Cannabis for pediatric epilepsy: protocol for a living systematic review

Abstract

BackgroundPediatric epilepsy, including treatment-resistant forms, has a major effect on the quality of life, morbidity, and mortality of affected children. Interest has been growing in the use of medical cannabis as a treatment for pediatric epilepsy, yet there has been no comprehensive review of the benefits and harms of cannabis use in this population. In this systematic review, we will search for, synthesize, and assess the published and gray literature in order to provide usable and relevant information to parents, clinicians, and policy makers.MethodsWe will perform a living systematic review of studies involving the use of cannabis to treat pediatric epilepsy. We will search the published and gray literature for studies involving children with any type of epilepsy taking any form of cannabis. Studies will be selected for inclusion by two independent reviewers. The primary outcome is seizure freedom. Secondary outcomes are seizure frequency, quality of life (child, caregiver), quality and quantity of sleep, status epilepticus, tonic-clonic seizures, death (all-cause, sudden unexpected death in epilepsy), gastrointestinal adverse events (diarrhea, vomiting), and visits to the emergency room. The quality of each included study will be assessed. If data are sufficient in quantity and sufficiently similar, we will conduct pairwise random-effects meta-analysis. We will repeat the literature search every 6 months to identify studies published after the previous search date. Sequential meta-analysis will be performed as necessary to update the review findings.DiscussionOur review aims to provide a comprehensive and up-to-date summary of the available evidence to inform decisions about the use of cannabis in children with treatment-resistant epilepsy. The results of this review will be of use to parents, clinicians, and policy makers as they navigate this rapidly evolving area.Systematic review registrationPROSPERO CRD42018084755Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0761-2) contains supplementary material, which is available to authorized users.

Cannabis‐based products for pediatric epilepsy: A systematic review

“…The protocol for this review was published a priori, and we followed rigorous systematic review methodology. To ensure the relevance of our findings to decision making, two family members of children with epilepsy and a pediatric neurologist were collaborators on this project.…”

“…The systematic review protocol was developed using guidance from the PRISMA‐P statement, registered in PROSPERO (), and published . Two family members (C.A., A.E.R.)…”

“…The full analysis plan is available . Descriptive summaries are provided for study selection, study and patient characteristics, and quality assessment.…”

Cannabis sativa L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment

“…Drug-resistant epilepsy is diagnosed when symptom control cannot be achieved despite the use of at least two different antiepileptic drugs in an appropriate dose [ 101 ]. Epilepsy with the greatest resistance to treatment includes LGS, DS, fever-related epilepsy syndrome, and epilepsy in tuberous sclerosis syndrome (TSC) [ 102 ].…”

“…In recent years, there has been an increased interest in the use of Cannabis as part of the treatment of childhood epilepsy, among others, due to numerous media reports on children whose symptoms improved with Cannabis . Many parents of children struggling with drug-resistant epilepsy turn to alternative therapeutic measures, sometimes with doctors’ help and sometimes on their own [ 101 ]. A lot of attention was focused on a Colorado family who was looking for alternative treatments for a girl suffering from DS, Charlotte Figi.…”