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      Oral Cannabidiol Use in Children With Autism Spectrum Disorder to Treat Related Symptoms and Co-morbidities

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          Abstract

          Objective: Children with autism spectrum disorder (ASD) commonly exhibit comorbid symptoms such as aggression, hyperactivity and anxiety. Several studies are being conducted worldwide on cannabidiol use in ASD; however, these studies are still ongoing, and data on the effects of its use is very limited. In this study we aimed to report the experience of parents who administer, under supervision, oral cannabinoids to their children with ASD.

          Methods: After obtaining a license from the Israeli Ministry of Health, parents of children with ASD were instructed by a nurse practitioner how to administer oral drops of cannabidiol oil. Information on comorbid symptoms and safety was prospectively recorded biweekly during follow-up interviews. An independent group of specialists analyzed these data for changes in ASD symptoms and drug safety.

          Results: 53 children at a median age of 11 (4–22) year received cannabidiol for a median duration of 66 days (30–588). Self-injury and rage attacks ( n = 34) improved in 67.6% and worsened in 8.8%. Hyperactivity symptoms ( n = 38) improved in 68.4%, did not change in 28.9% and worsened in 2.6%. Sleep problems ( n = 21) improved in 71.4% and worsened in 4.7%. Anxiety ( n = 17) improved in 47.1% and worsened in 23.5%. Adverse effects, mostly somnolence and change in appetite were mild.

          Conclusion: Parents’ reports suggest that cannabidiol may improve ASD comorbidity symptoms; however, the long-term effects should be evaluated in large scale studies.

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          Most cited references33

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          Diagnostic and Statistical Manual of Mental Disorders

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            Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects.

            Tetrahydrocannabinol (THC) has been the primary focus of cannabis research since 1964, when Raphael Mechoulam isolated and synthesized it. More recently, the synergistic contributions of cannabidiol to cannabis pharmacology and analgesia have been scientifically demonstrated. Other phytocannabinoids, including tetrahydrocannabivarin, cannabigerol and cannabichromene, exert additional effects of therapeutic interest. Innovative conventional plant breeding has yielded cannabis chemotypes expressing high titres of each component for future study. This review will explore another echelon of phytotherapeutic agents, the cannabis terpenoids: limonene, myrcene, α-pinene, linalool, β-caryophyllene, caryophyllene oxide, nerolidol and phytol. Terpenoids share a precursor with phytocannabinoids, and are all flavour and fragrance components common to human diets that have been designated Generally Recognized as Safe by the US Food and Drug Administration and other regulatory agencies. Terpenoids are quite potent, and affect animal and even human behaviour when inhaled from ambient air at serum levels in the single digits ng·mL(-1) . They display unique therapeutic effects that may contribute meaningfully to the entourage effects of cannabis-based medicinal extracts. Particular focus will be placed on phytocannabinoid-terpenoid interactions that could produce synergy with respect to treatment of pain, inflammation, depression, anxiety, addiction, epilepsy, cancer, fungal and bacterial infections (including methicillin-resistant Staphylococcus aureus). Scientific evidence is presented for non-cannabinoid plant components as putative antidotes to intoxicating effects of THC that could increase its therapeutic index. Methods for investigating entourage effects in future experiments will be proposed. Phytocannabinoid-terpenoid synergy, if proven, increases the likelihood that an extensive pipeline of new therapeutic products is possible from this venerable plant. http://dx.doi.org/10.1111/bph.2011.163.issue-7. © 2011 The Author. British Journal of Pharmacology © 2011 The British Pharmacological Society.
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              Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial.

              Almost a third of patients with epilepsy have a treatment-resistant form, which is associated with severe morbidity and increased mortality. Cannabis-based treatments for epilepsy have generated much interest, but scientific data are scarce. We aimed to establish whether addition of cannabidiol to existing anti-epileptic regimens would be safe, tolerated, and efficacious in children and young adults with treatment-resistant epilepsy.
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                Author and article information

                Contributors
                Journal
                Front Pharmacol
                Front Pharmacol
                Front. Pharmacol.
                Frontiers in Pharmacology
                Frontiers Media S.A.
                1663-9812
                09 January 2019
                2018
                : 9
                : 1521
                Affiliations
                [1] 1Clinical Pharmacology and Toxicology Unit, Assaf Harofeh Medical Center , Tel Aviv, Israel
                [2] 2Autistic Spectrum Disorder Clinic, Assaf Harofeh Medical Center , Tel Aviv, Israel
                [3] 3Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
                [4] 4Tikun Olam , Tel Aviv, Israel
                [5] 5Maccabi Institute for Health Services Research , Tel Aviv, Israel
                Author notes

                Edited by: Judith Ann Smith, The University of Texas Health Science Center at Houston, United States

                Reviewed by: Geert ’t Jong, University of Manitoba, Canada; Michael John Rieder, University of Western Ontario, Canada

                *Correspondence: Matitiahu Berkovitch, mberkovitch@ 123456asaf.health.gov.il

                These authors have contributed equally to this work

                This article was submitted to Obstetric and Pediatric Pharmacology, a section of the journal Frontiers in Pharmacology

                Article
                10.3389/fphar.2018.01521
                6333745
                30687090
                b5771749-2601-461e-b42e-88634e4ac963
                Copyright © 2019 Barchel, Stolar, De-Haan, Ziv-Baran, Saban, Fuchs, Koren and Berkovitch.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 17 August 2018
                : 12 December 2018
                Page count
                Figures: 0, Tables: 3, Equations: 0, References: 34, Pages: 5, Words: 0
                Categories
                Pharmacology
                Original Research

                Pharmacology & Pharmaceutical medicine
                cannabidiol,autism spectrum disorder,asd comorbid symptoms,asd treatment,pediatrics,clinical research trial,thc – tetrahydrocannabinol

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