Cognitive and behavioral effects of cannabidiol in patients with treatment-resistant epilepsy

Birgitta Metternich; Kathrin Wagner; Maximilian J Geiger; Martin Hirsch; Andreas Schulze-Bonhage; Kerstin A Klotz

doi:10.1016/j.yebeh.2020.107558

Cognitive and behavioral effects of cannabidiol in patients with treatment-resistant epilepsy

Epilepsy Behav. 2021 Jan;114(Pt A):107558. doi: 10.1016/j.yebeh.2020.107558. Epub 2020 Nov 25.

Authors

Birgitta Metternich¹, Kathrin Wagner², Maximilian J Geiger², Martin Hirsch², Andreas Schulze-Bonhage², Kerstin A Klotz³

Affiliations

¹ Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg Germany, Breisacher Straße 64, 79106 Freiburg, Germany. Electronic address: birgitta.metternich@uniklinik-freiburg.de.
² Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg Germany, Breisacher Straße 64, 79106 Freiburg, Germany.
³ Epilepsy Center, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg Germany, Breisacher Straße 64, 79106 Freiburg, Germany; Department of Neuropediatrics and Muscle Disorders, Medical Center-University of Freiburg, Faculty of Medicine University of Freiburg, Mathildenstraße 1, 79106 Freiburg, Germany; Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Germany.

PMID: 33246899
DOI: 10.1016/j.yebeh.2020.107558

Abstract

Purpose: Therapeutic use of cannabidiol (CBD) in intractable epilepsies has increased considerably over the last ten years. As more evidence for the potentially beneficial effects of CBD on different epilepsy types is emerging, it is important to monitor potential cognitive and behavioral side effects. So far, studies including standardized neuropsychological data in the context of treatment with CBD in epilepsy patients are sparse. The present open-label study examines cognitive and behavioral effects of CBD in children and adults with treatment resistant epilepsy.

Method: Thirty-nine patients with treatment-resistant epilepsy completed the study protocol, i.e. they were tested at baseline (T0) and after three months of CBD treatment (T1). Patients completed standardized neuropsychological tests on memory, executive functions and attention if they were capable. For cognitively impaired patients who could not complete cognitive tests, caregiver interviews were conducted and caregiver questionnaires completed.

Results: Significant cognitive decline from T0 to T1 was observed on none of the included measures. There was a significant improvement on a measure of selective attention and on a caregiver-rated behavioral measure. More than 89% of all individual test results remained stable or showed reliable improvement from T0 to T1. Cognitive and behavioral changes from T0 to T1 were not significantly correlated with CBD dose. Improvements in short-term/working memory were significantly related to better therapy response.

Conclusion: No adverse group-level effects of CBD treatment were detected. On an individual level, most test results remained stable or were improved. Cognitive change was not related to CBD dose. The present results show that, from a cognitive and behavioral point of view, CBD seems to have an encouraging side-effect profile. The results need to be replicated with larger samples.

Keywords: Adverse effects; Behavioral; Cannabidiol; Cognitive; Epilepsy; Treatment-resistant.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anticonvulsants / therapeutic use
Cannabidiol* / therapeutic use
Child
Cognition
Drug Resistant Epilepsy* / drug therapy
Epilepsy* / drug therapy
Executive Function
Humans

Substances

Anticonvulsants
Cannabidiol