Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide—A Survey of the Swiss Cerebral Palsy Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Inclusion Criteria and Definition of Groups
- Have you already worked with patients treated with cannabinoid drugs?
- Were any of them of pediatric age (0–18 years)?
- Were any of these children/adolescents diagnosed with cerebral palsy?
- Have you ever experienced a situation in which the prescription of cannabinoids in this type of patient was debated, but for some reason not prescribed?
2.3. Statistical Analysis
2.4. Ethical Statement
3. Results
3.1. Study Participants
3.2. Indications
3.3. Prescribed Formulas
3.4. Perceived Effect of the Treatment and Side Effects
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total n = 70 (%) | Experienced n = 47 (%) | Less Experienced n = 23 (%) | p-Value 2 | |
---|---|---|---|---|
Sex | 0.96 | |||
Male | 25 (36) | 17 (36) | 8 (35) | |
Female | 43 (61) | 29 (62) | 14 (61) | |
Unknown | 2 (3) | 1 (2) | 1 (4) | |
Age in years (interquartile range) | 48 (42–57) | 47.5 (41–56) | 50 (42–60) | 0.92 |
Specialization 1 | ||||
Pediatrics | 45 (64) | 33 (70) | 12 (52) | 0.14 |
Physical Medicine and Rehabilitation | 28 (40) | 18 (38) | 10 (44) | 0.80 |
Neurology | 10 (14) | 8 (17) | 2 (9) | 0.35 |
Anesthesia | 1 (1) | 0 | 1 (4) | 0.33 |
Subspecialization 1 | ||||
Yes | 53 (76) | 39 (83) | 14 (61) | 0.04 |
Neuropediatric | 28 (40) | 19 (40) | 9 (39) | 0.92 |
Pediatric rehabilitation medicine | 21 (30) | 18 (38) | 3 (13) | 0.05 |
Developmental pediatrics | 8 (11) | 5 (11) | 3 (13) | 1.0 |
Pediatric palliative care | 5 (7) | 3 (6) | 2 (9) | 1.0 |
Pediatric oncology–hematology | 1 (1) | 1 (2) | 0 (0) | 1.0 |
Neurometabolic | 1 (1) | 0 (0) | 1 (4) | 1.0 |
No | 17 (24) | 8 (17) | 9 (39) | |
Work experience in specialty in years | 0.81 | |||
0–5 | 12 (17) | 8 (17) | 4 (17) | |
6–10 | 13 (19) | 8 (17) | 5 (22) | |
11–15 | 10 (14) | 8 (17) | 2 (9) | |
>15 | 35 (50) | 23 (49) | 12 (52) | |
Work experience in the treatment of children with Cerebral Palsy in years | 0.72 | |||
0–5 | 15 (21) | 9 (19) | 6 (26) | |
6–10 | 16 (23) | 11 (23) | 5 (22) | |
11–15 | 18 (26) | 14 (30) | 4 (17) | |
>15 | 21 (30) | 13 (28) | 8 (35) | |
Workplace 1 | 0.01 | |||
Any hospital | 56 (80) | 42 (89) | 14 (61) | |
University hospital | 23 (33) | 20 (43) | 3 (13) | |
General hospital | 27 (39) | 18 (38) | 9 (39) | |
University and general hospital | 6 (9) | 4 (9) | 2 (9) | |
Rehabilitation center | 12 (17) | 4 (9) | 8 (35) | |
Private/Joined practice | 2 (3) | 2 (4) | 0 (0) | |
Knowledge Acquisition 1 | ||||
Individual learning | 45 (64) | 33 (70) | 12 (52) | 0.14 |
Colleagues | 28 (40) | 19 (40) | 9 (39) | 0.92 |
Conferences | 17 (24) | 11 (23) | 6 (26) | 0.81 |
Part of education | 15 (21) | 10 (21) | 5 (22) | 0.97 |
Parents and families | 10 (14) | 7 (15) | 3 (13) | 0.84 |
Institution | 8 (11) | 6 (13) | 2 (9) | 0.62 |
Companies | 2 (3) | 1 (2) | 1 (4) | 0.60 |
Country of Residence (grouped) | 0.004 | |||
Switzerland | 23 (33) | 15 (32) | 8 (35) | |
Europe excluding Switzerland | 27 (39) | 13 (28) | 14 (61) | |
North America | 18 (26) | 18 (38) | 0 (0) | |
Australia | 2 (3) | 1 (2) | 1 (4) |
Total n = 70, (%) | Experienced n = 47, (%) | Less Experienced n = 23, (%) | p-Value 3 | |
---|---|---|---|---|
Indication (overall) 1,2 | ||||
Epilepsy | 48 (69) | 37 (79) | 11 (48) | 0.009 |
Spasticity | 45 (64) | 34 (72) | 11 (48) | 0.04 |
Pain | 44 (63) | 33 (70) | 11 (48) | 0.06 |
Behavioral problems | 12 (17) | 9 (19) | 3 (13) | 0.74 |
Sleep disturbance | 11 (16) | 8 (17) | 3 (13) | 0.67 |
Dystonia | 8 (11) | 7 (15) | 1 (4) | 0.26 |
None | 5 (7) | 1 (2) | 4 (17) | 0.04 |
Context of prescription | 0.01 | |||
Co-medication | 28 (40) | 22 (47) | 6 (26) | |
Second-line treatment | 16 (23) | 11 (23) | 5 (22) | |
Palliative treatment | 7 (10) | 6 (13) | 1 (4) | |
First-line treatment | 2 (3) | 2 (4) | 0 (0) | |
Parents initiated treatment | 2 (3) | 2 (4) | 0 (0) | |
Not applicable | 6 (9) | 2 (4) | 4 (17) | |
No response | 9 (13) | 2 (4) | 7 (30) | |
Reasons to not initiate cannabinoids 1 | ||||
Lack of cost coverage | 24 (34) | 19 (40) | 5 (22) | 0.12 |
Age of the patient | 19 (27) | 15 (32) | 4 (17) | 0.26 |
Lack of evidence on effectiveness and side effects | 15 (21) | 10 (21) | 5 (22) | 0.97 |
Parents wish | 13 (19) | 10 (21) | 3 (13) | 0.52 |
Drug interaction | 10 (14) | 8 (17) | 2 (9) | 0.48 |
Other co-morbidities | 3 (4) | 3 (6) | 0 (0) | 0.55 |
None | 8 (11) | 5 (11) | 3 (13) | 1.00 |
Total | Total n = 70, (%) | Experienced n = 47, (%) | Less Experienced n = 23, (%) |
---|---|---|---|
Preparation | |||
Dronabinol solution: Δ9-THC 2.5% | 16 (23) | 14 (30) | 2 (9) |
Self-medication: Diff. contents of Δ9-THC & CBD | 13 (19) | 12 (26) | 1 (4) |
Cannabis oil: Δ9-THC/CBD = 11/24 mg per g | 11 (16) | 8 (17) | 3 (13) |
Cannabis tincture: Δ9-THC/CBD = 11/22 mg per g | 3 (4) | 2 (4) | 1 (4) |
Cannabis sativa spray (Sativex): Δ9-THC/CBD = 2.7/2.5 mg per spray | 4 (6) | 2 (4) | 2 (9) |
CBD 2,5,10% | 3 (4) | 1 (2) | 2 (9) |
Epidiolex® | 3 (4) | 2 (4) | 1 (4) |
No information | 17 (24) | 6 (13) | 11 (48) |
Total | Total n = 70, (%) | Experienced n = 47, (%) | Less Experienced n = 23, (%) |
---|---|---|---|
Effectiveness (physician reported) | |||
Insignificant | 2 (3) | 1 (2) | 1 (4) |
Weak | 12 (17) | 10 (21) | 2 (9) |
Moderate | 35 (50) | 28 (60) | 7 (30) |
Strong | 6 (9) | 4 (9) | 2 (9) |
No response | 15 (21) | 4 (9) | 11 (48) |
Short-term side effects 1 | |||
Yes | 29 (41) | 25 (53) | 4 (17) |
Drowsiness | 14 (20) | 12 (26) | 2 (9) |
Somnolence | 10 (14) | 9 (19) | 1 (4) |
Fatigue | 6 (9) | 6 (13) | 0 (0) |
Diarrhea | 6 (9) | 6 (13) | 0 (0) |
Nausea | 5 (7) | 4 (9) | 1 (4) |
Anxiety | 4 (6) | 4 (9) | 0 (0) |
Confusion | 4 (6) | 4 (9) | 0 (0) |
Disorientation | 3 (4) | 3 (6) | 0 (0) |
Euphoria | 3 (4) | 3 (6) | 0 (0) |
Dry mouth | 2 (3) | 2 (4) | 0 (0) |
Hallucination | 2 (3) | 2 (4) | 0 (0) |
Vomiting | 2 (3) | 2 (4) | 0 (0) |
Weakness | 1 (1) | 1 (2) | 0 (0) |
Asthenia | 1 (1) | 1 (2) | 0 (0) |
Depression | 1 (1) | 1 (2) | 0 (0) |
Dizziness | 1 (1) | 1 (2) | 0 (0) |
Paranoia | 1 (1) | 1 (2) | 0 (0) |
Psychosis | 1 (1) | 1 (2) | 0 (0) |
Hypotonia | 1 (1) | 1 (2) | 0 (0) |
Increased liver enzymes | 1 (1) | 1 (2) | 0 (0) |
No | 41 (59) | 22 (47) | 19 (83) |
Long-term side effects | |||
Yes | 0 (0) | 0 (0) | 0 (0) |
No | 41 (59) | 35 (75) | 6 (26) |
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Hunziker, S.; Morosoli, F.; Zuercher, K.; Tscherter, A.; Grunt, S., on behalf of the Swiss Cerebral Palsy Registry Group. Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide—A Survey of the Swiss Cerebral Palsy Registry. Children 2023, 10, 1838. https://doi.org/10.3390/children10121838
Hunziker S, Morosoli F, Zuercher K, Tscherter A, Grunt S on behalf of the Swiss Cerebral Palsy Registry Group. Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide—A Survey of the Swiss Cerebral Palsy Registry. Children. 2023; 10(12):1838. https://doi.org/10.3390/children10121838
Chicago/Turabian StyleHunziker, Sandra, Federico Morosoli, Kathrin Zuercher, Anne Tscherter, and Sebastian Grunt on behalf of the Swiss Cerebral Palsy Registry Group. 2023. "Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide—A Survey of the Swiss Cerebral Palsy Registry" Children 10, no. 12: 1838. https://doi.org/10.3390/children10121838
APA StyleHunziker, S., Morosoli, F., Zuercher, K., Tscherter, A., & Grunt, S., on behalf of the Swiss Cerebral Palsy Registry Group. (2023). Prescription Practices of Cannabinoids in Children with Cerebral Palsy Worldwide—A Survey of the Swiss Cerebral Palsy Registry. Children, 10(12), 1838. https://doi.org/10.3390/children10121838