A full-spectrum low-THC cannabis extract (NTI164) significantly improved OCD, tics, ADHD, and emotional regulation in 14 children with PANS, with multi-omics revealing that it modifies the epigenetic and immune dysregulation underlying the condition.
Pediatric neurologists, PANS/PANDAS specialists, parents of children with PANS, immunologists, and epigenetics researchers.
What the researchers found
12 weeks of NTI164 (20 mg/kg/day) decreased CGI-Severity from 4.8 to 3.3 (p=0.002) with significant improvements in OCD (p=0.0001), tics (p<0.0001), ADHD (p=0.028), emotional regulation (p<0.0001), and quality of life (p=0.011). Multi-omics revealed NTI164 modified dysregulated epigenetic, ribosomal, and immune pathways in patient leukocytes.
Why it matters
PANS is a devastating condition with limited treatment options, and this study provides both clinical evidence of benefit and mechanistic evidence that a cannabis extract can modify the underlying epigenetic and immune dysfunction.
The numbers in context
N=14; mean age 12.1; 20 mg/kg/day NTI164; CGI-S: 4.8→3.3 (p=0.002); CYBOCS-II OCD p=0.0001; YGTSS tics p<0.0001; Conner's ADHD p=0.028; RCADS-P emotional p<0.0001; EQ-5D-Y QoL p=0.011; well-tolerated
How the study worked
Open-label trial of 14 children with chronic-relapsing PANS (mean age 12.1, 71% male) receiving NTI164 for 12 weeks, with clinical assessments using gold-standard tools and pre/post blood samples analyzed by bulk and single-cell transcriptomics, proteomics, phosphoproteomics, and DNA methylation.
What this study cannot tell us
Open-label without placebo control; very small sample (n=14); PANS diagnosis can be heterogeneous; cannot separate placebo effects; NTI164 is a complex mixture making mechanism attribution difficult; 12-week duration only.
How to read the evidence
Open-label pilot with multi-omics validation provides compelling preliminary evidence, but lack of placebo control and small sample demand cautious interpretation.
When this study was published
Published 2026; represents cutting-edge integration of cannabinoid therapeutics and multi-omics.
The bigger picture
This is among the first studies to combine clinical outcomes with deep multi-omics profiling to show how a cannabis extract works at the molecular level, presenting epigenetic machinery as a new therapeutic target.
Questions still open
- Would a placebo-controlled trial confirm these results? Which components of NTI164 drive the epigenetic effects? Could this approach work for other autoimmune neuropsychiatric conditions? What are the long-term effects?
Common questions
Can cannabis help children with PANS?
How does cannabis affect PANS at the molecular level?
Read the original research
Medicinal cannabis plant extract (NTI164) modifies epigenetic, ribosomal, and immune pathways in paediatric acute-onset neuropsychiatric syndrome.
Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, e00828
Citation
Keating, Brooke A; Han, Velda X; Nishida, Hiroya; Aryamanesh, Nader; Marshall, Lee L; Gloss, Brian S; Lau, Xianzhong; Dissanayake, Ruwani; Dervish, Suat; Graham, Mark E; Mohammad, Shekeeb S; Kanhangad, Manoj; Fahey, Michael C; Patel, Shrujna; Dale, Russell C. (2026). Medicinal cannabis plant extract (NTI164) modifies epigenetic, ribosomal, and immune pathways in paediatric acute-onset neuropsychiatric syndrome.. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics, e00828. https://doi.org/10.1016/j.neurot.2025.e00828
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