Pensar Enfermagem / v.28 n.01 / November 2024
DOI: 10.71861/pensarenf.v28i1.333 104
Review Article
Abstract
Introduction
e rst clinical trials involving cannabidiol in humans were documented in the 1970s.
However, it was in the 1990s that the discovery of an endogenous cannabinoid signaling
system sparked interest in the therapeutic potential of cannabis for treating nervous system
disorders, including epilepsy.
Objective
To identify scientic evidence regarding the use of cannabidiol in children with cerebral
palsy.
Methods
is study presents an integrative review using the PubMed, Scopus, ScienceDirect, and
Embase databases in April 2024. e search descriptors included “Cannabidiol,” “Cere-
bral Palsy,” and “Child.” Nine articles that met the inclusion and exclusion criteria were
included.
Results
e ndings highlight the therapeutic potential of cannabinoids in cerebral palsy, focusing
on knowledge, safety, and challenges in prescribing these substances. Additionally, rese-
arch, regulation, and education emerged as key elements for understanding and properly
implementing this treatment.
Conclusion
Medicinal cannabinoids show promise in treating children with cerebral palsy, particularly
in managing spasticity, pain, and seizures. Further research is needed to dene their exact
role, but early results suggest that cannabinoids could be a safe and eective therapeutic
option, especially for severe cases.
Keywords
Cannabidiol; Cerebral Palsy; Child.
Exploring the erapeutic Potential of Cannabidiol in Chil-
dren with Cerebral Palsy: An Integrative Review
Camila Harmuch
orcid.org/0000-0002-1609-1037
Anny Caroline Ribeiro Devechi
orcid.org/0000-0001-8614-8708
Cecily Barbosa
orcid.org/0009-0005-1663-650X
Ana Luisa Serrano Lima
orcid.org/0 009-0008-7396-9185
Jéssica dos Santos Pini
orcid.org/0 000-0003-3077-4093
André Estevam Jaques
orcid.org/0 000-0001-7874-9589
Marcelle Paiano
orcid.org/0000-0002-7597-784X
Master. State University of Maringá, Maringá, Brazil.
Master. State University of Maringá, Maringá, Brazil.
Degree. State University of Maringá, Maringá, Brazil.
Degree. State University of Maringá, Maringá, Brazil.
PhD. Paraná State University, Paranavaí, Brazil.
PhD. State University of Maringá, Maringá, Brazil.
PhD. State University of Maringá, Maringá, Brazil.
How to cite this article: Harmuch C, Devechi ACR, Barbosa C, Lima ALS, Pini JS, Jaques AE, Paiano M. Explo-
rando o Potencial Terapêutico do Canabidiol em Crianças com Paralisia Cerebral: Uma Revisão Integrativa. Pen-
sar Enf [Internet]. 2024 Nov; 28(1): 104-112. Available from: https://doi.org/10.71861/pensarenf.v28i1.333
Corresponding author:
Camila Harmuch
E-mail: camila.harmuch@gmail.com
Received: Jun 26 2024
Accepted: Nov 20 2024
Harmuch, C.
Review Article
105
Introduction
e ecacy of cannabis in treating epilepsy was rst reported in
1800 B.C. Early clinical trials with cannabidiol (CBD) in hu-
mans were documented in the 1970s, but it was during the 1990s,
following the discovery of an endogenous cannabinoid signaling
system, that interest grew in the therapeutic potential of cannabis
for treating nervous system disorders, including epilepsy.
Mechoulam and Shvo (1963) rst described two compounds, the
psychoactive delta-9-tetrahydrocannabinol (THC) and the non-
-psychoactive CBD. Studies have shown that both THC and CBD
exhibit anticonvulsant properties in models involving in vitro
experiments and animals. However, most research indicates that
CBD is more eective in reducing epileptic activity compared to
THC, which has a higher potential to cause cognitive impairment
and chronic psychiatric disorders. Other benecial properties of
CBD include neuroprotective, anti-inammatory, and antioxidant
eects.
Despite the illegal status of cannabis in many countries, recent evi-
dence suggests its potential ecacy in treating epilepsy, mainly in
refractory patients.,
Cerebral palsy (CP) is a non-progressive disorder of posture and
movement resulting from a non-progressive malformation or lesion
in the brain, leading to a range of comorbidities in children, inclu-
ding epilepsy, intellectual disability, behavioral, musculoskeletal,
and nutritional issues, sleep problems, and pain.
Epilepsy is considered one of the most common comorbidities,
with a global prevalence of approximately 50 million people. Al-
though numerous antiepileptic drugs have been approved over the
last two decades, there remains a need for more options, as one-
-third of epileptic patients suer from drug-resistant epilepsy.
In the past decade, several countries and institutions have shown
great interest in investigating the role of CBD and its ecacy in
treating pediatric epilepsy, particularly when associated with CP.
As a result, the U.S. Food and Drug Administration (FDA) appro-
ved its use in 2018 for treating seizures in children who meet the
established criteria.
CBD was the rst FDA-approved drug containing a puried subs-
tance derived from cannabis and the rst authorized to treat pa-
tients with Dravet syndrome. However, the medical prescription of
CBD remains controversial. While some members of the medical
community support its use and present it as a treatment option,
others remain hesitant to prescribe and recommend the drug.
e history of the therapeutic use of cannabis, particularly CBD,
in treating epilepsy reveals a trajectory of signicant discoveries and
advancements over the centuries. Nonetheless, the ongoing con-
troversy surrounding its use underscores the need for continued
research, discussion, and guidance to ensure the safe utilization of
this drug. erefore, given the importance of this topic, this study
aims to identify scientic evidence on the use of cannabidiol in
children with cerebral palsy.
Methods
is study is an integrative review aimed at synthesizing existing
knowledge, identifying research gaps, and proposing new studies.
e process was systematic and rigorous, without applying time
restrictions to include as many relevant articles as possible on the
subject.
We followed six key stages: 1) identication of the topic and the
guiding research question, 2) establishment of inclusion and exclu-
sion criteria, 3) denition of the information to be extracted from
the selected studies and their characterization, 4) evaluation of the
included studies, 5) interpretation of the results, and 6) presenta-
tion of the review and synthesis of knowledge.
Initially, we formulated the guiding question using the PICo stra-
tegy: P (Population): children; I (Interest): use of CBD; and Co
(Context): cerebral palsy. Consequently, we adopted the research
question: What is the scientic evidence on the use of CBD in
children with cerebral palsy?
Next, we established the inclusion criteria, which comprised origi-
nal articles published in Portuguese and English, without any time
limits, and related to the guiding research question. As for exclu-
sion criteria, we excluded grey literature (theses, dissertations, mo-
nographs, books, book chapters, congress abstracts, proceedings,
programs, and government reports), opinion articles, letters to the
editor, brief communications, editorials, and integrative reviews.
e data collection took place in April 2024 using electronic da-
tabases: PubMed Central (PMC), Scopus (Elsevier), Embase, and
ScienceDirect. We applied Health Sciences Descriptors (DeCS)
and Medical Subject Headings (MeSH) in Portuguese and their
English equivalents: “Canabidiol/Cannabidiol,” “Paralisia Cere-
bral/Cerebral Palsy,” and “Criança/Child.”
e search strategies were adapted to each database based on the
PICo strategy and its keywords and entry terms. We applied the
OR boolean operator to distinguish terms and AND to associate
them, resulting in the following search expression: ((("cannabi-
diol"[MeSH Terms] OR "cannabidiol"[All Fields]) AND ("chil-
d"[MeSH Terms] OR "child"[All Fields])) AND ("cerebral palsy"[-
MeSH Terms] OR ("cerebral"[All Fields] AND "palsy"[All Fields])
OR "cerebral palsy"[All Fields])) AND ("epilepsy"[MeSH Terms]
OR "epilepsy" [All Fields]).
Once we retrieved the publications, we organized the studies using
Microsoft Excel® to identify and exclude duplicates, counting re-
peated studies only once. We reviewed the titles and abstracts to
include studies closely related to the research topic, followed by a
full-text reading to conrm their eligibility. We included studies
that fully addressed the research question, resulting in a nal sam-
ple of nine scientic articles.
e information from the articles was organized into a table contai-
ning data on the title, year of publication and country, objectives,
outcomes, and level of evidence (Table 1). We assessed the level
of evidence following the hierarchical classication of Melnyk and
Fineout Overholt10, which classies evidence into seven levels. I:
evidence from systematic reviews, meta-analyses, or clinical guide-
lines based on systematic reviews of randomized controlled trials
(RCTs); II: evidence from at least one RCT; III: evidence from
well-designed controlled trials without randomization; IV: eviden-
ce from well-designed cohort and case-control studies; V: evidence
from systematic reviews of descriptive and qualitative studies; VI:
evidence from a single descriptive or qualitative study; and VII:
evidence from expert opinions or expert committee reports. We
grouped the studies into three categories according to their cha-
racteristics.
Ethical approval was waived, as this was a review of publicly availa-
ble data without human involvement.
Review Article
Pensar Enfermagem / v.28 n.01 / November 2024
DOI: 10.71861/pensarenf.v28i1.333 106
Results
We used a owchart adapted from the Preferred Reporting Items
for Systematic Reviews and Meta-Analyses (PRISMA)11 to present
the search and selection stages of the articles. Figure 1 outlines the
process of identifying, screening, determining eligibility, and inclu-
ding the studies according to the databases consulted. Initially, we
identied 35 publications, of which 20 met the eligibility criteria.
However, only nine were included in the nal sample.
Regarding the publication timeframe, the articles were published
between 2019 and 2024. Most of the selected studies were pu-
blished in 2023 (three), followed by two in 2022, and one each
in 2019, 2020, 2021, and 2024. All the articles were written in
English. As for geographic origin, the studies were conducted in
Canada (n=3), Switzerland (n=2), Germany (n=2), South Korea,
and Argentina, each with one study.
Figure 1. Flowchart illustrating the study selection process inclu-
ded in the integrative review. Brazil, 2024.
In terms of evidence level, the sample included one study with level
I evidence, two studies with level II evidence, one study with level
IV evidence, and ve studies with level VI evidence. Based on the
analyzed articles, the sample from this review is summarized in the
synoptic table (Table 1).
Table 1. Characterization of the articles by authors, year, country
of publication, objectives, outcomes, and level of evidence. Brazil,
2024.
Harmuch, C.
Review Article
107
Inclusion
Studies included
(n =9)
Source: Page et al.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Homann TC, Mulrow CD, et al. e PRISMA 2020 statement: an updated guideline for reporting systema-
tic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71
Identication
Screening
Publications identied from databases
(n=179)
Pubmed (n=135)
Embase (n=20)
Science Direct (n=16)
Scopus (n=8)
Duplicate records removed
(n=6)
Articles selected for title and abstract scre-
ening
(n = 173)
Articles assessed for eligibility
(n = 20)
Articles excluded after title and abstract
screening
(n = 153)
Articles excluded for not addressing the
research question (n=11)
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Pensar Enfermagem / v.28 n.01 / November 2024
DOI: 10.71861/pensarenf.v28i1.333 108
Study Year and country Objective/Type of study Outcome Level of evidence
A1) Puried cannabidiol as add-
-on therapy in children with treat-
ment-resistantinfantile epileptic
spasms syndrome
2024
Argentine
Evaluate the highly puried
CBD oil as an add-on therapy
for patients with epileptic spasm
syndrome. Case-control study
In addition to improvements in
spasms, the study observed benets in
communication, behavior, and sleep.
Researchers suggest that CBD may ser-
ve as an eective and safe therapeutic
option, particularly for patients with
Down syndrome and cerebral palsy.
IV
A2) Prescription Practices
of Medical Cannabinoids in
Children with Cerebral Palsy - A
Survey of the Swiss Cerebral Palsy
Registry
2023
Switzerland
Evaluate cannabinoid prescription
practices in children with cerebral
palsy. Cross-sectional study
Physicians primarily prescribe CBD
for epilepsy, spasticity, and pain,
showing moderate ecacy with side
eects such as drowsiness and fatigue.
Further research, including rando-
mized clinical trials, must explore
additional potential indications.
VI
A3) Characteristics of Epilepsy in
Children with Cerebral Palsy: A
Single Tertiary Center Study
2023
South Korea
Describe the characteristics of
epilepsy in patients with cerebral
palsy (CP). Retrospective descrip-
tive study
e main indications for treatment
included epilepsy, spasticity, pain,
behavioral issues, sleep disturbances,
and dystonia. e study emphasizes
the need for more clinical trials to
establish appropriate indications.
VI
A4) Use and caregiver reported
ecacy of medical cannabis
in children and adolescents in
Switzerland
2021
Switzerland
Examine the clinical and
epidemiological characteristics
of medical cannabis treatment.
Retrospective descriptive study
Products containing THC were shown
to reduce pain and seizures, while
CBD products lowered the frequency
of seizures. More treatment guidelines
and clinical trials are required to assess
the long-term ecacy of medicinal
cannabis in young patients.
VI
A5) Medical cannabinoids: a
pharmacology-based systematic
review and meta-analysis for all
relevant medical indications
2022
Germany
Evaluate the ecacy, retention,
and adverse events across various
medical conditions. Systematic
review and meta-analysis
Cannabinoids have demonstrated
positive benets for various medical
conditions, such as epilepsy, chronic
pain, and Parkinson’s disease. High
quality evidence supports their use in
treating chronic pain and spasticity in
multiple sclerosis patients.
I
A6) Characterizing the Use of
Nabiximols (9-\Tetrahydrocan-
nabinol–Cannabidiol) Buccal
Spray in Pediatric Patients
2023
Canada
Describe the use of nabiximols
in hospitalized children. Clinical
trial
e study concluded that Nabiximols
was prescribed to children across
all age groups, mainly for pain and
nausea/vomiting, underscoring the
need for further research, especially
prospective randomized clinical trials.
II
A7) Dosage Related Ecacy and
Tolerability of Cannabidiol in
Children With Treatment-Resis-
tant Epileptic Encephalopathy:
Preliminary Results of the CARE-
-E Study
2019
Canada
Evaluate the ecacy and tolerabi-
lity of Cannabidiol (CBD) dosing
in children with treatment-re-
sistant epileptic encephalopathy.
Clinical trial
Regarding eectiveness, all seven
participants experienced improvements
in seizure frequency, scores on the
Modied Quality of Life in Childhood
Epilepsy Questionnaire (QOLCE),
and electroencephalogram (EEG) sco-
res, with three participants becoming
seizure-free.
II
A8) Clinician views on and ethics
priorities for authorizing medical
cannabis in the care of children
and youth in Canada: a qualitati-
ve study
2022
Canada
Outline clinicians’ perspectives,
ethical priorities, and values regar-
ding the authorization of medical
cannabis. Qualitative study
Participants, representing various
clinical specialties and experiences,
highlighted the importance of regula-
tory reforms and additional research to
enhance care for pediatric patients who
might benet from cannabis-based
products.
VI
A9) A Survey on Cannabinoid
Treatment of Pediatric Epilepsy
Among Neuropediatricians in
Scandinavia and Germany
2020
Germany/Scandinavia
Understand attitudes toward the
use of cannabinoids in pediatric
epilepsy treatment among pedia-
tric neurologists in Scandinavia
and Germany. Qualitative study
e study underscores the need for
careful monitoring of interactions
with other antiepileptic medications
when prescribing CBD therapy. With
the likely availability of an approved
CBD product and recent clinical trial
results, it is expected that the approach
to CBD-based therapy for pediatric
refractory epilepsy will evolve in the
future.
VI
Harmuch, C.
Review Article
109
We created a table that groups the articles based on the similarity of
their content within each section (Table 2).
Table 2 - Categorization of selected articles based on content si-
milarity
Categories Articles
e therapeutic potential of cannabinoids in
cerebral palsy
A2, A4,
A5
Knowledge on the use and prescription of
medicinal cannabinoids
A6, A8,
A9
Research and regulation on the therapeutic use
of cannabinoids in the treatment of epilepsy
A1, A3,
A7
Based on the analysis, we categorized the studies into three main
themes: the therapeutic potential of CBD, knowledge regarding
the use and prescription of CBD, and research and regulation in
the therapeutic use of CBD. We discussed the ndings in relation
to the scientic literature, which we will address in the following
section.
Discussion
In this section, we will address topics related to the therapeutic
potential of cannabinoids in cerebral palsy, epilepsy, and medicinal
use. We will discuss aspects such as knowledge, safety, and challen-
ges in prescribing cannabinoids, as well as research, regulation, and
education as key points for understanding and adequately imple-
menting this treatment.
e therapeutic potential of cannabinoids in cerebral palsy
Literature has described a wide range of therapeutic approaches
and medications for managing symptoms in patients with cerebral
palsy (CP). Medications are often prescribed to manage epilepsy
and movement disorders associated with this condition. In ad-
dition to conventional drugs, cannabinoids have been increasingly
used in various clinical settings, particularly in pediatrics.
Epilepsy is among the top three indications for the use of cannabi-
noids in children with CP, given the promising results observed in
treating specic forms of childhood epilepsy. Spasticity is the se-
cond most common condition treated with cannabinoids, followed
by pain, which is frequently reported as a symptom as well.13
Beyond seizure control, which is the primary criterion for CBD
use, evidence from parental reports highlights improvements in sle-
ep and behavior, which are also signicant in enhancing the quality
of life for these children.,-
is perspective is supported by a study conducted with caregivers
in California (USA), which concluded that CBD could be a bene-
cial adjunct for children with CP, particularly for those with more
severe symptoms. Caregivers reported signicant improvements in
emotional health, spasticity, and pain, reinforcing the perception of
CBD’s ecacy.-,
Additionally, children with complex movement disorders, which
encompass various neurological conditions, may also benet from
cannabinoid treatment. ese disorders are often associated with
severe orthopedic complications, chronic pain, feeding diculties,
constipation, and sleep disturbances, further justifying additional
investigations into the ecacy of medicinal cannabinoids.
CBD appears to act synergistically, enhancing THC’s benecial ef-
fects by reducing its psychoactivity, allowing patients to tolerate
higher doses and complement the antispasmodic eects of THC.
e mechanisms of action of cannabinoids in CP include antis-
pasmodic, anti-inammatory, and anticonvulsant properties. Al-
though mild to moderate adverse eects have been reported, no
long-term side eects were identied, suggesting a favorable safety
prole.
However, more research must be conducted, including larger and
more diverse samples, along with longer follow-up periods, to ac-
curately elucidate the role of cannabinoids in CP.,
Despite these needs, the data available so far suggest that canna-
binoids may represent an eective and safe therapeutic alternative
for children with CP, especially those facing more severe forms of
the disease. Continuing studies is essential to solidify these ndings
and expand treatment options for this population.
Knowledge of the use and prescription of medicinal cannabi-
noids
e increasing acceptance and use of medicinal cannabinoids as
therapeutic alternatives for various medical conditions have sparked
signicant debate regarding the safety, ecacy, and regulation of
these substances.19-20 e U.S. Food and Drug Administration
(FDA) has approved a highly puried oral CBD solution speci-
cally for treating seizures associated with certain epileptic syndro-
mes in patients aged two years and older.
A long-term study involving 607 patients with refractory epilepsy
administered doses ranging from 2 to 10 mg/kg/day, gradually in-
creasing to a limit of 25 to 50 mg/kg/day. Results showed that
52% of the patients experienced at least a 50% reduction in seizure
frequency after 12 weeks, and this rate remained stable over 96
weeks. e most frequently reported adverse eects were diarrhea
and drowsiness, but most patients (76%) reported improvements
in their quality of life, suggesting that the benets of the treatment
may outweigh the inconveniences.-
However, a study conducted in Australia with psychiatrists and
psychiatry residents revealed that more than half of the participants
still had diculty distinguishing between the therapeutic indica-
tions of CBD and THC, highlighting knowledge gaps that could
aect clinical practice.
CBD is particularly recommended for childhood epileptic syndro-
mes such as Dravet and Lennox-Gastaut, as well as for psychiatric
conditions in adults, with doses ranging from 200 to 800 mg/day,
divided into two or three administrations. e main side eects
include hypersensitivity, elevated liver transaminases, drowsiness,
and, in rare cases, suicidal thoughts and an increased risk of seizures
with abrupt discontinuation.
On the other hand, THC is indicated for treating chemotherapy-
-induced nausea and vomiting, chronic pain, anorexia and weight
loss associated with human immunodeciency virus (HIV), neu-
ropathic pain, and muscle spasticity in multiple sclerosis, with
doses typically ranging from 10 to 30 mg/day, divided into two
or three doses. THC’s side eects are more varied and can inclu-
de drowsiness, dry mouth, and, in rare cases, hallucinations and
dependence. is variability in side eect proles highlights the
importance of selecting the appropriate substance and dosage for
Review Article
Pensar Enfermagem / v.28 n.01 / November 2024
DOI: 10.71861/pensarenf.v28i1.333 110
each patient.
A European study identied that among physicians treating epi-
lepsy in children and adolescents, only 48% prescribed pure CBD,
indicating that many professionals still use preparations containing
THC. When CBD was prescribed, dosages ranged from less than
10 mg/kg to as much as 50 mg/kg per day, with 20 mg/kg showing
ecacy in clinical trials, although some patients may require higher
doses. e safety of higher doses is supported by the lack of conclu-
sive data establishing a maximum safe limit.
Another study that analyzed the use of CBD-enriched cannabis oil
in patients with West Syndrome showed promising results, with a
signicant reduction in seizure frequency in several patients aged
16 to 22 months. e initial dose was 2 mg/kg/day, increased to an
average of 12 mg/kg/day. Some patients also showed improvements
in electroencephalogram (EEG) results. e observed side eects
were mild and temporary, with no increase in liver enzymes, indi-
cating a favorable safety prole.
Additionally, researchers in Israel investigated the use of CBD-en-
riched cannabis oil extract in patients with drug resistant epilepsy,
with more than half of the participants experiencing a greater than
50% reduction in seizures, supporting the ecacy of the treatment.
However, 46% of the patients reported adverse reactions, which
was a primary reason for discontinuation.
Moreover, a cannabinoid oral spray containing THC and CBD has
been used in adults for conditions related to cancer pain and spas-
ticity. However, using this spray in children presents challenges,
especially regarding documentation and measurement of ecacy,
emphasizing the need for clearer protocols and more robust inves-
tigations.
In summary, as medicinal cannabinoid treatment options expand,
the reviewed studies provide valuable contributions regarding their
indications and ecacy. Dierentiating between CBD and THC,
understanding their associated side eects, and ensuring adequate
training for healthcare professionals are crucial factors to consider
in cannabinoid therapy.
Research and regulation of cannabinoid use in epilepsy treat-
ment
e increasing popularity of CBD as a therapeutic alternative
makes it essential for its use to be backed by solid scientic eviden-
ce. Enhanced research can expand our understanding of the eects,
benets, and potential risks associated with cannabidiol, promo-
ting its acceptance and safe use in clinical practice.
Cannabinoids such as THC and CBD interact with CB1 and CB2
receptors in the endocannabinoid system. While THC acts as a
partial agonist at these receptors and produces psychotropic eects,
CBD demonstrates low anity, suggesting that its antiepileptic ac-
tivity is not directly linked to the endocannabinoid system. is
highlights the importance of continuing to investigate CBD’s the-
rapeutic properties.
Studies suggest the “entourage eect,” which refers to the synergis-
tic action of multiple components of the cannabis plant, may lead
to greater ecacy than isolated use of CBD or THC, enhancing to-
lerance and the therapeutic potential of cannabinoids. Moreover,
research shows that THC has anticonvulsant eects in 61% of cases
examined but also pro-convulsant potential in a small percentage
of studies conducted across six animal species. In contrast, CBD
and cannabidivarin exhibited anticonvulsant properties in 80.5%
of evaluations without displaying pro-convulsant eects.
ese ndings have fueled the use of pure CBD and CBD enriched
cannabis extracts in treating epilepsy in humans, though reports
on ecacy and side eects vary, requiring careful analysis to fully
understand these outcomes.
Studies have demonstrated signicant benets in seizure control,
showing reductions in seizure frequency, along with improvements
in sleep, alertness, and mood when treated with CBD-rich canna-
bis extracts. However, a key limitation of these studies lies in the
diversity of epilepsy types analyzed and variations in chemical com-
positions, dosages, administration methods, and manufacturing
processes.is creates inconsistency in the quality and
reliability of available products, especially homemade ones, which
often lack strict quality controls. Reports of products containing
little to no CBD or quantities far below those claimed underscore
the need for adherence to regulatory standards.
Examples of products meeting strict standards exist, such as the
cannabis extract marketed in Israel, which oers CBD to-THC ra-
tios of 2:1, 5:1, and 20:1, with the latter being the most common.
is extract has shown ecacy in controlling seizures in refractory
patients. Most patients treated with this extract experienced signi-
cant reductions in seizure frequency, along with improvements in
behavior, alertness, motor skills, and sleep.
Although the available evidence is promising, the ecacy and safety
of CBD-enriched cannabis extracts still need conrmation throu-
gh controlled clinical trials. Nevertheless, substantial data support
the use of pure CBD in managing refractory epilepsy, especially in
conditions like Dravet syndrome and Lennox-Gastaut syndrome.
Despite existing gaps, cannabinoids are emerging as a viable and
promising alternative for treating refractory epilepsies.
erefore, cannabinoids prove therapeutically eective for various
medical conditions, provided their pharmacological specicities are
considered. Conducting research and implementing regulations are
essential to ensure the quality and safety of cannabis-based pro-
ducts in the treatment of refractory epilepsy. e use of standardi-
zed products and the execution of controlled clinical trials are cru-
cial to validate the ecacy of cannabis extracts containing CBD.
Conclusion
We found that the use of medicinal cannabinoids for treating chil-
dren with cerebral palsy (CP) shows promising results, particular-
ly in controlling spasticity, pain, and seizures. Despite signicant
improvements in patients’ quality of life and the relatively low in-
cidence of adverse events, further research is necessary to dene
the precise role of cannabinoids in managing CP. However, current
ndings suggest that cannabinoids may oer an eective and safe
therapeutic option, especially for children with more severe forms
of the condition.
As the prescription of medicinal cannabinoids continues to raise
both interest and uncertainty, the reviewed studies provide essential
insights into their usage and ecacy. Understanding the dierences
between CBD and THC, their respective indications, and side ef-
fects are critical factors to consider when opting for this treatment
approach.
Cannabinoids have therapeutic ecacy for various medical condi-
tions, provided their specic pharmacological properties are care-
fully considered. Continued research and regulatory frameworks
Harmuch, C.
Review Article
111
are crucial to ensuring the quality and safety of cannabis-based pro-
ducts in the treatment of refractory epilepsy. Standardized products
and controlled clinical trials are vital to validating the ecacy of
cannabis extracts containing CBD. Furthermore, educating heal-
thcare professionals about cannabis is key to reducing stigma and
fostering informed decision-making.
One limitation of this study is its language selection, focusing only
on English and Portuguese, which may have excluded relevant re-
search published in other languages and underrepresented Latin
American contexts. e absence of databases such as LILACS and
SciELO restricts the generalizability of these ndings. Neverthe-
less, this study stands out by oering valuable insights into aca-
demic production in the chosen languages, thus contributing to
advancing knowledge in the eld.
e practical implications of this research on the use of cannabi-
noids, particularly CBD, in managing symptoms in patients with
CP and other medical conditions are signicant. e study highli-
ghts an expansion of therapeutic options, presenting CBD as an
eective and safe alternative for treating symptoms like epilepsy,
spasticity, and pain, thereby enriching healthcare professionals’
strategies. Additionally, the possibility of personalized treatment is
reinforced as improvements are seen in seizure control and patients’
overall quality of life.
Education and training for healthcare professionals are essential,
given the need to bridge knowledge gaps regarding CBD’s thera-
peutic indications. Moreover, comprehensive studies are crucial
to generating robust evidence that justies incorporating canna-
binoids into clinical practice, especially considering the potential
side eects that require close monitoring.
Finally, implementing an interdisciplinary treatment approach and
properly regulating available products are crucial for ensuring the
safety of cannabinoids in clinical settings. In this regard, promoting
open dialogue between healthcare professionals, patients, and care-
givers is vital for making well-informed, evidence-based decisions.
Authorship and contributions
.Harmuch, Camila: Conception and design of the study; Data col-
lection; Data analysis and interpretation; Statistical analysis; Ma-
nuscript writing;
Devechi, Anny CR: Conception and design of the study; Data col-
lection; Data analysis and interpretation; Statistical analysis; Ma-
nuscript writing;
Barbosa, Cecily: Conception and design of the study; Data collec-
tion; Data analysis and interpretation; Statistical analysis; Manus-
cript writing;
Lima, Ana LS: Conception and design of the study; Data collec-
tion; Data analysis and interpretation; Statistical analysis; Manus-
cript writing;
Pini, Jéssica S: Critical revision of the manuscript; Approve the -
nal manuscript and assumption of responsibility.
Jaques, André E: Critical revision of the manuscript; Approve the
nal manuscript and assumption of responsibility.
Paiano, Marcelle: Critical revision of the manuscript; Approve the
nal manuscript and assumption of responsibility.
Conicts of interest and Funding
No conicts of interest have been declared by the authors.
Sources of support / Financing
e study was not funded.
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