Dados do Trabalho

Título

THE USE OF CANNABIDIOL IN REFRACTORY EPILEPSY

Apresentação do caso

H.C.D.M., 6 years old, female, white, single, student.
Patient born by cesarean section, at term, with adequate weight.
Fruit of the 2nd pregnancy, from non-consanguineous parents.
Gestation, childbirth and post childbirth without complications.
Father with an epileptic history.

The patient started epileptic condition at 1 year of age, in 2017, with recurrent spasms that were difficult-to-control. In July/2020, at 4 years of age, she had 3 types of seizures - atonic, spasms and absence - with an average of 60 to 80 seizures a day, in addition to aggressive behavior, psychomotor agitation and NPMD with speech delay. She was using phenobarbital, clobazam and levetiracetam.

Discussão

The patient started follow-up in July/2020 at the Pediatric Epilepsy Ambulatory due to refractory epilepsy. At first, the doses of medications in force at the time were adjusted. She progressed without significant clinical improvement, and doses were adjusted and/or medications replaced at each medical visit. There were several therapeutic failures. The patient used sodium valproate, sodium divalproate, levetiracetam, vigabatrin, ACTH and corticosteroids. She did ketogenic therapy for a certain time, in an external service. During the follow-up, the patient evolved with a change in one of the types of crisis, presenting atonic, absence and bilateral tonic-clonic.
In May/2022, when she was using phenobarbital, clobazam, topiramate, risperidone and pyridoxine, it was opted to start using cannabidiol gradually, in an incessant attempt to control the crises, adding it to the other current medications. It started with 1mg/kg/day of cannabidiol, reaching a dose of 3.5mg/kg/day (cannabidiol 6000mg - 100mg/ml). Evolved with significant improvement in epileptic seizures, behavior and NPMD. The patient had days with only 1 episode of crisis and even days without crisis, after the introduction of cannabidiol in his treatment.

Exams already performed described below:
Skull CT (August/2018): Exam within the normal range.
Skull MRI (August/2020): Exam within the normal range.
EEG (September/2020): Exam in spontaneous sleep, showing disorganization and diffuse and bilateral slowing, multifocal pattern and generalized discharges of short duration.
Rare Genome Project (June/2021): Result in progress.

Comentários finais

Epilepsy is a chronic disease, of varied etiology and evolution, treated with anticonvulsant drugs in order to stop epileptic seizures as early as possible, minimizing cognitive, motor and social damage that directly harm the life of the patient and their families. However, 30% of cases are refractory to treatment.
In this scenario, the use of cannabidiol, alone or associated with other medications, has been shown to be a safe and effective alternative in reducing the frequency and severity of seizures, especially in drug-resistant epilepsies. The absence of adverse effects and severe toxicities, together with the absence of neurological and psychiatric alterations, are relevant points in its use. However, clinical studies are necessary to evaluate the ideal dose, drug interactions and effects with prolonged use.
Currently, the patient in question shows a significant improvement in her epileptic condition after the introduction of cannabidiol in her pharmacological therapy - she maintains a good clinical evolution and follows in a diagnostic investigation of her difficult-to-control epilepsy.

Declaração de conflito de interesses de TODOS os autores

Declaramos não estarmos submetidos a qualquer tipo de conflito de interesse, direto ou indireto, para o desenvolvimento do projeto de pesquisa intitulado "THE USE OF CANNABIDIOL IN REFRACTORY EPILEPSY", cujo os pesquisadores envolvidos são os autores previamente inscritos nesse trabalho.