Neuropediatrics 2015; 46 - PS01-40
DOI: 10.1055/s-0035-1550707

Retrospective Analysis of Tetrahydrocannabinol Based on 31 Neurologically Critically Ill Children

M. Schimpfößl 1, S. Berweck 1, C. Betzler 1, E. Dotzler 1, T. Herberhold 1, M. Pringsheim 1, M. Staudt 1, C. von Stülpnagel-Steinbeis 1, G. Kluger 1
  • 1Schön Klinik Vogtareuth, Vogtareuth, Germany

Aims: Tetrahydrocannabinol (THC), the psychoactive main substance of cannabis, is increasingly used as an off-label therapy. The aim of our study was to investigate the efficacy in neurologically critically ill children.

Methods: The evaluation of the efficacy of an in-patient THC treatment was investigated by a pediatric nurse and a neuropediatrician, based on the patient's charts using a sum score of individual effects on spasticity, dystonia, pain, agitation/vegetative disorders, mood, sleep, feeding, and epileptic seizures.

Results: The patients, n = 31; age 0.5 to 21 years; mean: 9. The patient is suffering from mainly severe residual defects after near-drowning (n = 5), asphyxia (n = 4), other hypoxic events (n = 8) and brain injury (n = 3) with prolonged disorders of consciousness (n = 27), pharmacoresistant symptomatic epilepsies (n = 28), nutritional disturbances with gastric tube feeding (n = 29) as well as artificial ventilation/tracheostoma (n = 6). Overall, six patients could not be evaluated.

Effectiveness: An ongoing positive effect was noticed in 44% (11/25) and classified as light in six, obvious in four cases, and strong in one patient. Individual positive effects were noticed in mood disturbance (4/6; 67%), agitation/vegetative disorders (7/16; 44%), spasticity (3/8; 38%), sleep disorders (2/4; 50%), and pain (3/3; 100%). An effect on epileptic seizures could not be noticed. Temporary effects remained unconsidered in the statistical evaluation.

Side effects: The side effects were tiredness n = 6; increase of opisthotonus n = 1; decline of valproic acid blood level n = 2.

Conclusion: Considering all the limitations of our retrospective study, THC showed an overall ongoing positive effect with good tolerability in 44% of the patients studied, who are mainly in palliative situations. An improvement on epileptic seizures could not be noticed. Further controlled (long-term) studies on THC and not psychoactive substances of cannabis, such as cannabidiol, are needed as well as a clear definition of the therapeutic aims.

Keyword: tetrahydrocannabinol.