Abstract
BackgroundMedical cannabis may be a useful tool for managing treatment-resistant epilepsy and chronic pain, which affect many patients in pediatric palliative care (PPC); however, little evidence is available in this setting.Case presentationWe aimed to describe a clinical experience in a setting where high-level evidence may not be obtained. We report our clinical experience in a pediatric palliative care department in Italy. Caregivers reported changes in intensity and frequency of pain and epilepsy events. Six patients received a titrated plant extract of cannabis sativa for 1 year. Only mild and transient adverse events occurred: drowsiness, euphoria, restlessness and tachycardia; the resolution was either spontaneous or obtained by modifying the administration schedule. Treatment was never discontinued. No overdoses occurred. All patients experienced seizures during the pre-treatment observation period, and obtained a reduction in seizure frequency, although with variable extent while receiving cannabis. In addition, a benefit on pain was observed, based on the caregiver’s evaluation, and a reduction of analgesic use.ConclusionOur experience suggests that a titrated plant extract preparation of medical cannabis may be useful to control treatment-resistant pain and epilepsy in PPC patients.
Highlights
Medical cannabis may be a useful tool for managing treatment-resistant epilepsy and chronic pain, which affect many patients in pediatric palliative care (PPC); little evidence is available in this setting.Case presentation: We aimed to describe a clinical experience in a setting where high-level evidence may not be obtained
Our experience suggests that a titrated plant extract preparation of medical cannabis may be useful to control treatment-resistant pain and epilepsy in PPC patients
We report here our clinical experience with six patients in PPC who received a titrated plant extract of cannabis sativa for 1 year
Summary
Medical cannabis may be a useful tool for managing treatment-resistant epilepsy and chronic pain, which affect many patients in pediatric palliative care (PPC); little evidence is available in this setting.Case presentation: We aimed to describe a clinical experience in a setting where high-level evidence may not be obtained. Medical cannabis may be a useful tool for managing treatment-resistant epilepsy and chronic pain, which affect many patients in pediatric palliative care (PPC); little evidence is available in this setting. Pediatric palliative care (PPC) aims to improve the quality of life of children with complex needs who are affected by a wide range of serious medical conditions for which no curative treatments are available. In this setting, a special focus on the care of families is pivotal. A systematic review of clinical trials assessing pharmaceutical-grade cannabidiol (CBD) in children with epilepsy, including data from 17 observational studies, showed that 20 mg/kg/day CBD was more effective than placebo in terms of seizure number reduction [4]. A higher responder rate was obtained with a cannabis extract
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