Retrospective Analysis of Tetrahydrocannabinol Based on 31 Neurologically Critically Ill Children
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.