Medical Cannabis for Epilepsy UK: Epidyolex, Access and Evidence

Cannabis and Epilepsy: The Strongest Evidence in the Field

Epilepsy is the condition with the most robust clinical evidence for cannabis-based treatment. Epidyolex - a pharmaceutical-grade CBD medicine derived from cannabis - is fully licensed by the MHRA and available on NHS prescription for two specific rare epilepsy syndromes. This makes epilepsy unique among cannabis medicine indications in the UK.

Epidyolex: The Licensed NHS Option

Epidyolex (cannabidiol, 100mg/ml oral solution) is licensed for:

• Dravet syndrome: A severe form of childhood epilepsy characterised by prolonged seizures often triggered by fever. Phase III trials showed Epidyolex reduced seizure frequency by 39% compared to 13% for placebo.
• Lennox-Gastaut syndrome (LGS): A severe childhood epilepsy with multiple seizure types. Epidyolex reduced drop seizures by 37-42% in clinical trials.
• Tuberous sclerosis complex (TSC): Added in 2021 as a third indication. Phase III trials showed 48% reduction in seizures.

Epidyolex is prescribed by NHS paediatric neurologists. It is not available over the counter and requires specialist NHS referral.

Adult Epilepsy: The Private Prescribing Gap

For adults with epilepsy that does not qualify for Epidyolex - or adults who have not responded to Epidyolex - private cannabis clinics can prescribe a wider range of products including higher-dose CBD oils and in some cases THC-containing medicines.

Evidence from adult epilepsy trials is less robust than paediatric data, but real-world studies from UK clinics show meaningful seizure reduction in approximately 40-50% of patients with treatment-resistant epilepsy.

Which Types of Epilepsy Respond to Cannabis?

• Treatment-resistant epilepsy: Defined as failure of 2+ anti-epileptic drugs. Cannabis is most studied in this population.
• Focal epilepsy: Some evidence of seizure reduction with CBD.
• Generalised epilepsy: Variable response depending on syndrome type.
• Febrile seizures: Not an established indication for cannabis.

Getting a Prescription for Epilepsy

For Epidyolex: referral through your NHS neurologist if you or your child has Dravet syndrome, LGS or TSC.

For private cannabis prescribing for other epilepsy presentations: specialist cannabis clinics with neurologists on the team. Sapphire Medical and Zerenia have established epilepsy programmes. Documentation required includes seizure diary, neurology letters, and records of anti-epileptic drugs tried.

Costs

NHS Epidyolex: available on prescription with standard NHS prescription charges. Private cannabis prescribing for epilepsy: initial consultation £150-199, monthly medicine costs £100-250 depending on products prescribed.