Condition · ICD-11 8A60
Treatment-resistant epilepsy
Reviewed by Dr. Placeholder D (HPCSA MP0XXXXX · Neurology) · Last updated · Published
Treatment-resistant epilepsy — where seizures persist despite two or more appropriately chosen and dosed anti-seizure medications — is one of the indications with the strongest evidence base for high-CBD cannabinoid therapy, particularly in Dravet syndrome and Lennox-Gastaut syndrome. This pathway is rigorously gated. It is coordinated with the treating neurologist or paediatric neurologist; it is never initiated in isolation. Paediatric cases in particular require explicit involvement of the specialist team.
What the evidence says
Multiple randomised controlled trials of pharmaceutical-grade high-CBD formulations have demonstrated significant reductions in seizure frequency in Dravet syndrome and Lennox-Gastaut syndrome compared with placebo, and are FDA/EMA approved for these indications. The evidence for other epilepsy types is more limited. CBD has clinically relevant interactions with clobazam and valproate, which are commonly used in refractory epilepsy — careful dose management is essential.
How the doctor will evaluate you
Expect a requirement for recent neurology or paediatric-neurology correspondence, EEG summary, imaging if available, complete anti-seizure medication list with doses and trial durations, and seizure-diary data. Where paediatric cases are involved, the treating paediatric neurologist must be in the loop — Docto24’s doctors will not prescribe outside that coordination. LFTs and close monitoring are required when CBD is co-prescribed with clobazam or valproate.
When to see a doctor urgently
- Status epilepticus or recent acute neurology admission — defer until stabilised
- Liver-function derangement — monitoring pathway may be required
- Paediatric case without active paediatric-neurology involvement
- Incomplete medication-trial history
If any of the above apply, seek in-person medical care — do not wait for a remote Section 21 consultation.
The South African Section 21 pathway
Epilepsy is a well-established Section 21 indication in SA where conventional treatment has failed. Applications are supported by specialist correspondence; authorisations typically require LFT monitoring and clearly defined review points. Renewals depend on demonstrated clinical benefit.
Frequently asked
- Is this the same as buying CBD oil online?
- No. Consumer CBD products sold under Schedule 0 are limited to 600 mg per pack / 20 mg per dose and are for general health claims only — not for epilepsy treatment. Clinically relevant anti-seizure doses are pharmaceutical-grade formulations accessed under Section 21 on specialist advice.
- Can my child access this pathway?
- Paediatric cases are accepted only with the treating paediatric neurologist explicitly in the loop. Guardian consent and the specialist’s written support are prerequisites.
- What monitoring is required?
- When CBD is co-prescribed with clobazam or valproate, liver-function tests at baseline, 1 month, and 3 months are standard. Your doctor will discuss the schedule specific to your case.
Related conditions
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