CBD-Based Epilepsy Treatments in Children May Carry Unknown Developmental Risks | Research

The takeaway

While CBD-enriched cannabis extracts have been successfully used to treat childhood epilepsy, the endocannabinoid system plays critical roles in brain development, and there is insufficient data on the long-term neurodevelopmental effects of early cannabinoid exposure.

Pediatric neurologists, parents of children on CBD therapy, regulatory bodies.

The endocannabinoid system regulates neural differentiation, migration, and survival from early developmental stages - the same system modulated by CBD treatment.

What the researchers found

The endocannabinoid system regulates progenitor cell fate, neural differentiation, migration, and survival from early developmental stages. Exogenous cannabinoids including CBD can interact with this system. While CBD has proven therapeutic value for pediatric epilepsy, potential long-term neurodevelopmental effects of modulating the ECS during childhood remain largely unstudied.

Why it matters

Thousands of children are now taking CBD for epilepsy. This review raises an important cautionary point: the same system being modulated therapeutically also plays essential roles in brain development, and we do not yet know the long-term consequences.

The numbers in context

CBD has both endocannabinoid (ECS-mediated) and non-endocannabinoid targets. ECS components are functional from early developmental stages. FDA approved purified CBD from Cannabis for pediatric epilepsy.

How the study worked

Review of current knowledge on CBD-based therapies in pediatric patients, CBD mechanisms of action, and the role of the endocannabinoid system in neurodevelopment.

What this study cannot tell us

Largely theoretical concerns based on the known biology of the ECS in development. No direct evidence of harm from CBD treatment in children. Extrapolating from basic science to clinical risk involves significant uncertainty.

How to read the evidence

Moderate - comprehensive review of relevant biology, but concerns are largely theoretical rather than based on observed clinical harms.

When this study was published

Published in 2018. Long-term follow-up data from CBD trials in children is now beginning to emerge.

The bigger picture

The tension between CBD's proven short-term benefits for severe epilepsy and its unknown long-term neurodevelopmental effects mirrors a common challenge in pediatric medicine: weighing immediate therapeutic need against potential future risks.

Questions still open

Do the theoretical developmental risks materialize in children taking CBD long-term? Is purified CBD safer than whole-plant extracts for children? Should neurodevelopmental monitoring be standard for children on CBD therapy?

Common questions

Is CBD safe for children long-term?

CBD has proven short-term benefits for severe childhood epilepsy, but this review points out that the endocannabinoid system plays critical roles in brain development. Long-term neurodevelopmental effects of modulating this system in children have not been adequately studied.

Is pure CBD safer than cannabis extract for children?

The authors suggest purified CBD may be safer than CBD-enriched cannabis extracts for young patients, since extracts also contain THC. However, they note that even pure CBD interacts with the endocannabinoid system and has many other molecular targets.

Read the original research

Cannabinoid-Based Therapies and Brain Development: Potential Harmful Effect of Early Modulation of the Endocannabinoid System.

CNS drugs, 32(8), 697-712

View on PubMed ↗Publisher’s paper ↗

Citation

Schonhofen, Patrícia; Bristot, Ivi Juliana; Crippa, José Alexandre; Hallak, Jaime Eduardo Cecílio; Zuardi, Antônio Waldo; Parsons, Richard B; Klamt, Fábio. (2018). Cannabinoid-Based Therapies and Brain Development: Potential Harmful Effect of Early Modulation of the Endocannabinoid System.. CNS drugs, 32(8), 697-712. https://doi.org/10.1007/s40263-018-0550-4