Facharzt für Kinderneurologie, Universität Ljubljana
Leiter des "Paediatric Council" im Gesundheitsministerium in Slowenien
VORTRAG: Die Verwendung von Cannabinoiden und medizinischem Cannabis in der Kinderneurologie
Dr. med. Prof. Dr. David Neubauer ist auf die Neonatale Neurologie, Kinderneurophysiologie, seltene Neurodegenerative und Neurometabolische Erkrankungen spezialisiert. Prof. Neubauer wird in seinem Vortrag von seinen Erfahrungen und aktuellen Studien zum Einsatz von Cannabinioiden (vorrangig CBD und THC) in der Kinderneurologie berichten.
Hier eine Zusammenfassung seines Vortrags (in englischer Sprache):
The interest of researchers, the pharmaceutical industry and especially clinicians for treatment with cannabinoids (especially cannabidiol – CBD) and natural cannabis products (or medicinal grade cannabis – MGC, which also contains certain amounts of delta-9-tetrahydrocannabinol - THC) has increased enormously during the past decade. At the beginning there were just anecdotal reports about the benefits of these substances for use with children having resistant epilepsies and some other severe neurological conditions. Thereafter, a few open-label studies appeared on a small number of such children, confirming the efficacy of cannabidiol and MGC (Devinsky et al, 2016, Tzadok et al., 2016) and today there are multicentre and randomised, double blind, placebo-controlled trials confirming these facts (Devinsky, Marsh et al., 2016, Devinsky et al., 2017. Thiele et al., 2018). In our own study (Neubauer et al., 2018) from a single tertiary centre in Slovenia we have also seen excellent results (using only pure CBD), as out of 66 children with severe epilepsies and even encephalopathies, thirty-two (48.5%) patients had a more than 50% improvement regarding seizure burden, 14 of whom (21.2%) became seizure-free. None of the patients reported a worsening of seizure frequency, and adverse effects were very mild and reported in only 5 of 66 children. Recently the first cannabis-derived medication got approval from the US Food and Drug Administration (FDA) and waiting for approval from European Medicines Agency (EMA). This CBD formulation significantly reduces seizures as an adjunct to standard antiepileptic therapies in patients ≥2 years old with severe epilepsy syndromes (Devinsky et al., 2019)
Even beyond epilepsies and encephalopathies there are also research data on excellent results for the treatment of some other severe neurological conditions. Possible effective targets in the near future will be: severe brain damage due to hypoxia at birth (hypoxic-ischaemic encephalopathy), autism and other developmental disorders, obsessive-compulsive behaviour, tics and Gilles de la Tourette syndrome, and especially spasticity and dystonia in children with cerebral palsy (Devinsky et al., 2014). Until today not many studies are available for these indications; however, in a study carried out in Germany using synthetic THC (dronabinol) for severe cases of spasticity, either in CP children or in children with neurodegenerative disease, dronabinol (in low doses - from 0.08 to 1.0 mg/kg/d with a median of 0.33 mg/kg/d) showed promising effects in treatment-resistant spasticity (Kuhlen M et al., 2016). And there is new study from an Israeli group, which revealed a significant improvement in spasticity and dystonia, and (which is even more important) in the quality of life of children and their families (improvement in sleep and less pain) using two different enriched-cannabis extracts with ratios of CBD:THC 20:1 and 6:1, respectively, with few side effects (Libzon S. et al., 2018). It seems that today more and more clinicians opt to use CBD or MGC in those children where standard treatment options do not give valuable or effective results. We believe that this is the reason why, together with well-designed and planned research studies (including randomized, double-blind, placebo-controlled trials), their use in children with severe neurological impairments and disabilities will expand in future years.
Projects (cooperation) EU and International:
- Hypoxic-ischaemic encephalopathy
- RESPECT – ethical issues on children research
- nEUroped – rare diseases in neuropaediatrics
- NOTE – on-line learning in Neonatology
- SCPE-4Net – Surveillance of cerebral palsy in Europe
- PHIME – impact of mercury on early child development
Vortrag in Englisch.