Severe, Refractory Epilepsy


Severe, Refractory Epilepsy

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. They can cause a wide range of symptoms. Epilepsy can start at any age, but usually starts either in childhood or in people over 60. It's often lifelong, but can sometimes get slowly better over time.  Refractory epilepsy is a form of epilepsy that does not respond to treatment with medication


The symptoms of refractory epilepsy are seizures despite taking anti-seizure medication. Your seizures could take different forms and last from a few seconds to a few minutes.

You may have convulsions, which means you can't stop your body from shaking. When you have a seizure, you may also:

  • Black out
  • Lose control of your bowels or bladder
  • Stare into space
  • Fall down suddenly
  • Get stiff muscles
  • Bite your tongue


Anti-epileptic drugs (AEDs) are the mainstay for the treatment of epilepsy and are
intended to mitigate seizures. AEDs primarily act by reducing neurotransmitters which
increase neuronal excitability (e.g. glutamic acid) and enhancing inhibitory neurotransmitters (e.g. GABA).

Despite the growing number of AEDs, approximately 1/3 of people with epilepsy (PWE) have persistent seizures. Surgical treatment may be an alternative in up to 25% of these cases.

THC rich compounds are not recommended because their effect on seizure control is uncertain and they have psychotropic effects. They may present a risk of dependence, depression, psychosis and suicide attempts. CBD has a better safety profile. Usually, adverse events are mild and only observed in the first month. The most frequent adverse events are drowsiness, reduced appetite, diarrhoea, vomiting, fatigue and fever.  The discontinuity rate associated with CBD is low.

CBD is seen as an effective treatment for patients with Dravet and Lennox-Gastaut syndromes. The use of cannabis and other THC rich products is questioned because of its dubious effect on seizure control and negative psychotropic effect

Find out more about the treatment of medical cannabis for Severe, Refractory Epilepsy under the MCAP

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