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The aim of this study is to evaluate efficacy, safety, and long\u2010term retention of CBD in a large pediatric population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We prospectively included all consecutive patients initiating CBD for drug\u2010resistant epilepsy at our pediatric tertiary center from 2019 to 2021. Efficacy and safety were assessed via parental questionnaires on seizure and non\u2010seizure outcomes at 1, 2, and 6\u2009months, comparing each item to prior clinic visits. Retention rate was evaluated at 18\u2009months.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 103 patients (mean age 11.2\u2009years), with 47% receiving CBD for label\u2010approved syndromes (23 DS, 15 LGS, 10 TSC) and 53% off\u2010label. At 1\u2009month, 54% of caregivers reported reduced seizure frequency and duration, with a positive overall impression in 62%. By months 2\u20136, 48% maintained seizure improvement, alongside sustained gains in communication (60%), alertness (54%), and motor skills (44%). Retention rates were 97% at 1\u2009month, 90% at 2\u2009months, 82% at 6\u2009months, 66% at 12\u2009months, and 55% at 18\u2009months. Off\u2010label use (<jats:italic>p<\/jats:italic>\u2009=\u20090.02), male gender (<jats:italic>p<\/jats:italic>\u2009=\u20090.049), and older age at initiation (<jats:italic>p<\/jats:italic>\u2009=\u20090.03) were associated with higher retention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>CBD reduced seizures and improved non seizures' morbidities in drug\u2010resistant epilepsy. Strong 18\u2010month retention rate, including off\u2010label use, highlights efficacy and tolerability, underscoring the need for further real\u2010world data in various rare epilepsy syndromes beyond its market approval.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ene.70304","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T05:53:27Z","timestamp":1758261207000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessing Real World Efficacy, Safety, and 18\u2010Month Retention Rates of Cannabidiol in Individuals With Drug Resistant Epilepsies"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2333-9408","authenticated-orcid":false,"given":"Nicole","family":"Chemaly","sequence":"first","affiliation":[{"name":"Department of Pediatric Neurology, Reference Center for Rare Epilepsies H\u00f4pital Necker\u2010Enfants Malades, Member of ERN EpiCARE  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5944-2204","authenticated-orcid":false,"given":"Mathieu","family":"Kuchenbuch","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Reference Center for Rare Epilepsies H\u00f4pital Necker\u2010Enfants Malades, Member of ERN EpiCARE  Paris France"},{"name":"Universit\u00e9 de Lorraine, CNRS, IMoPA  F\u201054000 Nancy France"},{"name":"Service de P\u00e9diatrie, Reference Center for Rare Epilepsies, Member of ERN EpiCARE Universit\u00e9 de Lorraine, CHRU\u2010Nancy  F\u201054000 Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Losito","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Reference Center for Rare Epilepsies H\u00f4pital Necker\u2010Enfants Malades, Member of ERN EpiCARE  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3805-6651","authenticated-orcid":false,"given":"Anna","family":"Kaminska","sequence":"additional","affiliation":[{"name":"Unit of Pediatric Neurophysiology Necker Enfants Malades Hospital, AP\u2010HP  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4063-5345","authenticated-orcid":false,"given":"Delphine","family":"Coste\u2010Zeitoun","sequence":"additional","affiliation":[{"name":"Unit of Pediatric Neurophysiology Necker Enfants Malades Hospital, AP\u2010HP  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6657-5040","authenticated-orcid":false,"given":"Giulia","family":"Barcia","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Paris Cit\u00e9  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4074-5862","authenticated-orcid":false,"given":"Isabelle","family":"Desguerre","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Reference Center for Rare Epilepsies H\u00f4pital Necker\u2010Enfants Malades, Member of ERN EpiCARE  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1742-3590","authenticated-orcid":false,"given":"Marie","family":"Hully","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Reference Center for Rare Epilepsies H\u00f4pital Necker\u2010Enfants Malades, Member of ERN EpiCARE  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5877-4074","authenticated-orcid":false,"given":"Rima","family":"Nabbout","sequence":"additional","affiliation":[{"name":"Department of Pediatric Neurology, Reference Center for Rare Epilepsies H\u00f4pital Necker\u2010Enfants Malades, Member of ERN EpiCARE  Paris France"},{"name":"Universit\u00e9 de Paris Cit\u00e9  Paris France"},{"name":"Laboratory of Translational Research for Neurological Disorders INSERM MR1163, Imagine Institute  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"A Summary of Antiseizure Medications Available in the United States","author":"Vossler D. 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