What is Sudden Unexpected Death in Epilepsy Patients (SUDEP)

Seizures in 20-30% of epileptics are resistant to treatment with anti-epileptic drugs (AED). This chapter evaluates studies on the efficacy of cannabinoids as adjunctive therapy for control of intractable seizures, with a focus on developmental epileptic encephalopathies (DEE). A systematic review conducted by literature search through PubMed, EBSCO, and ProQuest electronic databases identified 16 studies in the last seven years. Moderate- to low-certainty of evidence supports the benefits of cannabinoids in reducing seizure frequency, intensity, duration, and epileptics' overall condition in many types of intractable seizures. Studies used either synthetic cannabidiol (CBD), highly purified plant-derived CBD (Epidiolex®), or less pure cannabis plant-based CBD oils, and extended over months to two years. Drug interactions of ingested CBD with concomitant valproate and clobazam could be avoided with sublingual CBD. Five percent of patients became seizure free. Future studies are warranted to optimize the anti-seizure effects of emerging cannabinoid treatment strategies.