I am performing a quality assurance review of my epilepsy practice. As a pediatric epilepsy specialist I treat many patients who suffer from refractory epilepsy. That is, they continue to have seizures despite adequate trials of two anticonvulsants. Refractory epilepsy is a disabling condition that strikes approximately 20% of people with epilepsy.
Since last year I have been a member of the state of Texas Compassionate Use Program. As such I have recommended low THC cannabis for my patients with the State of Texas Compassionate use program. This program the state of Texas authorizes dispensaries to sell patients with epilepsy an oil containing 100 mg of Cannabadiol per ml and no more than .5% tetrahydrocannabinol.
I have over 60 of my patients in the registry. The effects on epilepsy are similar to other publications and I will bring those forward any future posting.
Because there are current legislative considerations regarding the use of this product in autism, I want to post my observations which have not yet been published.
I am performing a de-identified retrospective review based on parent/patient report.
There is a need for more literature about the risks and benefits about this treatment especially focussing on autism.
Insomnia and aggression are major problems for people with autism and their families. Their are no medications that are FDA approved for insomnia in children. There are two medications approved for behavioral problems in autism. These agents frequently fail.
I have data on a subgroup of these patients who have co-morbid autism. The N is 11.
Results:
Sleep Improvement
- 9% - No Improvement
- 27.2% - No or slight Improvement
- 73% - 25-100% Improvement.
Aggression
- 54% have a 25 -100% improvement.
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| Texas low-THC cannabis appears to improve sleep and aggression in autism |
Of all the kids with epilepsy 54% had their quality of life at least much improved.
Of kids with epilepsy and autism 58% had their quality of life at least much improved
Side effects were minimal and I will share this data in future posts.
Discussion
CBD with under .5% THC appears to have a positive effect on sleep in children with refractory epilepsy and autism.
CBD with under .5% THC appears to have a positive effect on reducing aggression in children with refractory epilepsy and autism.
Certainly thee are weaknesses in a retrospective, descriptive report.
Further, I have not controlled for success of epilepsy treatment. Is the sleep improvement due to restoration of circadian rhythms with successful treatment? Is the sleep improvement due to medication interactions?
Yet, this data should be public to inform public debate.
Insomnia impairs development. Treatment of insomnia improves social function and behavior in children with autism.
Insomnia is a family crushing problem in kids with autism. The US Army published data on the effects of chronic insomnia on behavior. How can a family sleep well with a child wandering the house? They do not.
There are no medications FDA-approved for insomnia in children. The anti-psychotic medications used off-label for insomnia cause significant side effects such as morbid obesity. Some antihistamines may provoke seizures. Antidepressants are often used off label. Melatonin is frequently prescribed and fails in this setting.
Using CBD for insomnia in children with autism would be a "compassionate use" if ever there was one.
Dr. Rotenberg
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