For the use of cannabis-based medicinal products in severe treatment-resistant epilepsy, the guidance refers to two technology appraisals which are currently in DRAFT stage (final appraisal determination): the use of cannabidiol for adjuvant treatment of seizures associated with Lennox-Gastaut syndrome, and for adjuvant treatment of seizures associated with Dravet syndrome.
Both of these DRAFT technology appraisals recommend cannabidiol with clobazam as an option for treating seizures associated with these conditions in people aged 2 years and older, only if the frequency of drop seizures is checked every 6 months and cannabidiol is stopped if the frequency has not fallen by at least 30% compared with the 6 months before starting treatment.
Separately, in this guidance NICE now recommends tetrahydrocannabinol and cannabidiol spray (Sativex) as a 4 week trial to treat moderate to severe spasticity in adults with multiple sclerosis, if other pharmacological treatments for spasticity are not effective (see the recommendations on spasticity in NICE's guideline on multiple sclerosis in adults), and the company provides the product according to its pay-for-responders scheme. After the 4-week trial, the spray may be continued if the person has had at least a 20% reduction in spasticity-related symptoms on a 0 to 10 patient-reported numeric rating scale.