Abstract
The growing interest in cannabidiol (CBD) emphasizes the need for data on effects, side effects, and mode of action in various domains. Parents self-medicate children with severe illnesses in the hope of a cure despite the lack of safety data.
A 4-year-old female patient who is an identical twin was diagnosed in 2013 with a cerebellar pilocytic astrocytoma (CPA) located in the medulla oblongata; chemotherapy was administered for 12 months and an open biopsy and fenestration of the cyst was performed. Magnetic resonance imaging of the brain showed regression of the size of the cyst and the patient was stable from a neurological perspective except for transient dysarthria, dizziness, and fatigue. Parent report regarding sequelae (anamnestic interview) revealed nausea, fatigue, mood instability, memory deficits, irritability, little appetite, and dysarthria when the cyst filled with cerebrospinal fluid. CPA constitutes the second largest tumor group, which is usually accompanied by a range of long-term sequelae (Pletschko et al. 2018).
In 2018, the patient was started on CBD 180 mg by the general practitioner. When CBD was stopped due to financial reasons after 2 months, the family observed the following symptoms which reportedly decreased daily functioning: reduced appetite, increased fatigue, and intermittent irritability. Therefore, the parents requested prescription of CBD. It was agreed to prescribe CBD for a trial period with close monitoring of effects and possible side effects of the substance to decide whether CBD should be prescribed on a regular basis. After a 4-month washout phase, 200 mg CBD oral solution was administered daily for 3 months starting with 50 mg, increase to 100 mg for the second week followed by 200 mg.
Results
See Table 1 for detailed results regarding psychological assessment at three time points.
Overview Over Key Psychological Parameters at Three Time Points
All information regarding the psychological assessments are in the Supplementary Data.
CBCL, Child Behavior Checklist; GBB-KJ; inconsp, inconspicuous; IQ, intelligence quotient; KINDL, Health-related Quality of Life Assessment in Children; KITAP, Testbatterie zur Aufmerksamkeitsprüfung für Kinder (Test Battery for Attention in Children); PR, percentile rank; VLMT, Verbaler Lern-und Merkfähigkeitstest (The Auditory
All information regarding the psychological assessments are in the Supplementary Data.
Discussion
Several changes were noted in the field of cognitive performance, behavior, and quality of life in a juvenile CPA patient with a decline after cessation of CBD. This led the pediatrician to prescribe CBD as a long-term treatment for this child. Apart from a slight improvement in overall cognitive functioning (WISC), minor declines in attentional functioning were observed. Determining whether this is due to a potentially neurocognitive effect of CBD is difficult at this stage. Similarly, the small effects on body-related quality of life (fewer colds and less fatigue) might be due to anti-inflammatory potential of CBD, and the slight decrease in aggressive behavior may be attributed to an enhancement of frontostriatal connectivity as postulated by Grimm et al. (2018). In sum, however carefully designed research, in the best case RCTs are needed to further substantiate these associations and establish causality.
When declining treatment to a patient, clinicians should consider what might happen: self-medication, no evaluation of side effects, unsafe sources through internet with the risk of contamination (Rianprakaisang et al. 2020). As a recent review states: “The most we can do is encourage patients to at least talk to us if they are considering trying or have already tried CBD….” (VanDolah et al. 2019). The authors aim to direct patients toward products that appear to be safer, monitor their liver function and potential interactions between CBD and other drugs they are taking.
Footnotes
Authors' Contributions
C.M.K., A.F., C.L., G.P.A. and O.D.K. conceptualized and designed the study; C.M.K., A.F., and G.P.A. drafted the initial article; A.F. and O.D.K. designed the data collection instruments, collected, and analyzed the data. All authors contributed to article revision, read and approved the submitted version.
Informed Consent and Assent
The study was exempt from ethics approval as only a single case was studied; both parents gave written informed consent and the child gave oral consent.
Disclosures
No competing financial interests exist.
Supplementary Material
Supplementary Data
References
Supplementary Material
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