Longitudinal impact of cannabidiol on EEG measures in subjects with treatment-resistant epilepsy

Leslie Grayson; Steve Ampah; Kathleen Hernando; Pongkiat Kankirawatana; Tyler Gaston; Gary Cutter; Jerzy P Szaflarski; Elizabeth Martina Bebin; UAB CBD Program

doi:10.1016/j.yebeh.2021.108190

Longitudinal impact of cannabidiol on EEG measures in subjects with treatment-resistant epilepsy

Epilepsy Behav. 2021 Sep:122:108190. doi: 10.1016/j.yebeh.2021.108190. Epub 2021 Jul 14.

Authors

Leslie Grayson¹, Steve Ampah², Kathleen Hernando³, Pongkiat Kankirawatana⁴, Tyler Gaston³, Gary Cutter², Jerzy P Szaflarski⁵, Elizabeth Martina Bebin³; UAB CBD Program

Affiliations

¹ Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA. Electronic address: leperry@uabmc.edu.
² Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA.
⁴ Division of Neurology, Children's of Alabama and University of Alabama at Birmingham, Birmingham, AL, USA.
⁵ Department of Neurology and the UAB Epilepsy Center, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Neurosurgery and Neurobiology, University of Alabama at Birmingham, Birmingham, AL, USA.

PMID: 34273739
DOI: 10.1016/j.yebeh.2021.108190

Abstract

Objective: To assess the longitudinal impact of highly purified cannabidiol (CBD) on the electroencephalogram (EEG) of children and adults.

Methods: Participants received an EEG prior to starting CBD, after approximately 12 weeks of CBD (FU1) and after approximately one year of CBD therapy (FU2). Longitudinal changes in five EEG measures (background frequency, focal slowing, reactivity, frequency of interictal, and ictal discharges) were examined following CBD exposure. Data were compared between pediatric and adult groups at two follow-up time points and within groups over time. Population-averaged models with generalized estimation equations or linear mixed effects models were used to analyze data where appropriate. Correlation analysis was used to assess any association between changes in seizure frequency and changes in EEG interictal discharge (IED) frequency. An alpha level of 5% was used to assess statistical significance.

Results: At FU1, the adult group showed significant decrease in IED/minute (IDR 0.07, 95% CI [0.04, 0.14], P < 0.001); a nonsignificant decrease was observed among children (IDR 0.87, 95% CI [0.47, 0.64], P = 0.67). The difference in changes over time between participant groups was significant after adjusting for last CBD dose (IDR 11.8, 95% CI [4.86, 28.65], P < 0.0001). At FU2 both groups showed significant reduction from baseline after controlling for last CBD dose. This decrease was more pronounced in children (IDR 15.38, 95% CI [4.93, 47.99], P < 0.001). There was no significant correlation between changes in seizure frequency and EEG IED frequency at each timepoint (P = 0.542, 0.917 and 0.989 from baseline to FU1, FU1 to FU2 and baseline to FU2, respectively).

Significance: This longitudinal EEG study shows that highly-purified plant-derived CBD has positive effects on interictal epileptiform discharge frequency but no effects on other EEG measures. The effect of CBD does not appear to be dose or treatment-duration dependent.

Keywords: Cannabidiol (CBD); Electroencephalogram (EEG); Epidiolex®; Epilepsy; Interictal discharges (IED).

Publication types

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

MeSH terms

Adult
Cannabidiol* / therapeutic use
Child
Drug Resistant Epilepsy* / drug therapy
Electroencephalography
Epilepsy* / drug therapy
Humans
Seizures

Substances

Cannabidiol