levetiracetam, topiramate, phenytoin, valproate, high-dose phenobarbital, and ACTH therapy. The boy was discharged from hospital at 130 days of age still averaging tonic seizures 20-30 times per day. We started him on a cannabidiol supplement on day 207, increasing the dosage to 18 mg/kg/d on day 219. His seizures reduced in frequency and completely disappeared by day 234. These effects were maintained, with improved EEG background, even after his other medications were discontinued. Cannabidiol’s effectiveness in treating drug-resistant epilepsy has been confirmed in large-scale clinical trials in Europe and the United States; however, no such trials have been run in Asia. In addition, no reports to date have documented its efficacy in an infant as young as six months of age. This important case suggests that high-dose artisanal cannabidiol may effectively treat drug-resistant epilepsy in patients without access to pharmaceutical-grade CBD.

Keywords: ACTH, adrenocorticotropin hormone; Br, bromide; CBD, cannabidiol; CLB, clobazam; Cannabidiol; EEG, electroencephalogram; EIEE, early infantile epileptic encephalopathy; Early infantile epileptic encephalopathy; Epilepsy; LEV, levetiracetam; LTG, lamotrigine; Medical marijuana; PB, phenobarbital; PHT, phenytoin; THC, tetrahydrocannabidiol; TPM, topiramate; VPA, valproic acid; ZNS, zonisamide.

Conflict of interest statement

Authors YM, IT, HY have no conflict of interest. EM is a member of Greenwich Pharmaceutical Speakers Bureau Program. This report is not a funded research.

Figures

Fig. 1a

Fig. 1a

Sleep EEG (day 30): Burst–suppression pattern with 3–4 s of suppression between bursts of high amplitude slow wave with multi-focal spikes.

Fig. 1b

Fig. 1b

EEG during an attack (day 30): brief generalized spikes were recorded. Epileptic spasms were recorded on video synchronous with the high amplitude slow waves with overriding fast activity.

Fig. 2a

Fig. 2a

Seizure chart (Day 0–30). Vertical axis: number of generalized seizures per day. Horizontal axis: Age (day). PB: phenobarbital, MDZ: midazolam, DZP: diazepam, ZNS: zonisamide, VitB6: vitamin B6, CLB: clobazam, LEV: levetiracetam, PHT: phenytoin.

Fig. 2b

Fig. 2b

Seizure chart (Day 30–120). Vertical axis: number of generalized seizures per day. Horizontal axis: Age (day). PB: phenobarbital, ZNS: zonisamide, PHT: phenytoin, VPA: sodium valproate, TPM: topiramate, ACTH: adrenocorticotropic hormone, LTG: lamotrigine, Br: potassium bromide.

Fig. 3

Fig. 3

Seizure event diary around CBD initiation. The patient started taking CBD paste (50 mg/day) noted at first white line and increased to CBD tincture (150 mg/day) noted at second white line. Hash marks are individual tonic seizures observed by parents. Daily count summarized in the column to the far right of the day number.

Fig. 4

Fig. 4

Seizure chart after discharge (Day 121–460). Vertical axis: number of generalized seizures per day. Horizontal axis: Age (day). PB: phenobarbital, LTG: lamotrigine, Br: potassium bromide, CBD: cannabidiol.

Fig. 5

Fig. 5

Sleeping EEG (Day 326). Background rhythms improved compared with Fig. 1a, Fig. 1b.

References

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