Condition · ICD-11 8A60
Treatment-resistant epilepsy
Reviewed by the Docto24 clinical team · 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.
- How is this different from pharmaceutical-grade CBD products like Epidiolex?
- Pharmaceutical-grade CBD (such as Epidiolex internationally) is a standardised, regulator-approved formulation with established dosing for specific epilepsy syndromes (Dravet, Lennox-Gastaut, tuberous sclerosis). In SA, accessing it requires a Section 21 application — the product itself is not routinely registered locally. The doctor will help identify which formulation is most appropriate for your seizure type.
- What happens if my CBD interacts with another anti-seizure medication?
- Clinically significant interactions exist with clobazam and valproate especially. The neurologist may recommend a dose adjustment of the existing anti-seizure medication when CBD is initiated, alongside the LFT monitoring schedule. These interactions are predictable and manageable — they require monitoring, not avoidance.
Related conditions
Glossary — terms used on this page
Quick definitions for terminology referenced above. Each links to a fuller entry.
- CBD (cannabidiol)Non-psychoactive cannabinoid with established use in some seizure disorders and emerging use in anxiety.
- CYP450Family of liver enzymes that metabolise many drugs, including cannabinoids — source of many clinically relevant interactions.
- Section 21SAHPRA authorisation for access to unregistered medicines — the primary legal pathway for medical cannabis in SA.
- Named Patient Application (NPA)A Section 21 application for a single, identified patient.
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