Introduction: Exploring CBD in Epilepsy Treatment
The use of cannabidiol (CBD) as a treatment for monogenic epilepsies is an area of growing interest. This study aims to evaluate how effective highly purified CBD can be for patients with genetic epilepsy, including those who have not been part of approved CBD indications.

Study Overview
This multicenter, retrospective study included 266 patients from 27 epilepsy centers. All participants had monogenic epilepsies and were treated with CBD for at least three months. The median age at treatment initiation was 12 years, and the average follow-up was 17 months.

Genetic Causes of Epilepsy
The study involved a range of genetic mutations, with SCN1A being the most common at 32.3%. Other prevalent genes included TSC2 (13.5%) and CDKL5, MECP2 (both at 4.5%). These genetic variations allowed the study to look at how different mutations influenced CBD’s effectiveness.

CBD’s Impact on Seizure Reduction
Overall, patients showed a 38.6% reduction in seizures. Notably, 47.5% of patients experienced a reduction of at least 50%, and 7.4% achieved seizure freedom. These promising results highlight CBD’s potential as a therapeutic option.

Factors Affecting CBD Effectiveness
Several factors influenced treatment outcomes. Specifically, patients with a shorter duration of seizure freedom before CBD treatment or those with a higher degree of intellectual disability showed a lower response to CBD. Interestingly, no significant differences in outcomes were observed between approved CBD uses and off-label uses.

Conclusion: Potential of CBD in Treating Genetic Epilepsies
This study supports the potential of CBD for treating monogenic epilepsies beyond its approved indications. While outcomes may vary by genetic subgroup, CBD appears to be a viable treatment option for many patients, with future studies needed to further refine its use.

Keywords: CBD, Lennox–Gastaut syndrome, developmental and epileptic encephalopathy, effectiveness, epilepsy, intellectual disability