Inadequate seizure control is still common in patients with drug-resistant epilepsy (DRE). Traditional anti-seizure medications (ASMs) can often cause severe adverse effects, and therefore there continues to be a growing interest in marijuana-based therapy (MBT) products to help treat epilepsy [1], [2]. Following several major placebo-controlled randomized trials, pharmaceutical-grade cannabidiol (CBD) was approved by the FDA in June 2018 for seizure control in patients greater than 2 years of age with Dravet Syndrome (DS) or Lennox-Gastaut Syndrome (LGS). In patients with these drug-resistant epilepsies (DREs), MBT has been shown to offer significant reduction in seizure frequency [3].

Several randomized clinical trials have explored the risk and benefits associated with MBT; however, there is limited research exploring the clinical benefit of trying a different MBT formulation(s) after a first is tried. Artisanal MBT encompasses all other non-pharmaceutical-grade MBT, including medical marijuana, hemp oils, and other commercially-available MBT products. Hemp is defined under the 2018 Farm Bill to include any cannabis plant, or derivative thereof, that contains not more than 0.3% delta-9 tetrahydrocannabinol ("THC”) on a dry-weight basis [4].

In this retrospective study, we reviewed the response to a second MBT after a first was already tried. Specifically, we studied efficacy rates in patients taking artisanal products, pharmaceutical-grade MBT, and hemp. The goal of this study was to determine if utilization of different MBT formulations would be effective after a first is tried.