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Objective To report our experience of cannabidiol in adults with Lennox Gastaut Syndrome (LGS).Methodology Retrospective record reviewResults Seventy-nine (40 male, aged 18-62 years) were followed up for up to 72 months (median 36.5). Sixty-seven (86%) continue on cannabidiol, 19 still undergoing titration. Eight withdrew due to side-effects/inefficacy. Four died of comorbidities unrelated to medication.At six months, 48(61%) achieved >50% reduction in overall seizures (50-75% n=26; 75-90% n=17; >90% n=5). Seizure-free days increased from an average of 7/month to 11/month. In 32 (41%), reduced buccal midazolam use was reported. Hospital attendance reduced from an average of 0.3/year to 0.05/year (21 unknown). In around half, cognitive improvements were reported. Clinically significant drug interactions with clobazam, valproate, lamotrigine and phenytoin necessitated dose adjustments. Liver function abnormalities in 12 responded to adjustments in valproate/clobazam. Diarrhoea (n=24) resulted in withdrawal (n=2) or dose reduction and slower/limited titration. Forty-one took regular clobazam before cannabidiol, 37 after, to satisfy NICE requirements for prescribing. Where not tolerated, minimal doses were used (≤2.5mg/day (n=29), ≤1mg/day (n=14). Concomitant medications were reduced (13). Titration/dose adjustments continued well beyond the 6 months reported here.Conclusion Cannabidiol demonstrates good efficacy and tolerability with high retention rates in adults with LGS.pyae.aung2@nhs.net