Jednoczesne stosowanie diety ketogenicznej i kannabidiolu u dzieci i dorosłych z epilepsją: wieloośrodkowe badanie retrospektywne

Cannabidiol (CBD) and Ketogenic Diet Therapy (KDT) are evidence-based treatments for pharmacoresistant epilepsy with growing popularity in recent years. Even though CBD and KDT are used for many of the same indications, there is only limited research that characterizes the interactions between these two treatments. We conducted a retrospective chart review of subjects who were treated for epilepsy with CBD and KDT at our institutions. Fifty-eight participants (median age 2 years at combination therapy initiation (range 0-60)) were identified who received combined CBD and KDT between 2018 and 2025. The average duration of combination therapy was 17.4 months. Forty-four (76%) of the participants received prescription CBD (Epidiolex™) and 14 (24%) received artisanal CBD; 35 (60%) were on the classic ketogenic diet. Thirty-three (57%) received CBD before starting KDT. At 1 and 3 months, 40% and 28% had > 50% seizure reduction, respectively. Overall, 87% reported moderate-large urinary ketosis, and for those who added CBD to KDT, 8/13 had no change in ketosis. Five (15%) with documented liver function tests before and during the combination had increased values, mostly minor. Younger patients were more likely to start the classic KD, be treated with prescription cannabidiol, and not lose weight. There was greater seizure reduction when CBD was initiated before KDT rather than after. Overall, the results of this study show similar efficacy of the combination therapy in treating epilepsy compared to either CBD or KDT alone, but suggests it is worth considering as an additive option, especially when KDT is added to CBD.