The use of medicinal marijuana for treating Cerebral Palsy: a literature review

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However, MM has rarely been used for the treatment of Cerebral Palsy (CP) complications in adults. The aim of this literature review was to explore MM interventions globally, with a focus on identifying the best practice with MM for the treatment of complications of CP. Methods A literature search was performed using keywords and synonyms related to MM treatment and CP complications. Inclusions and exclusions were scoped to scholarly peer reviewed academic literature published 2019 to 2021 located in the Deakin Library collection. A screening process confirmed criteria adherence and identified additional papers in referencing. The papers were appraised and evaluated to ensure selections do not have perceived or actual bias. Results From 409 publications, 27 papers were selected for review because they investigated the benefits of MM treatment for patients with sleep, pain, and spasm complications. There was no literature found on the use of MM for adults with CP. Discussion Recent research has demonstrated that with an informed understanding of MM treatment adult patients with varying medical diagnoses and symptoms can use MM to manage sleep disruption and improve relaxation. Therefore, there are potential benefits for the use of MM in treating spasticity, pain, sleep and improvement of quality of life, and social and emotional wellbeing in adult patients with CP. No funding was sort or provided for this review and the results are specific to adults with CP, so they are not to be generalized to other populations. 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F1000Research 2025, 13 :825 ( https://doi.org/10.12688/f1000research.150792.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review Revised The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] Daniel McDonough 1 , James Charles 2 , Trent Shaw https://orcid.org/0009-0007-9502-664X 2 Daniel McDonough 1 , James Charles 2 , Trent Shaw https://orcid.org/0009-0007-9502-664X 2 PUBLISHED 06 Feb 2025 Author details Author details 1 South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia 2 Griffith University, Gold Coast, Queensland, Australia Daniel McDonough Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing James Charles Roles: Supervision, Writing – Review & Editing Trent Shaw Roles: Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Recent studies have established that Medicinal Marijuana (MM) is beneficial in the treatment of spasms, sleep, and pain in adult patients with varying medical diagnoses and symptoms. However, MM has rarely been used for the treatment of Cerebral Palsy (CP) complications in adults. The aim of this literature review was to explore MM interventions globally, with a focus on identifying the best practice with MM for the treatment of complications of CP. Methods A literature search was performed using keywords and synonyms related to MM treatment and CP complications. Inclusions and exclusions were scoped to scholarly peer reviewed academic literature published 2019 to 2021 located in the Deakin Library collection. A screening process confirmed criteria adherence and identified additional papers in referencing. The papers were appraised and evaluated to ensure selections do not have perceived or actual bias. Results From 409 publications, 27 papers were selected for review because they investigated the benefits of MM treatment for patients with sleep, pain, and spasm complications. There was no literature found on the use of MM for adults with CP. Discussion Recent research has demonstrated that with an informed understanding of MM treatment adult patients with varying medical diagnoses and symptoms can use MM to manage sleep disruption and improve relaxation. Therefore, there are potential benefits for the use of MM in treating spasticity, pain, sleep and improvement of quality of life, and social and emotional wellbeing in adult patients with CP. No funding was sort or provided for this review and the results are specific to adults with CP, so they are not to be generalized to other populations. READ ALL READ LESS Keywords Medicnal Marjuana, Cerebral Palsy, Treatment, Benefits Corresponding Author(s) Daniel McDonough ( [email protected] ) Close Corresponding author: Daniel McDonough Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2025 McDonough D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: McDonough D, Charles J and Shaw T. The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.12688/f1000research.150792.2 ) First published: 23 Jul 2024, 13 :825 ( https://doi.org/10.12688/f1000research.150792.1 ) Latest published: 06 Feb 2025, 13 :825 ( https://doi.org/10.12688/f1000research.150792.2 ) Revised Amendments from Version 1 The main change to the new version is that we have a far more in depth result section, detailing the types of MM administration, dose, side effects used to treat pain, spasticity and sleep disorders. Also, we have explained in more detail of the types of studies included with the review. The main change to the new version is that we have a far more in depth result section, detailing the types of MM administration, dose, side effects used to treat pain, spasticity and sleep disorders. Also, we have explained in more detail of the types of studies included with the review. See the authors' detailed response to the review by Mê-Linh Lê See the authors' detailed response to the review by Natalia Szejko READ REVIEWER RESPONSES Introduction Adults with Cerebral Palsy (CP) are at a higher risk of non-communicable diseases such as cancer, stroke, and chronic obstructive pulmonary disease. This is believed to be related to a lack of medical screening and insufficient services when they transition into adult healthcare service environments ( Murphy, 2018 ). A recent report showed that a patient with CP aged > 18 years is 72% more likely to develop advanced CKD after adjusting from cardiometabolic diseases compared to those without CP ( Whitney et al., 2020 ). It is common for people suffering with CP to have coexisting conditions that are outside of age-based developmental stages such as pain 75%, intellectual disability 50%, hip replacement 33%, incontinence 25%, epilepsy 25%, inability to speak 25%, sleep disorders 20-25%, and behaviour problems 20-25% ( Vitrikas et al., 2020 ). People with CP entering adult life have difficulty swallowing, as many muscles are affected in the oral cavity, making eating solid foods a challenge ( Speyer et al., 2019 ). Several studies have investigated the benefits of Medicinal Marijuana (MM) in the treatment of muscle spasms ( Nielsen et al., 2019 ; Singh & Singh, 2019 ; Stang et al., 2019 ), pain ( Campbell et al., 2019 ; Clem et al., 2020 ; Dzierżanowski, 2019 ; Wildes et al., 2020 ), sleep disturbance ( Skobic et al., 2020 ; Sznitman et al., 2020 ), quality of life (QOL), and social and emotional wellbeing (SEWB) ( Capano et al., 2020 ; Palace & Reingold, 2019 ). In addition, spasticity commonly occurs with neurological conditions including Cerebral Palsy, multiple sclerosis, stroke and spinal cord injuries. There is some evidence MM can be an effective treatment of adults with multiple sclerosis suffering from spasticity, with modest efficacy reducing spasticity ( Nielsen et al., 2019 ). However, there is limited evidence of MM reducing spasticity effectively with other neurological conditions ( Nielsen et al., 2019 ). The use of MM can provide better relevant resistance of spasticity compared to anti spasticity medications alone ( Markovà et al., 2019 ). However, MM has rarely been used to treat CP complications in adults. This literature review explored MM interventions globally, with a focus on identifying the best practices with MM for the treatment of complications in adults with CP. CP effects two–three people per 1,000 live births, and its diagnosis is usually determined between 12 and 24 months of age ( Vitrikas et al., 2020 ). There are many symptoms of CP such as poor posture, balance and movement resulting from brain disfunction and restricted movement known as spasticity, which is caused by compression of the brain and spinal cord, due to reduced blood flow reducing oxygen levels ( Stang et al., 2019 ). Patients with CP have numerous complications and problematic health-related experiences that continue to develop into adulthood such as high muscle tone, spasms, and motor skills, which often contribute to brain injury and developmental problems, seizures, cognitive dysfunction, osteoporosis, pressure ulcers, speech impairment, and hearing impairment ( Gulati & Sondhi, 2018 ; Vitrikas et al., 2020 ). CP is the most common form of spasticity resulting from a damaged non-progressive central nervous system that can inhibit motor function capacity development leading to low performance, and retardation ( Singh & Singh, 2019 ). Throughout history, cannabinoids have been used to treat various medical conditions worldwide and have been used medically for thousands of years in various cultures ( Crowder, 2019 ), including to manage spasms ( Fairhurst et al., 2020 ). In the human body, the endocannabinoid system has two key primary cannabinoid receptors, CB1 and CB2, that are linked to the central and peripheral nervous systems ( Rosi & Sorbello, 2019 ). CB1 receptors are found in the nervous system, organs, connective tissue, glands, immune cells, and the brain ( Rosi & Sorbello, 2019 ). CB2 receptors are primarily found in the immune system and can be non-responsive to anti-inflammation in certain parts of the human body during injury ( Rosi & Sorbello, 2019 ). Through the anandamide system, the body produces its own cannabinoids and cannabinoid receptors to produce several psychological effects and activities. Cannabidiol (CBD) and tetrahydrocannabinol (THC) both originate from the cannabis sativa plant and have the potential to modify muscle tone ( Fairhurst et al., 2020 ). THC is an active element and is known to have the most profound effect on pain relief and relaxation ( Rosi & Sorbello, 2019 ). The primary medicinal effects of THC include psychoactive properties, such as stimulation of appetite, muscle relaxation, analgesia, and antiemesis ( Fairhurst et al., 2020 ) However, a higher volume dose of THC can trigger paranoia ( Rosi & Sorbello, 2019 ). CBD also affects antipsychotic activity, muscle relaxants, antioxidants, anticonvulsants, and anxiolytic but does not cause intoxication ( Fairhurst et al., 2020 ; Rosi & Sorbello, 2019 ) CBD can increase the THC pain relief potential and limit psychoactive effects by working together to increase anti-inflammatory, antioxidant, and antiviral effects ( Rosi & Sorbello, 2019 ). Scientific techniques have been developed to extract oils and provide additional delivery systems for MM, which are grouped into four delivery methods to determine the best possible outcome for each individual ( Table 1 ) ( Rosi & Sorbello, 2019 ). Table 1. MM Methods. Method Description Inhalation Inhalation, vaporizing, or smoking, when looking for immediate relief taking effects within minutes or seconds, achieving maximum affect after 15 minutes, and lasting two–four hours. Psychoactive response is high due to the high concentrate of 25-30 %, of the traditional flower cannabinoid. Ingestion After ingestion, patients who report regular cannabis use can have a systematic relief effect. Sublingual Sublingual Medicated Edibles take 45-60 minutes to affect and are the most common practice for ingestible methods. The ingestible method can be difficult for patients who are new to administering cannabis; a low accurate dose at the beginning is important to achieve the best possible relief. Transdermal Topical administration is most effective for treating pain and joints that are closer to the skin surface and can be used as a slave patch. Relief can take between 15-60 minutes and last several hours depending on the area being treated. For topical administration, it is very important to individualize each patient and start at a low dose, recommended between 5 and 10 mg. In patients with severe pain, topical administration is not as effective as oral administration and inhalation of cannabis ( Rosi & Sorbello, 2019 ). Pain is one of the most common reasons for therapeutic use of MM. Recent studies on patients who use cannabis for pain have mainly used opioids to help control pain management previously ( Cooke et al., 2020 ). MM has also been extensively used to treat sleep disruption and improve relaxation in a variety of patients ( Skobic et al., 2020 ). In the last twenty years medical cannabis has been used to reduce pain for patients who have conditions such as spasticity and multiple sclerosis ( Fairhurst et al., 2020 ). In 2016, Australia passed legislation allowing registered health professionals the capacity to prescribe MM for their patients ( Lintzeris et al., 2020 ). Currently, MM is prescribed in some Australian states for the treatment of various medical conditions and health issues, such as pain, anxiety, and sleep disorders ( Albee & Penilton, 2019 ). Method Literature search methodology A literature search methodology was undertaken ( Figure 1 ) to identify interventions related to MM and the various types of MM use and methods amongst populations globally by adopting keywords and synonyms related to the topic ( Table 2 ). A set of inclusions and exclusions ( Table 3 ) were applied so the search scope was limited to relevant scholarly peer-reviewed literature publications from 2019 to 2021 that were available from the Deakin Library collection across five different databases ( Table 4 ). Figure 1. PRISMA flow diagram. Table 2. Search keywords and terms. Line Keywords Line 1 “Medicinal Marijuana” or “Medicinal Cannabis” or “Medical Marijuana” or “Medical Cannabis” or Cannabis or Marijuana or THC or CBD or Tetrahydrocannabinol or Cannabidiol or Cannabinoids or Hemp or “Hemp Oil”. Line 2 “Cerebral Palsy” or CP or “Spastic Quadriplegia” or “Spastic Quadriplegic Cerebral Palsy” or Spasticity or Spasms. Line 3 Treatment or Therapy or Management or Rehabilitation or Clinical or Therapeutic. Line 4 Sleep or “Sleep Deprivation” or “Sleep Disturbance” or “Reduced Sleep” or “Sleep Loss” or “Lack of Sleep” or “Short Sleep Duration” or Insomnia. Line 5 Pain or “Pain Management” or “Pain Relief” or “Pain Control” or “Pain Reduction” or Headache or Migraine. Table 3. Inclusion and exclusion criteria. Search Parameter Criteria Inclusion • Available in Deakin Library collection across five databases ( Table 4 ) • Published 2019 to 2021 • At least one keyword from line 1 and at least one other keyword from lines 2-4, and the keywords were included in the title or subject line of the publication ( Table 2 ) Exclusion • Literature Reviews • Conference Papers • Papers not published in English • Studies on Animals • Abstracts Only • Papers on drug “Therapy”, • Posters Presentations • Research on Children Table 4. Initial search results. Databases Number of publications MEDLINE Complete 184 ScienceDirect 97 CINAHL Complete 44 Gale OneFile: Health and Medicine 78 Health Source: Nursing/Academic Edition 6 Total Number of Papers 409 Results Literature search results The literature search results ( Figure 1 ) initially presented 409 publications as available for review although 71 duplicates were removed. Then a screening process based on a set of conditions ( Table 5 ) identified 25 papers aligned with the review aim. The reference lists of these 25 papers were then scanned using the same literature screening process and 2 more papers were added resulting in a total of 27 papers ( Table 6 ) selected for this literature review. The first and second authors of this paper both individually completed the entire search and screening process. If there were any conflicts for inclusion the third author was invited to resolve any conflicts. However, both the first and second author agreed with all inclusions, so the third author was not required to participate. Table 5. Literature screening process. Conditions Criteria 1 • Publication had at least one keyword from Line 1 ( Table 2 ) 2 • Publication had at least one keyword from either Line 2 or Line 3 or Line 4 or Line 5 ( Table 2 ) 3 • Keywords ( Table 2 ) must be included in the title or subject line Table 6. Papers selected for review. 1. Albee, T., & Penilton, D. (2019). Consideration of Medical Marijuana Inclusion in Life Care Planning: Implications and Challenges. Journal of Life Care Planning, 17(4), 9-16. https://ezproxy.deakin.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=141420263&authtype=sso&custid=deakin&site=eds-live&scope=site 2. Babson, K., Sottile, J., Morabito, D., & Babson, K. A. (2017). Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Current Psychiatry Reports, 19(4), 1. https://ezproxy.deakin.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=122896491&authtype=sso&custid=deakin&site=eds-live&scope=site 3. Campbell, G., Stockings, E., & Nielsen, S. (2019). Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain. European archives of psychiatry and clinical neuroscience, 269(1), 135-144. https://doi.org/10.1007/s00406-018-0960-9 4. Capano, A., Weaver, R., & Burkman, E. J. P. m. (2020). Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. 132(1), 56-61. 5. Clem, S. N., Bigand, T. L., & Wilson, M. (2020). Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction [Article]. Pain Management Nursing, 21(1), 43-47. https://doi.org/10.1016/j.pmn.2019.06.009 6. Cooke, A., Chavez, L., & Freisthler, B. (2020). The relationships between chronic pain and changes in health with cannabis consumption patterns [Article]. International Journal of Drug Policy, 76. https://doi.org/10.1016/j.drugpo.2019.102657 7. Crowder, L. (2019). A concise cannabis guide: History, laws and regulations [Chronology]. California Agriculture(03), 103. https://doi.org/10.3733/ca.2019a0022 8. Dzierżanowski, T. (2019). Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence. Cancers, 11(2), 129. https://doi.org/10.3390/cancers11020129 9. Fairhurst, C., Kumar, R., Checketts, D., Tayo, B., & Turner, S. (2020). Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: a randomized controlled trial. Developmental medicine and child neurology. https://doi.org/10.1111/dmcn.14548 10. Gulati, S., & Sondhi, V. J. T. I. J. o. P. (2018). Cerebral palsy: an overview. 85(11), 1006-1016. 11. Lintzeris, N., Mills, L., Suraev, A., Bravo, M., Arkell, T., Arnold, J. C., Benson, M. J., & McGregor, I. S. J. H. R. J. (2020). Medical cannabis use in the Australian community following introduction of legal access: the 2018–2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18). 17, 1-12. 12. Markovà, J., Essner, U., Akmaz, B., Marinelli, M., Trompke, C., Lentschat, A., & Vila, C. (2019). Sativex ® as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. The International journal of neuroscience, 129(2), 119-128. https://doi.org/10.1080/00207454.2018.1481066 13. Murphy, K. P. (2018). Cerebral palsy, non-communicable diseases, and lifespan care. Developmental Medicine & Child Neurology, 60(8), 733-733. https://doi.org/10.1111/dmcn.13784 14. Nielsen, S., Murnion, B., Campbell, G., Young, H., & Hall, W. (2019). Cannabinoids for the treatment of spasticity. Developmental Medicine & Child Neurology, 61(6), 631. https://ezproxy.deakin.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=136200848&authtype=sso&custid=deakin&site=eds-live&scope=site 15. Palace, Z. J., & Reingold, D. A. J. J. o. t. A. M. D. A. (2019). Medical cannabis in the skilled nursing facility: A novel approach to improving symptom management and quality of life. 20(1), 94-98. 16. Pham, M. N., Hudnall, M. T., & Nadler, R. B. (2020). Marijuana, Lower Urinary Tract Symptoms, and Pain in the Urologic Patient [Review Article]. Urology, 139, 8-13. https://doi.org/10.1016/j.urology.2020.01.029 17. Rosi, P., & Sorbello, J. (2019). MEDICAL MARIJUANA AND PAIN MANAGEMENT. Journal of Nurse Life Care Planning, 19(3), 20-24. https://ezproxy.deakin.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=138528279&authtype=sso&custid=deakin&site=eds-live&scope=site 18. Singh, A., & Singh, M. (2019). Comparison of Modified Ashworth Scale and Modified Tardieu Scale on Assessment of Lower Limb Spasticity in Hemiplegic and Diplegic Cerebral Palsy [Article]. Indian Journal of Public Health Research & Development, 10(11), 2766-2771. https://doi.org/10.5958/0976-5506.2019.04038.5 19. Skobic, I., Apolinar, G. R., Quan, S. F., & Haynes, P. L. (2020). Marijuana versus evidence-based treatments for sleep and relaxation: A cross-sectional study of use and dose modification following involuntary job loss [Article]. Sleep Health: Journal of the National Sleep Foundation. https://doi.org/10.1016/j.sleh.2020.06.008 20. Speyer, R., Cordier, R., Kim, J.-H., Cocks, N., Michou, E., & Wilkes-Gillan, S. (2019). Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. In (Vol. 61, pp. 1249). 21. Stang, K. M., King, N. E., Gaebler-Spira, D., & Green, M. M. (2019). It all started with a clubfoot: Beliefs surrounding cerebral palsy throughout history [Article]. Journal of Pediatric Rehabilitation Medicine, 12(2), 115-121. https://doi.org/10.3233/PRM-190005 22. Sznitman, S. R., Shochat, T., & Greene, T. (2020). Is time elapsed between cannabis use and sleep start time associated with sleep continuity? An experience sampling method [Article]. Drug and Alcohol Dependence, 208. https://doi.org/10.1016/j.drugalcdep.2020.107846 23. Tawfik, G. M., Hashan, M. R., Abdelaal, A., Tieu, T. M., & Huy, N. T. (2019). A commentary on the medicinal use of marijuana. Tropical Medicine and Health(1). https://doi.org/10.1186/s41182-019-0161-x 24. Vitrikas, K., Dalton, H., & Breish, D. (2020). Cerebral Palsy: An Overview. American family physician, 101(4), 213-220. https://ezproxy.deakin.edu.au/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mdc&AN=32053326&authtype=sso&custid=deakin&site=eds-live&scope=site 25. Whitney, D. G., Oliverio, A. L., Kamdar, N. S., Viglianti, B. L., Naik, A., & Schmidt, M. (2020). Advanced CKD Among Adults With Cerebral Palsy: Incidence and Risk Factors [Article]. Kidney Medicine. https://doi.org/10.1016/j.xkme.2020.05.012 26. Wildes, M., Bigand, T. L., Layton, M. E., & Wilson, M. (2020). Cannabis Use and Cognition in Adults Prescribed Opioids for Persistent Pain [Article]. Pain Management Nursing, 21(1), 94-99. https://doi.org/10.1016/j.pmn.2019.06.014 27. Zhand, N., & Milin, R. (2018). What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review [journal article]. American Journal on Addictions, 27(6), 453-464. https://doi.org/10.1111/ajad.12783 Main results The literature search was conducted to investigate the use of MM for the treatment of adults with CP in relation to pain, sleep and improvement of quality of life. The search strategy found studies including randomized control trials, cross sectional studies, prospective cohort studies, placebo-controlled randomized clinical trials, cohort studies, and retrospective studies, meta-analysis and longitudinal observational studies. The results of this study demonstrated there was some evidence of MM being beneficial for the treatment of pain, sleep, spasticity and SEWB. For example, in A double-blind placebo controlled randomised trial using THC/CBD oromucosal spray (Sativex) for patients with spasticity, as a add on therapy to optimized standard spasticity with moderate to severe multiple sclerosis MS. Patients with moderate to severe MS spasticity after a 12-week period receiving THC/CBD oromucosal spray (Sativex) achieved 30% improvement for MS spasticity compared to the placebo for therapeutic gain for spasticity. Also THC/CBD spray showed some improvements for secondary measures including spasms, pain and sleep disruptions ( Markovà et al., 2019 ). This study found the recommended dose, under these conditions, clinically meaningful for improvement of MS spasticity with a recommended average dose of 7 sprays, which was reported by more than three quarters of patients ( Markovà et al., 2019 ). However, many studies did not specify the type of the MM used, the type of administration employed, and the exact dose used. This is likely due to the individual patients’ needs and requirements of relief of different levels of pain, sleep, spasticity and SEWB. This also is related to different types and levels of health conditions e.g. MS, cancer treatment. Although there were some studies were patients responded positively with a specific type off MM and dose, the results of this review indicate that it is very difficult to recommend a specific type of MM and precise dose that could be recommended for all patients. In addition, some studies found adverse side effects such as vomiting and hallucinations from the administration of MM, which varied between individual and patient condition. Although this review found no evidence of the use of MM for the treatment of adults with CP, there is evidence that MM could be used for the treatment of some of the conditions e.g. pain, sleep, spasticity and SEWB which is related to adults suffering from CP. Analysis of selected papers Various appraisal and evaluation tools ( Table 7 ) were utilised to determine the paper’s quality and credibility as well as ensuring the review was without perceived or actual bias. Each paper was then scanned to confirm topic relevance and appropriate coverage of topics ( Table 8 ) towards objectively validating findings. The process revealed there was no literature or study on the use of MM for adults with CP to treat common health-related symptoms and conditions. Table 7. Appraisal and evaluation tools. Tool Purpose Critical Appraisal Skills Programme ( CASP, 2014 ) qualitative and quantitative appraisal tool Joanna Briggs Institute (JBI) ( Aromataris, 2017 ) checklist for text and opinion Scimago Journal & Country Rank (SJR) ( SCImago, 2007 ) evaluate the strength and quality of each selected paper National Health and Medical Research Council (NHMRC) hierarchy of evidence ( NHMRC, 2000 ) rank the selected papers’ rigour, quality, and credibility of the research Table 8. Coverage of review topics in selected papers. Review Paper CP MM MM Treatments Sleep Pain Spasticity QOL / SEWB Albee & Penilton (2019) ⊠ ⊠ ⊠ ⊠ □ □ Babson et al. (2017) □ ⊠ ⊠ □ □ □ Campbell et al. (2019) □ ⊠ □ □ □ □ Capano et al. (2020) □ ⊠ □ ⊠ □ ⊠ Clem et al. (2020) □ ⊠ □ ⊠ □ □ Cooke et al. (2020) □ ⊠ □ ⊠ □ □ Crowder (2019) □ ⊠ □ □ □ ⊠ Dzierżanowski (2019) □ ⊠ ⊠ ⊠ ⊠ □ Fairhurst et al. (2020) ⊠ ⊠ □ □ ⊠ □ Gulati & Sondhi (2018) ⊠ □ □ □ □ □ Lintzeris et al. (2020) □ ⊠ ⊠ ⊠ □ □ Markovà et al. (2019) □ ⊠ □ □ ⊠ □ Murphy (2018) ⊠ □ □ □ □ □ Nielsen et al. (2019) □ ⊠ □ □ ⊠ □ Palace & Reingold (2019) □ ⊠ □ □ □ ⊠ Pham et al. (2020) □ ⊠ □ ⊠ □ □ Rosi & Sorbello (2019) □ ⊠ □ ⊠ □ □ Singh & Singh (2019) ⊠ □ □ □ ⊠ □ Skobic et al. (2020) □ ⊠ ⊠ □ □ □ Speyer et al. (2019) ⊠ □ □ □ □ □ Stang et al. (2019) ⊠ □ □ □ □ □ Sznitman et al. (2020) □ ⊠ ⊠ □ □ □ Tawfik et al. (2019) □ ⊠ □ ⊠ □ ⊠ Vitrikas et al. (2020) ⊠ □ □ □ □ □ Whitney et al. (2020) ⊠ □ □ □ □ □ Wildes et al. (2020) □ ⊠ □ ⊠ □ □ Zhand & Milin (2018) □ ⊠ ⊠ □ □ □ Discussion A follow-up survey conducted 2018-2019 on the self-identified therapeutic reasons for the use of medical cannabis, 2-years after the initial survey following the introduction the legal access of medical cannabis in Australia, demonstrated to close similarity across both surveys that pain, mental health/substance use, sleep or other conditions as the main condition for the use of medical cannabis ( Lintzeris et al., 2020 ). The most recent survey report identified the overwhelming majority of 1388 respondents believed their symptoms improved from the use of MM ( Lintzeris et al., 2020 ). Alarmingly, in the same survey period, 25.8% (284/1103) of the respondents reported they were unaware of the CBD/THC composition of their medical cannabis or that compositions between batches varied 23.9% (264/1103) ( Lintzeris et al., 2020 ). Unfortunately, the potential concern raised for the ill-formed user of medical cannabis is also apparent in other studies that suggest more research is needed on the appropriate composition, dosage, and timing of MM when treating and managing specific medical conditions and symptoms ( Babson et al., 2017 ; Skobic et al., 2020 ; Sznitman et al., 2020 ). Internationally, there are many reasons why individuals pursue the use medical cannabis including but not limited to pain, anxiety, spasticity, and sleep disorders ( Albee & Penilton, 2019 ). There is some evidence that MM has beneficial effects for adults in relieving spasticity symptoms, pain management, and sleep apnoea ( Tawfik et al., 2019 ). A review of evidence for the effectiveness of cannabinoids in Oncology and palliative care practice acknowledged the limited and contradictory results on the effects of MM treatment for symptoms, including pain, sleep, and spasticity, though determined with consideration of finding the appropriate dosage then the benefits overweighed the possible risk for palliative care patients, especially in the earlier phases of progressive disease ( Dzierżanowski, 2019 ). The following sections presents more results in relation to MM treatments for sleep, pain, spasticity, QOL, and SEWB. MM treatments for sleep In recent years, research has shown an understanding on the effects of MM and cannabinoids derivatives that have been used for treating sleep disorders ( Babson et al., 2017 ). It is known that MM with cannabidiol has different effects based on dose; for example, a lower dose has been shown to be stimulating and is related to sleep disorders, and a higher dose can have the effect of sedation ( Babson et al., 2017 ). People with sleep disorders found that cannabidiol at medium to high doses can improve sleep ( Babson et al., 2017 ). Recent clinical trials have suggested that the THC/CBD ratio (Sativex) at the right dose can improve sleep in people with chronic pain. A study comparing the self-reported use of marijuana to evidence-based treatments for sleep/relaxation concluded that differences in THC/CBD composition and timing of dosage changes results ( Skobic et al., 2020 ). For instance, it was found that 160mg/day of CBD increased sleep time and reduced sleep disturbance, while a high dose (15mg) of THC at night could result in memory impairment, increased sleepiness, and mood changes in the day after ( Skobic et al., 2020 ). A study on the use of cannabis at a particular time to improve sleep presented the notion that the cannabis industry are making various unfounded claims on potential benefits of MM treatment for sleep leading to suggesting cannabis users be more informed and seek evidenced-based alternatives to improve sleep, such as, pharmacological and behavioural treatments ( Sznitman et al., 2020 ). However, the study sample was of 802 frequent cannabis users, and it is not made clear whether or not the participants used cannabis for a sleep disorder nor that the cannabis used was medicinal or recreational ( Sznitman et al., 2020 ). A literature review on the pharmacotherapeutic management of insomnia in cannabis withdrawal determined there is inconclusive evidence for treatment options due to the preliminary stages of the work ( Zhand & Milin, 2018 ). There has been limited research on MM to improve sleep, with studies having limitations of small sample sizes. Therefore, caution must be exercised when interpreting presented results. There have also been limitations with follow-up, highlighting the importance of examining the long-term effects of MM as a treatment for improving sleep ( Babson et al., 2017 ). MM treatments for pain Research by Cooke et al. (2020) was one of the first studies to evaluate the daily use of cannabis in comparison with the change in health status associated with pain severity ( Cooke et al., 2020 ). They examined cannabis consumption patterns associated with chronic pain and the control of different types of pain as well as investigating the demographics of each patient, impact of cannabis use, and overall health of patients ( Cooke et al., 2020 ). The research was a cross-sectional study design, which has limitations of conclusions about causation i.e. “cannabis might depress general health for people who have high pain” ( Cooke et al., 2020 ). The sample size (n=295) included medical cannabis patients, and the evaluation was designed for patients with both low and high pain levels. They measured daily cannabis consumption and the difference between low and high pain levels with the significance of MM ( Cooke et al., 2020 ). The relationship between cannabis use and the treatment of chronic pain can be dependent on route of administration and dose response effects. Given the complex nature of chronic pain, a myriad of causes and combinations of cannabis use have been identified. Therefore, it is difficult to determine the frequency of cannabis use among patients and how it affects the health of patients with chronic pain. Further research is needed to determine the frequency of cannabis use in patients with chronic pain ( Cooke et al., 2020 ). A review of 48 studies conducted by Pham et al. (2020) aimed to describe the role of MM and cannabinoids in lower urinary tract symptoms (LUTS) and dysfunction related to chronic pain, determined in clinical trials and preclinical studies ( Pham et al., 2020 ). The review revealed mixed results and limited evidence though there was enough evidence to suggest MM could target the endocannabinoid system to treat LUTS and other bladder conditions ( Pham et al., 2020 ). Unfortunately, the increased availability of legalised MM and cannabinoid derivatives will continue to outpace clinical investigations into the benefits of MM treatment for pain and as such will require physician-patient conversations to be held with a better understanding of how MM interacts with the human body ( Pham et al., 2020 ). Wildes et al. (2020) also concluded at the end of their study that more research is needed to better understand the effects of MM on the human body, in particular cognition and mood ( Wildes et al., 2020 ). They attempted to unpack the complex interplay of variables of persistent pain and how CBD and THC could affect change leading to the determination more investigations are required in relation to THC/CBD composition and dosage ( Wildes et al., 2020 ). A different study on the use MM for the treatment of persistent pain identified study participants were motivated to use MM to manage a variety of health-related symptoms such as pain, sleep, anxiety, and withdrawal instead of opioids ( Clem et al., 2020 ). Even though the study had limitations restricting generalizable findings the study investigated the motivation of participants to use MM to treat pain and as such were able to recommend a better understanding of alternative therapies that could help reduce the overall use of opioids given the well-documented side effect complications and likely opioid dependency ( Clem et al., 2020 ). MM treatments for spasticity The study conducted by Fairhurst et al. (2020) was the only study that used MM as a treatment for CP. It was a prospective randomized placebo-controlled trial, which focused on 72 adolescents (8 to 18 years old) who suffered from spasticity and traumatic central nervous system (CNS) injury and investigated the efficacy, safety, and tolerance of MM ( Fairhurst et al., 2020 ). The study investigated the benefits of sleep improvement with MM and although the results were not statistically significant, sleep scores showed some relevant numerical improvements ( Fairhurst et al., 2020 ). It should be noted that the measures investigated in this study were designed and developed for adults (>30 years), and several adverse reactions were experienced by young people after receiving MM. These adverse reactions may have been related to doses designed for adults, regardless of the reason why the adverse reactions affected the progression of the trial ( Fairhurst et al., 2020 ). A review of studies that included adults and paediatric participants in examining the effectiveness of cannabinoids in treating spasticity determined more favourable outcomes for adults than paediatric patients ( Nielsen et al., 2019 ). The paediatric studies produced low quality evidence whereas the adult studies of randomized controlled clinical trials demonstrated cannabinoids have more efficacy in reducing muscle spasticity ( Nielsen et al., 2019 ). A study of 191 participants on the use of MM to treat spasticity with adult (18y+) multiple sclerosis patients did prove the trialled THC: CBD spray demonstrated a more efficacious alternative to readjusting underlying antispasticity drugs ( Markovà et al., 2019 ). Markovà et al. (2019) conducted a randomized control trial to investigate a 12-week treatment program for using Sativex ® as an add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in a two-phase trial. Optimization of the underlying antispasticity medications was permitted in both groups across all study periods ( Markovà et al., 2019 ). The study criteria included adult (18y+) multiple sclerosis patients that had encountered spasticity for at least 12 months and had co-existing symptoms of chronic pain, spasm, low mobility, sleep disturbance, depression, anxiety, and fatigue ( Markovà et al., 2019 ). The criteria excluded who had taken THC, CBD spray in the past, or currently using cannabis or cannabinoid-based drugs of any form within 30 days prior to the study period and any family history of psychiatric disorders ( Markovà et al., 2019 ). MM treatments for QOL and SEWB An 8-week prospective, single-arm cohort study of 97 chronic pain patients for the potential role of cannabinoids as an alternative for opioids concluded a significant effect on reducing opioid intake, reducing pain, and improving QOL ( Capano et al., 2020 ). The study enrolled 30–65-year-old patients suffering from moderate to severe chronic pain for at least 3 years and had been stable on opioids for 1 year. Then they excluded participants if they had any history of substance disorder; any psychotic disorder; an abnormal drug screen in the previous 12-months; a history of non-fatal overdose; any epileptic activity in the previous 12-months; an incapacitating system disorder (cardiac, renal, or hepatic), or any known allergy to cannabis-based products ( Capano et al., 2020 ). Analysis of results were evaluated with four indices - Pain Disability Index (PDI-4); Pittsburgh Sleep Quality Index (PSQI), Pain Intensity and Interference (PEG); and Patient Health Questionnaire (PHQ-4). The study found 53% of the participants who added CBD hemp extract reduced or eliminated opioids and 94% of all CBD users reported QOL improvements ( Capano et al., 2020 ). An evaluation of a MM symptom management program implemented in an American skilled nursing facility for the safe use of MM for chronic conditions, especially chronic pain, neuropathy, and Parkinson’s disease influenced the recommendation that clinicians should consider the historical experiences and contemporary findings in the potential benefits of MM as an alternative therapy ( Palace & Reingold, 2019 ). Prior to the program implementation, an evaluation of meta-analysis from various trials, studies, and reviews found mixed results and relevant findings that aligned with the geriatric medical practice of focusing on simplifying medication regimes, avoiding polypharmacy, and eliminating medications with potentially harmful side effect profiles ( Palace & Reingold, 2019 ). The innovative program ignored traditional options for symptom management guided by Food and Drug Administration (FDA) approved medications and created an approved program so residents were able to legally obtain and use MM for symptom management in the facility ( Palace & Reingold, 2019 ). The program evaluation found most residents using MM to treat pain reported sustained improvement in chronic pain severity leading to opioid dosage reduction and an improved sense of SEWB ( Palace & Reingold, 2019 ). Limitations This literature review only examined publications that specifically investigated MM in adults in relation to sleep, pain, and spasm. The limitation of the focus of this study is that the results may not be generalizable to other populations. Conclusion There is no literature on the use of MM in adults with CP. This literature review found the evidenced-based potential benefits for the use of MM to treat spasticity, pain, and sleep symptoms and for improving QOL, and SEWB. However, from the findings of this review, further studies are needed on the appropriate composition, dosage and timing of MM when used as a treatment therapy. Furthermore, the review findings have established a need to study the use of MM treatment for adults with CP in relation to treating spasticity, pain, and sleep symptoms as well as improving QOL, and SEWB. Data availability No data are associated with this article. Extended data All extended data for this article can be found here: Figshare : The Use of Medicinal Marijuana for Treating Cerebral Palsy: A Literature Review, https://doi.org/10.6084/m9.figshare.25928494.v2 ( Shaw et al., 2024 ). This project contains the following underlying data: • The Use of Medicinal Marijuana for Treating Cerebral Palsy: A Literature Review. ○ This is a literature review to explore MM interventions globally with a focus on MM treatment of symptoms and conditions associated with adult CP patients, including spasticity, pain, sleep, QOL, and SEWB. • Review The Use of MM for CP 24 #30 Flow Diagram. ○ This is a flow diagram of the research methodology. • Review The Use of MM for CP 24 #30 abstract checklist. ○ A checklist of abstract items within the literature review. • Review The Use of MM for CP 24 #30 checklist. ○ A checklist of sections and items within the literature review. Detail of license Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgements I would like to acknowledge the traditional owners of all the many Aboriginal and Torres Strait Islander Nations that make up the great continent of Australia. As a Kaurna man I would like to acknowledge my Kaurna community, our Elders, representatives, and ancestors. References Albee T, Penilton D: Consideration of Medical Marijuana Inclusion in Life Care Planning: Implications and Challenges. J. Life Care Plan. 2019; 17 (4): 9–16. Reference Source Aromataris EMZ: Joanna Briggs Institute Reviewer’s Manual.2017. https://reviewersmanual.joannabriggs.org/ Babson K, Sottile J, Morabito D, et al. : Cannabis, Cannabinoids, and Sleep: a Review of the Literature. Curr. Psychiatry Rep. 2017; 19 (4): 1. Publisher Full Text Reference Source Campbell G, Stockings E, Nielsen S: Understanding the evidence for medical cannabis and cannabis-based medicines for the treatment of chronic non-cancer pain. Eur. Arch. Psychiatry Clin. Neurosci. 2019; 269 (1): 135–144. PubMed Abstract | Publisher Full Text Capano A, Weaver R, Burkman E: Evaluation of the effects of CBD hemp extract on opioid use and quality of life indicators in chronic pain patients: a prospective cohort study. Postgrad. Med. 2020; 132 (1): 56–61. PubMed Abstract | Publisher Full Text CASP: CASP checklists. Critical Appraisal Skills Programme (CASP): Making sense of evidence.2014. Clem SN, Bigand TL, Wilson M: Cannabis Use Motivations among Adults Prescribed Opioids for Pain versus Opioid Addiction. Pain Manag. Nurs. 2020; 21 (1): 43–47. PubMed Abstract | Publisher Full Text Cooke A, Chavez L, Freisthler B: The relationships between chronic pain and changes in health with cannabis consumption patterns. Int. J. Drug Policy. 2020; 76 : 102657. PubMed Abstract | Publisher Full Text | Free Full Text Crowder L: A concise cannabis guide: History, laws and regulations. Calif. Agric. 2019; 73 : 103. Publisher Full Text Dzierżanowski T: Prospects for the Use of Cannabinoids in Oncology and Palliative Care Practice: A Review of the Evidence. Cancers. 2019; 11 (2): 129. PubMed Abstract | Publisher Full Text | Free Full Text Fairhurst C, Kumar R, Checketts D, et al. : Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: a randomized controlled trial. Dev. Med. Child Neurol. 2020; 62 : 1031–1039. Publisher Full Text Gulati S, Sondhi V: Cerebral palsy: an overview. Indian J. Pediatr. 2018; 85 (11): 1006–1016. Publisher Full Text Lintzeris N, Mills L, Suraev A, et al. : Medical cannabis use in the Australian community following introduction of legal access: the 2018–2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18). Harm Reduct. J. 2020; 17 : 1–12. Publisher Full Text Markovà J, Essner U, Akmaz B, et al. : Sativex ® as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: a double-blind, placebo-controlled randomised clinical trial. Int. J. Neurosci. 2019; 129 (2): 119–128. PubMed Abstract | Publisher Full Text Murphy KP: Cerebral palsy, non-communicable diseases, and lifespan care. Dev. Med. Child Neurol. 2018; 60 (8): 733–733. PubMed Abstract | Publisher Full Text NHMRC: How to use the evidence: assessment and application of scientific evidence. Canberra: Australian Government; 2000. Nielsen S, Murnion B, Campbell G, et al. : Cannabinoids for the treatment of spasticity. Dev. Med. Child Neurol. 2019; 61 (6): 631–638. Publisher Full Text Reference Source Palace ZJ, Reingold DA: Medical cannabis in the skilled nursing facility: A novel approach to improving symptom management and quality of life. J. Am. Med. Dir. Assoc. 2019; 20 (1): 94–98. PubMed Abstract | Publisher Full Text Pham MN, Hudnall MT, Nadler RB: Marijuana, Lower Urinary Tract Symptoms, and Pain in the Urologic Patient. Urology. 2020; 139 : 8–13. PubMed Abstract | Publisher Full Text Rosi P, Sorbello J: MEDICAL MARIJUANA AND PAIN MANAGEMENT. J. Nurse Life Care Plan. 2019; 19 (3): 20–24. Reference Source SCImago: Scimago Journal & Country Rank.2007. Reference Source Shaw T, Charles J, McDonough D: The Use of Medicinal Marijuana for Treating Cerebral Palsy: A Literature Review. figshare. Journal contribution. 2024. Publisher Full Text Singh A, Singh M: Comparison of Modified Ashworth Scale and Modified Tardieu Scale on Assessment of Lower Limb Spasticity in Hemiplegic and Diplegic Cerebral Palsy. Indian J. Public Health Res. Dev. 2019; 10 (11): 2766–2771. Publisher Full Text Skobic I, Apolinar GR, Quan SF, et al. : Marijuana versus evidence-based treatments for sleep and relaxation: A cross-sectional study of use and dose modification following involuntary job loss. Sleep Health. 2020; 7 : 113–117. PubMed Abstract | Publisher Full Text | Free Full Text Speyer R, Cordier R, Kim J-H, et al. : Prevalence of drooling, swallowing, and feeding problems in cerebral palsy across the lifespan: a systematic review and meta-analyses. Dev. Med. Child Neurol. 2019; 61 : 1249. Stang KM, King NE, Gaebler-Spira D, et al. : It all started with a clubfoot: Beliefs surrounding cerebral palsy throughout history. J. Pediatr. Rehabil. Med. 2019; 12 (2): 115–121. PubMed Abstract | Publisher Full Text Sznitman SR, Shochat T, Greene T: Is time elapsed between cannabis use and sleep start time associated with sleep continuity? An experience sampling method. Drug Alcohol Depend. 2020; 208 : 107846. PubMed Abstract | Publisher Full Text Tawfik GM, Hashan MR, Abdelaal A, et al. : A commentary on the medicinal use of marijuana. Tropical Medicine and Health. 2019; 47 : 35. PubMed Abstract | Publisher Full Text | Free Full Text Vitrikas K, Dalton H, Breish D: Cerebral Palsy: An Overview. Am. Fam. Physician. 2020; 101 (4): 213–220. Reference Source Whitney DG, Oliverio AL, Kamdar NS, et al. : Advanced CKD Among Adults With Cerebral Palsy: Incidence and Risk Factors. Kidney Medicine. 2020; 2 : 569–577.e1. PubMed Abstract | Publisher Full Text | Free Full Text Wildes M, Bigand TL, Layton ME, et al. : Cannabis Use and Cognition in Adults Prescribed Opioids for Persistent Pain. Pain Manag. Nurs. 2020; 21 (1): 94–99. PubMed Abstract | Publisher Full Text Zhand N, Milin R: What do we know about the pharmacotheraputic management of insomnia in cannabis withdrawal: A systematic review. Am. J. Addict. 2018; 27 (6): 453–464. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 23 Jul 2024 ADD YOUR COMMENT Comment Author details Author details 1 South Australian Health and Medical Research Institute Limited, Adelaide, South Australia, Australia 2 Griffith University, Gold Coast, Queensland, Australia Daniel McDonough Roles: Investigation, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing James Charles Roles: Supervision, Writing – Review & Editing Trent Shaw Roles: Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (2) version 2 Revised Published: 06 Feb 2025, 13:825 https://doi.org/10.12688/f1000research.150792.2 version 1 Published: 23 Jul 2024, 13:825 https://doi.org/10.12688/f1000research.150792.1 Copyright © 2025 McDonough D et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article McDonough D, Charles J and Shaw T. The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.12688/f1000research.150792.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 06 Feb 2025 Revised Views 0 Cite How to cite this report: Friebert S. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.177700.r433967 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v2#referee-response-433967 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 11 Dec 2025 Sarah Friebert , Akron Children's Hospital, Akron, Ohio, USA Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.177700.r433967 Overall, this article purports to examine the use of medical cannabis in adults with CP. I think this is a valuable topic to explore, and one that clearly requires more research. However, the authors then go on to diverge from ... Continue reading READ ALL Overall, this article purports to examine the use of medical cannabis in adults with CP. I think this is a valuable topic to explore, and one that clearly requires more research. However, the authors then go on to diverge from their stated objectives and highlight a very narrow body of literature that focuses on symptoms outside of CP. The title is also misleading - this is not focused on treating CP but rather treating the symptoms and suffering from associated effects of CP. I would suggest that the authors use the term "medical cannabis" (MC) which is more correctly reflective of the therapies that are in use medically, since "marijuana" technically only refers to THC, and the word "medicinal" is not generally the accepted terminology. I found the writing to be confusing and awkward, so I've offered some suggestions to improve readability. Specific language/grammar issues: Abstract : - Discussion: "No funding was sort or provided" is not a correct sentence - Keywords: "Medicnal" is misspelled Introduction: - It is not clear to me why the authors mention non-communicable diseases as this is not relevant to the review topic; also, the phrasing "after adjusting from cardiometabolic diseases" is not clear - What does "outside of age-based developmental stages" mean? - 2nd paragraph: delete "reducing spasticity" as it is repetitive in the sentence about MS - Revise the last sentence of paragraph 2: "While there is limited evidence...conditions, the use of MC may be more effective in reducing spasticity compared to..." ("relevant resistance of spasticity" is a confusing phrase) - Paragraph 4: should be "CP affects" not effects; and be consistent using numerals vs words (two-three alongside 12 and 24...?) - 4th paragraph: "motor skills" is incorrect here - do they mean "impaired motor skills"? - the word "retardation" should be deleted and replaced with appropriate language - Paragraph 6: needs a "." after sentence on THC's primary medicinal effects - Paragraph 6: "CBD also affects... " is a non-sensical sentence. Are they trying to say that CBD has antipsychotic, muscle relaxant, antioxidant, anticonvulsant, and anxiolytic effects? - There are many other references about the effects of CBD and THC, and the endocannabinoid distribution in humans. I would suggest the authors expand beyond Rosi & Sorbello. - In Table 1, there are some strange sentences - should be improved for readability. Also, what is a "slave patch"? - Final paragraph of introduction: "help control pain management" is improper - "help control pain" or "help with pain management" Methods should be titled METHODS (not method) Table 1: registry, not register? Not clear what "reason 1 = 0, reason 2 = 0" etc means or how it's relevant? Table 2: why were headache and migraine included when the search was about CP? Table 3: why did the authors select such a limited time frame and those years in particular? - remove comma after drug therapy Table 5 seems unnecessary Main results - Quality of life is mentioned here but is not in any of the search terms or previously included - how can the authors claim this? - What is SEWB? (not spelled out before abbreviation used) - Sentence poorly written: "For example, in A (shouldn't be capitalized) double-blind...as a add-on therapy (should be an)..". to "optimized standard spasticity" makes no sense. This is also not a complete sentence. - sentence: "Although there were some studies" should be WHERE not "were," specific type OF not "off" - the last sentence of that paragraph: "...spasticity, and SEWB which contribute to suffering for adults with CP" The authors don't specify how they determined "without perceived or actual bias." This needs to be described/clarified. Discussion - The first paragraph is almost unreadable. - second paragraph: "A review of evidence... " is a run-on sentence and the second part of it is nonsensical. It is unclear to me why the authors go on to discuss MC in sleep and pain without CP, when their review is by far not inclusive of the larger body of research in these more general topics. Also, the inclusion of the Fairhurst study on adolescents, not adults, should have fallen out of their search strategy if the article is about adults. It is somewhat irresponsible to cite one adolescent study that highlights adverse reactions, when this wasn't the stated purpose of this study. Again, if QOL is to be included and discussed, it should be identified up front and included in the search strategy. In summary, while the topic important and valuable, the search strategy is not well justified, and the article is written in a confusing way that is distracting to read and undermines the intended effect. Are the rationale for, and objectives of, the Systematic Review clearly stated? Partly Are sufficient details of the methods and analysis provided to allow replication by others? Partly Is the statistical analysis and its interpretation appropriate? Not applicable Are the conclusions drawn adequately supported by the results presented in the review? Partly If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Pediatrics/young adults, medical cannabis, palliative care I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Friebert S. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.177700.r433967 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v2#referee-response-433967 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Lê ML. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.177700.r364982 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v2#referee-response-364982 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Feb 2025 Mê-Linh Lê , Health Sciences Librarian, Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada Approved VIEWS 0 https://doi.org/10.5256/f1000research.177700.r364982 The authors have addressed my concerns related to the important distinctions and methodological rigour between a literature review and a systematic review. Their revised methods and description of their literature review process are now clear on the work that was ... Continue reading READ ALL The authors have addressed my concerns related to the important distinctions and methodological rigour between a literature review and a systematic review. Their revised methods and description of their literature review process are now clear on the work that was completed. Competing Interests: No competing interests were disclosed. Reviewer Expertise: Information professional with 10+ years of knowledge synthesis work I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Lê ML. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.177700.r364982 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v2#referee-response-364982 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 23 Jul 2024 Views 0 Cite How to cite this report: Lê ML. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.165390.r330974 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v1#referee-response-330974 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 14 Nov 2024 Mê-Linh Lê , Health Sciences Librarian, Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.165390.r330974 As an information professional, I have limited my comments below to those relating to the methodology and citations of the paper. Methods While the title of this article says it is a literature review, throughout the ... Continue reading READ ALL As an information professional, I have limited my comments below to those relating to the methodology and citations of the paper. Methods While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. — Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? No Is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are the conclusions drawn adequately supported by the results presented in the review? No If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Information professional with 10+ years of knowledge synthesis work I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Lê ML. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.165390.r330974 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v1#referee-response-330974 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 06 Feb 2025 Daniel McDonough , Research, Telethon Kids Institute, Adelaide, Australia 06 Feb 2025 Author Response Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the ... Continue reading Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. Comment The use of the term “systematic” in the body of the paper referred to systematic nature of our search for repeatability and the use of a PRISMA flowchart and checklist. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. Comment We chose to only have two years as we wanted to look at the most recent and up to date literature on the topic. Also, we agree not how a SR is completed, it was never our attention to do an SR and we have now removed any mention systematic review throughout the paper. Reviewer 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms Comment Thank you for your comment, we understand limitations of not using individual data bases. Just to clarify the first author Daniel McDonough was enrolled at Deakin University and conducted this literature review as part of his thesis for his Master of Public Health. We only used Deakin University library database, for convenience and accessibilit y. Reviewer 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. Comment We agree and understand the limitations of our search strategy conducted. However, this literature review was never intended to be an all-encompassing systematic literature review. It was conducted for a specific reason i.e. Investigate the use of MM for treatment of pain, sleep, spasms, SEWB for adults with CP. The result of this study was used to inform a proposed research project investigating the use of MM for the complications of CP, which has now been completed. Reviewer 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. Comment Thanks for picking this up we have changed to “The first and second authors of this paper both individually completed the entire search and screening process. If there were any conflicts for inclusion the third author was invited to resolve any conflicts. However, both the first and second author agreed with all inclusions, so the third author was not required to participate”. See literature search results. Reviewer 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. Comment Apologies this was not clear, we used the study type exclusion inclusion with keywords as a convenient way to student to include and exclude papers we have now modified the table to more consistent and accurate. Reviewer 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. Comment Thank you for your comment we have tried to clarify the inclusion and exclusion and removed any mention of SR. Reviewer 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests Comment Understand your point however, we are clinicians and clinical researchers, we conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a research study, investigating medicinal marijuana for the treatment of adults with Cerebral Palsy. Therefore, we were not interested in studies investigating children. Reviewer 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. Comment Thanks for picking this up, this information is not relevant for the focus of this paper, we have now removed this. Reviewer 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. Comment Thankyou for bringing this to our attention we have now attempted to make corrections. Sorry we can’t see the numerical in PRISMA flowchart can you clarify for us to make appropriate changes. Reviewer Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a research project which was also a part of his Master of Public Health. The first author has now completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our research. We have now submitted the findings of our research for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Therefore, we appreciate your suggestion, but we feel this literature could be really helpful for other clinical researchers and unfortunately, we are not in the position to expand our search. Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. Comment The use of the term “systematic” in the body of the paper referred to systematic nature of our search for repeatability and the use of a PRISMA flowchart and checklist. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. Comment We chose to only have two years as we wanted to look at the most recent and up to date literature on the topic. Also, we agree not how a SR is completed, it was never our attention to do an SR and we have now removed any mention systematic review throughout the paper. Reviewer 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms Comment Thank you for your comment, we understand limitations of not using individual data bases. Just to clarify the first author Daniel McDonough was enrolled at Deakin University and conducted this literature review as part of his thesis for his Master of Public Health. We only used Deakin University library database, for convenience and accessibilit y. Reviewer 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. Comment We agree and understand the limitations of our search strategy conducted. However, this literature review was never intended to be an all-encompassing systematic literature review. It was conducted for a specific reason i.e. Investigate the use of MM for treatment of pain, sleep, spasms, SEWB for adults with CP. The result of this study was used to inform a proposed research project investigating the use of MM for the complications of CP, which has now been completed. Reviewer 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. Comment Thanks for picking this up we have changed to “The first and second authors of this paper both individually completed the entire search and screening process. If there were any conflicts for inclusion the third author was invited to resolve any conflicts. However, both the first and second author agreed with all inclusions, so the third author was not required to participate”. See literature search results. Reviewer 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. Comment Apologies this was not clear, we used the study type exclusion inclusion with keywords as a convenient way to student to include and exclude papers we have now modified the table to more consistent and accurate. Reviewer 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. Comment Thank you for your comment we have tried to clarify the inclusion and exclusion and removed any mention of SR. Reviewer 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests Comment Understand your point however, we are clinicians and clinical researchers, we conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a research study, investigating medicinal marijuana for the treatment of adults with Cerebral Palsy. Therefore, we were not interested in studies investigating children. Reviewer 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. Comment Thanks for picking this up, this information is not relevant for the focus of this paper, we have now removed this. Reviewer 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. Comment Thankyou for bringing this to our attention we have now attempted to make corrections. Sorry we can’t see the numerical in PRISMA flowchart can you clarify for us to make appropriate changes. Reviewer Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a research project which was also a part of his Master of Public Health. The first author has now completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our research. We have now submitted the findings of our research for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Therefore, we appreciate your suggestion, but we feel this literature could be really helpful for other clinical researchers and unfortunately, we are not in the position to expand our search. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 06 Feb 2025 Daniel McDonough , Research, Telethon Kids Institute, Adelaide, Australia 06 Feb 2025 Author Response Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the ... Continue reading Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. Comment The use of the term “systematic” in the body of the paper referred to systematic nature of our search for repeatability and the use of a PRISMA flowchart and checklist. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. Comment We chose to only have two years as we wanted to look at the most recent and up to date literature on the topic. Also, we agree not how a SR is completed, it was never our attention to do an SR and we have now removed any mention systematic review throughout the paper. Reviewer 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms Comment Thank you for your comment, we understand limitations of not using individual data bases. Just to clarify the first author Daniel McDonough was enrolled at Deakin University and conducted this literature review as part of his thesis for his Master of Public Health. We only used Deakin University library database, for convenience and accessibilit y. Reviewer 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. Comment We agree and understand the limitations of our search strategy conducted. However, this literature review was never intended to be an all-encompassing systematic literature review. It was conducted for a specific reason i.e. Investigate the use of MM for treatment of pain, sleep, spasms, SEWB for adults with CP. The result of this study was used to inform a proposed research project investigating the use of MM for the complications of CP, which has now been completed. Reviewer 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. Comment Thanks for picking this up we have changed to “The first and second authors of this paper both individually completed the entire search and screening process. If there were any conflicts for inclusion the third author was invited to resolve any conflicts. However, both the first and second author agreed with all inclusions, so the third author was not required to participate”. See literature search results. Reviewer 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. Comment Apologies this was not clear, we used the study type exclusion inclusion with keywords as a convenient way to student to include and exclude papers we have now modified the table to more consistent and accurate. Reviewer 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. Comment Thank you for your comment we have tried to clarify the inclusion and exclusion and removed any mention of SR. Reviewer 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests Comment Understand your point however, we are clinicians and clinical researchers, we conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a research study, investigating medicinal marijuana for the treatment of adults with Cerebral Palsy. Therefore, we were not interested in studies investigating children. Reviewer 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. Comment Thanks for picking this up, this information is not relevant for the focus of this paper, we have now removed this. Reviewer 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. Comment Thankyou for bringing this to our attention we have now attempted to make corrections. Sorry we can’t see the numerical in PRISMA flowchart can you clarify for us to make appropriate changes. Reviewer Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a research project which was also a part of his Master of Public Health. The first author has now completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our research. We have now submitted the findings of our research for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Therefore, we appreciate your suggestion, but we feel this literature could be really helpful for other clinical researchers and unfortunately, we are not in the position to expand our search. Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. Comment The use of the term “systematic” in the body of the paper referred to systematic nature of our search for repeatability and the use of a PRISMA flowchart and checklist. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. Comment We chose to only have two years as we wanted to look at the most recent and up to date literature on the topic. Also, we agree not how a SR is completed, it was never our attention to do an SR and we have now removed any mention systematic review throughout the paper. Reviewer 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms Comment Thank you for your comment, we understand limitations of not using individual data bases. Just to clarify the first author Daniel McDonough was enrolled at Deakin University and conducted this literature review as part of his thesis for his Master of Public Health. We only used Deakin University library database, for convenience and accessibilit y. Reviewer 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. Comment We agree and understand the limitations of our search strategy conducted. However, this literature review was never intended to be an all-encompassing systematic literature review. It was conducted for a specific reason i.e. Investigate the use of MM for treatment of pain, sleep, spasms, SEWB for adults with CP. The result of this study was used to inform a proposed research project investigating the use of MM for the complications of CP, which has now been completed. Reviewer 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. Comment Thanks for picking this up we have changed to “The first and second authors of this paper both individually completed the entire search and screening process. If there were any conflicts for inclusion the third author was invited to resolve any conflicts. However, both the first and second author agreed with all inclusions, so the third author was not required to participate”. See literature search results. Reviewer 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. Comment Apologies this was not clear, we used the study type exclusion inclusion with keywords as a convenient way to student to include and exclude papers we have now modified the table to more consistent and accurate. Reviewer 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. Comment Thank you for your comment we have tried to clarify the inclusion and exclusion and removed any mention of SR. Reviewer 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests Comment Understand your point however, we are clinicians and clinical researchers, we conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a research study, investigating medicinal marijuana for the treatment of adults with Cerebral Palsy. Therefore, we were not interested in studies investigating children. Reviewer 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. Comment Thanks for picking this up, this information is not relevant for the focus of this paper, we have now removed this. Reviewer 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. Comment Thankyou for bringing this to our attention we have now attempted to make corrections. Sorry we can’t see the numerical in PRISMA flowchart can you clarify for us to make appropriate changes. Reviewer Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a research project which was also a part of his Master of Public Health. The first author has now completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our research. We have now submitted the findings of our research for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Therefore, we appreciate your suggestion, but we feel this literature could be really helpful for other clinical researchers and unfortunately, we are not in the position to expand our search. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Szejko N. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.165390.r330978 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v1#referee-response-330978 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 28 Oct 2024 Natalia Szejko , University of Calgary, Calgary, Alberta, Canada Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.165390.r330978 Thank you for providing me the opportunity to review this interesting paper that concerns an interesting topic of CP and use of cannabis based medicine. Overall the paper is interesting and relevant to the field. However, I ... Continue reading READ ALL Thank you for providing me the opportunity to review this interesting paper that concerns an interesting topic of CP and use of cannabis based medicine. Overall the paper is interesting and relevant to the field. However, I have some small suggestions that could be considered before the paper will be indexed. It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Please provide more information, maybe consider merging both? I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Are there any RCTs or meta analyses? As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results – are the studies included RCTs, case reports, retrospective studies? What are the main results? If CBM is effective to treat pain, which CBM specifically? At which dose? Any side effects? The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. I would also not say that one treats quality of life, but would rather name it as improvement of quality of life. Could the authors also clarify the abbreviation SEWB? Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Cannabis based medicine, neurology, psychiatry I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Szejko N. Reviewer Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.165390.r330978 ) The direct URL for this report is: https://f1000research.com/articles/13-825/v1#referee-response-330978 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 06 Feb 2025 Daniel McDonough , Research, Telethon Kids Institute, Adelaide, Australia 06 Feb 2025 Author Response Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is ... Continue reading Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Comment - Thank you for your suggestion, we have now combined background and Introduction together see new introduction. Reviewer - Please provide more information, maybe consider merging both? Comment - We have now merged both as suggested. Reviewer - I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Comment - We have added treatment of spasticity in the relation CBM see introduction paragraph two. Reviewer - Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Comment - Sorry if this wasn’t clear but our search did not find any papers in relation to MM for a treatment for adults with CP, although there was paper that claimed to focus on the treatment for CP for MM for adults on a closer analysis it focused on the treatment of adolescents see page 14 Reviewer - Are there any RCTs or meta-analyses? Comment - Our search strategy only found one paper that was a RCT i.e. Fairhurst et. al 2020 and there were several meta-analyses i.e. Zhand, N., & Milin, R. (2018). Dzierżanowski, T. (2019). Babson, K., Sottile, J., Morabito, D., & Babson, K. A. (2017). Now we have attempted to highlight this in the paper, see results section. Reviewer - As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Comment - The use of systematic in the body of the paper referred to systematic nature of our search for repeatability. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer - Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results are the studies included RCTs, case reports, retrospective studies? Comment - We have added to the results section, see paragraph in main results section on the types of studies examined i.e. randomized control trials, cross sectional studies, prospective cohort studies, placebo-controlled randomized clinical trials, cohort studies, and retrospective studies, meta-analysis and longitudinal observational studies. Reviewer - What are the main results? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - If CBM is effective to treat pain, which CBM specifically? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - At which dose? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - Any side effects? Comment - Side effects is described in the discussion section but have also added to the main results section as suggested Reviewer - The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. Comment - We have attempted to describe in more detail the symptoms and have added it to the results section as suggested. Reviewer - I would also not say that one treats quality of life, but would rather name it as improvement of quality of life? Comment - Thanks for pointing this out, we have now modified the language to use terms like “improving quality of life”. Reviewer - Could the authors also clarify the abbreviation SEWB? Comment - Thanks for pointing this out, we have written this in full i.e. Social and emotional wellbeing, prior to using the acronym. Reviewer - Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Comment - We conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a case study, investigating medicinal marijuana for the treatment of an adults with Cerebral Palsy. Additional comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a case study which was also a part of his Master of Public Health. The first author has completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our case study. We also believe other clinical researchers proposing to conduct research to treat symptoms with CP may also find it helpful. We have now submitted the findings of our case study for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Comment - Thank you for your suggestion, we have now combined background and Introduction together see new introduction. Reviewer - Please provide more information, maybe consider merging both? Comment - We have now merged both as suggested. Reviewer - I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Comment - We have added treatment of spasticity in the relation CBM see introduction paragraph two. Reviewer - Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Comment - Sorry if this wasn’t clear but our search did not find any papers in relation to MM for a treatment for adults with CP, although there was paper that claimed to focus on the treatment for CP for MM for adults on a closer analysis it focused on the treatment of adolescents see page 14 Reviewer - Are there any RCTs or meta-analyses? Comment - Our search strategy only found one paper that was a RCT i.e. Fairhurst et. al 2020 and there were several meta-analyses i.e. Zhand, N., & Milin, R. (2018). Dzierżanowski, T. (2019). Babson, K., Sottile, J., Morabito, D., & Babson, K. A. (2017). Now we have attempted to highlight this in the paper, see results section. Reviewer - As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Comment - The use of systematic in the body of the paper referred to systematic nature of our search for repeatability. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer - Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results are the studies included RCTs, case reports, retrospective studies? Comment - We have added to the results section, see paragraph in main results section on the types of studies examined i.e. randomized control trials, cross sectional studies, prospective cohort studies, placebo-controlled randomized clinical trials, cohort studies, and retrospective studies, meta-analysis and longitudinal observational studies. Reviewer - What are the main results? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - If CBM is effective to treat pain, which CBM specifically? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - At which dose? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - Any side effects? Comment - Side effects is described in the discussion section but have also added to the main results section as suggested Reviewer - The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. Comment - We have attempted to describe in more detail the symptoms and have added it to the results section as suggested. Reviewer - I would also not say that one treats quality of life, but would rather name it as improvement of quality of life? Comment - Thanks for pointing this out, we have now modified the language to use terms like “improving quality of life”. Reviewer - Could the authors also clarify the abbreviation SEWB? Comment - Thanks for pointing this out, we have written this in full i.e. Social and emotional wellbeing, prior to using the acronym. Reviewer - Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Comment - We conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a case study, investigating medicinal marijuana for the treatment of an adults with Cerebral Palsy. Additional comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a case study which was also a part of his Master of Public Health. The first author has completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our case study. We also believe other clinical researchers proposing to conduct research to treat symptoms with CP may also find it helpful. We have now submitted the findings of our case study for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 06 Feb 2025 Daniel McDonough , Research, Telethon Kids Institute, Adelaide, Australia 06 Feb 2025 Author Response Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is ... Continue reading Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Comment - Thank you for your suggestion, we have now combined background and Introduction together see new introduction. Reviewer - Please provide more information, maybe consider merging both? Comment - We have now merged both as suggested. Reviewer - I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Comment - We have added treatment of spasticity in the relation CBM see introduction paragraph two. Reviewer - Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Comment - Sorry if this wasn’t clear but our search did not find any papers in relation to MM for a treatment for adults with CP, although there was paper that claimed to focus on the treatment for CP for MM for adults on a closer analysis it focused on the treatment of adolescents see page 14 Reviewer - Are there any RCTs or meta-analyses? Comment - Our search strategy only found one paper that was a RCT i.e. Fairhurst et. al 2020 and there were several meta-analyses i.e. Zhand, N., & Milin, R. (2018). Dzierżanowski, T. (2019). Babson, K., Sottile, J., Morabito, D., & Babson, K. A. (2017). Now we have attempted to highlight this in the paper, see results section. Reviewer - As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Comment - The use of systematic in the body of the paper referred to systematic nature of our search for repeatability. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer - Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results are the studies included RCTs, case reports, retrospective studies? Comment - We have added to the results section, see paragraph in main results section on the types of studies examined i.e. randomized control trials, cross sectional studies, prospective cohort studies, placebo-controlled randomized clinical trials, cohort studies, and retrospective studies, meta-analysis and longitudinal observational studies. Reviewer - What are the main results? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - If CBM is effective to treat pain, which CBM specifically? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - At which dose? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - Any side effects? Comment - Side effects is described in the discussion section but have also added to the main results section as suggested Reviewer - The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. Comment - We have attempted to describe in more detail the symptoms and have added it to the results section as suggested. Reviewer - I would also not say that one treats quality of life, but would rather name it as improvement of quality of life? Comment - Thanks for pointing this out, we have now modified the language to use terms like “improving quality of life”. Reviewer - Could the authors also clarify the abbreviation SEWB? Comment - Thanks for pointing this out, we have written this in full i.e. Social and emotional wellbeing, prior to using the acronym. Reviewer - Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Comment - We conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a case study, investigating medicinal marijuana for the treatment of an adults with Cerebral Palsy. Additional comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a case study which was also a part of his Master of Public Health. The first author has completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our case study. We also believe other clinical researchers proposing to conduct research to treat symptoms with CP may also find it helpful. We have now submitted the findings of our case study for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Comment - Thank you for your suggestion, we have now combined background and Introduction together see new introduction. Reviewer - Please provide more information, maybe consider merging both? Comment - We have now merged both as suggested. Reviewer - I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Comment - We have added treatment of spasticity in the relation CBM see introduction paragraph two. Reviewer - Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Comment - Sorry if this wasn’t clear but our search did not find any papers in relation to MM for a treatment for adults with CP, although there was paper that claimed to focus on the treatment for CP for MM for adults on a closer analysis it focused on the treatment of adolescents see page 14 Reviewer - Are there any RCTs or meta-analyses? Comment - Our search strategy only found one paper that was a RCT i.e. Fairhurst et. al 2020 and there were several meta-analyses i.e. Zhand, N., & Milin, R. (2018). Dzierżanowski, T. (2019). Babson, K., Sottile, J., Morabito, D., & Babson, K. A. (2017). Now we have attempted to highlight this in the paper, see results section. Reviewer - As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Comment - The use of systematic in the body of the paper referred to systematic nature of our search for repeatability. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer - Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results are the studies included RCTs, case reports, retrospective studies? Comment - We have added to the results section, see paragraph in main results section on the types of studies examined i.e. randomized control trials, cross sectional studies, prospective cohort studies, placebo-controlled randomized clinical trials, cohort studies, and retrospective studies, meta-analysis and longitudinal observational studies. Reviewer - What are the main results? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - If CBM is effective to treat pain, which CBM specifically? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - At which dose? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - Any side effects? Comment - Side effects is described in the discussion section but have also added to the main results section as suggested Reviewer - The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. Comment - We have attempted to describe in more detail the symptoms and have added it to the results section as suggested. Reviewer - I would also not say that one treats quality of life, but would rather name it as improvement of quality of life? Comment - Thanks for pointing this out, we have now modified the language to use terms like “improving quality of life”. Reviewer - Could the authors also clarify the abbreviation SEWB? Comment - Thanks for pointing this out, we have written this in full i.e. Social and emotional wellbeing, prior to using the acronym. Reviewer - Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Comment - We conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a case study, investigating medicinal marijuana for the treatment of an adults with Cerebral Palsy. Additional comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a case study which was also a part of his Master of Public Health. The first author has completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our case study. We also believe other clinical researchers proposing to conduct research to treat symptoms with CP may also find it helpful. We have now submitted the findings of our case study for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 2 VERSION 2 PUBLISHED 23 Jul 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 2 (revision) 06 Feb 25 read read Version 1 23 Jul 24 read read Natalia Szejko , University of Calgary, Calgary, Canada Mê-Linh Lê , University of Manitoba, Winnipeg, Canada Sarah Friebert , Akron Children's Hospital, Akron, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Friebert S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 11 Dec 2025 | for Version 2 Sarah Friebert , Akron Children's Hospital, Akron, Ohio, USA 0 Views copyright © 2025 Friebert S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Overall, this article purports to examine the use of medical cannabis in adults with CP. I think this is a valuable topic to explore, and one that clearly requires more research. However, the authors then go on to diverge from their stated objectives and highlight a very narrow body of literature that focuses on symptoms outside of CP. The title is also misleading - this is not focused on treating CP but rather treating the symptoms and suffering from associated effects of CP. I would suggest that the authors use the term "medical cannabis" (MC) which is more correctly reflective of the therapies that are in use medically, since "marijuana" technically only refers to THC, and the word "medicinal" is not generally the accepted terminology. I found the writing to be confusing and awkward, so I've offered some suggestions to improve readability. Specific language/grammar issues: Abstract : - Discussion: "No funding was sort or provided" is not a correct sentence - Keywords: "Medicnal" is misspelled Introduction: - It is not clear to me why the authors mention non-communicable diseases as this is not relevant to the review topic; also, the phrasing "after adjusting from cardiometabolic diseases" is not clear - What does "outside of age-based developmental stages" mean? - 2nd paragraph: delete "reducing spasticity" as it is repetitive in the sentence about MS - Revise the last sentence of paragraph 2: "While there is limited evidence...conditions, the use of MC may be more effective in reducing spasticity compared to..." ("relevant resistance of spasticity" is a confusing phrase) - Paragraph 4: should be "CP affects" not effects; and be consistent using numerals vs words (two-three alongside 12 and 24...?) - 4th paragraph: "motor skills" is incorrect here - do they mean "impaired motor skills"? - the word "retardation" should be deleted and replaced with appropriate language - Paragraph 6: needs a "." after sentence on THC's primary medicinal effects - Paragraph 6: "CBD also affects... " is a non-sensical sentence. Are they trying to say that CBD has antipsychotic, muscle relaxant, antioxidant, anticonvulsant, and anxiolytic effects? - There are many other references about the effects of CBD and THC, and the endocannabinoid distribution in humans. I would suggest the authors expand beyond Rosi & Sorbello. - In Table 1, there are some strange sentences - should be improved for readability. Also, what is a "slave patch"? - Final paragraph of introduction: "help control pain management" is improper - "help control pain" or "help with pain management" Methods should be titled METHODS (not method) Table 1: registry, not register? Not clear what "reason 1 = 0, reason 2 = 0" etc means or how it's relevant? Table 2: why were headache and migraine included when the search was about CP? Table 3: why did the authors select such a limited time frame and those years in particular? - remove comma after drug therapy Table 5 seems unnecessary Main results - Quality of life is mentioned here but is not in any of the search terms or previously included - how can the authors claim this? - What is SEWB? (not spelled out before abbreviation used) - Sentence poorly written: "For example, in A (shouldn't be capitalized) double-blind...as a add-on therapy (should be an)..". to "optimized standard spasticity" makes no sense. This is also not a complete sentence. - sentence: "Although there were some studies" should be WHERE not "were," specific type OF not "off" - the last sentence of that paragraph: "...spasticity, and SEWB which contribute to suffering for adults with CP" The authors don't specify how they determined "without perceived or actual bias." This needs to be described/clarified. Discussion - The first paragraph is almost unreadable. - second paragraph: "A review of evidence... " is a run-on sentence and the second part of it is nonsensical. It is unclear to me why the authors go on to discuss MC in sleep and pain without CP, when their review is by far not inclusive of the larger body of research in these more general topics. Also, the inclusion of the Fairhurst study on adolescents, not adults, should have fallen out of their search strategy if the article is about adults. It is somewhat irresponsible to cite one adolescent study that highlights adverse reactions, when this wasn't the stated purpose of this study. Again, if QOL is to be included and discussed, it should be identified up front and included in the search strategy. In summary, while the topic important and valuable, the search strategy is not well justified, and the article is written in a confusing way that is distracting to read and undermines the intended effect. Are the rationale for, and objectives of, the Systematic Review clearly stated? Partly Are sufficient details of the methods and analysis provided to allow replication by others? Partly Is the statistical analysis and its interpretation appropriate? Not applicable Are the conclusions drawn adequately supported by the results presented in the review? Partly If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Pediatrics/young adults, medical cannabis, palliative care I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Friebert S. Peer Review Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.177700.r433967) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-825/v2#referee-response-433967 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Lê M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Feb 2025 | for Version 2 Mê-Linh Lê , Health Sciences Librarian, Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada 0 Views copyright © 2025 Lê M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The authors have addressed my concerns related to the important distinctions and methodological rigour between a literature review and a systematic review. Their revised methods and description of their literature review process are now clear on the work that was completed. Competing Interests No competing interests were disclosed. Reviewer Expertise Information professional with 10+ years of knowledge synthesis work I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Lê ML. Peer Review Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.177700.r364982) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-825/v2#referee-response-364982 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Lê M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 14 Nov 2024 | for Version 1 Mê-Linh Lê , Health Sciences Librarian, Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, Canada 0 Views copyright © 2024 Lê M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions As an information professional, I have limited my comments below to those relating to the methodology and citations of the paper. Methods While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. — Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? No Is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are the conclusions drawn adequately supported by the results presented in the review? No If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Information professional with 10+ years of knowledge synthesis work I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 06 Feb 2025 Daniel McDonough, Research, Telethon Kids Institute, Adelaide, Australia Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer Methods: While the title of this article says it is a literature review, throughout the text the terms used is systematic review (SR), and several practices (e.g., use of a PRISMA flow chart, PRISMA checklist) suggest the authors attempted some aspects of a SR. However, the methods as outlined here are not those of a systematic review and should not be written as such. Comment The use of the term “systematic” in the body of the paper referred to systematic nature of our search for repeatability and the use of a PRISMA flowchart and checklist. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer In brief, some of the issues are: 1. An extremely limited time frame of 2 years and the authors included only material available in their specific library collection. This is not how SRs are completed as they must locate ALL evidence on a specific topic. Comment We chose to only have two years as we wanted to look at the most recent and up to date literature on the topic. Also, we agree not how a SR is completed, it was never our attention to do an SR and we have now removed any mention systematic review throughout the paper. Reviewer 2. Lack of use of any subject terms specific to individual databases, such as MESH or CINAHL search terms Comment Thank you for your comment, we understand limitations of not using individual data bases. Just to clarify the first author Daniel McDonough was enrolled at Deakin University and conducted this literature review as part of his thesis for his Master of Public Health. We only used Deakin University library database, for convenience and accessibilit y. Reviewer 3. Lack of any reproducible search strategy for any database (although really all databases search strategies should be provided). Listing only the keywords is not sufficient. A quick search in MEDLINE using more advanced search terms quickly found several papers that would have been relevant to this article. Comment We agree and understand the limitations of our search strategy conducted. However, this literature review was never intended to be an all-encompassing systematic literature review. It was conducted for a specific reason i.e. Investigate the use of MM for treatment of pain, sleep, spasms, SEWB for adults with CP. The result of this study was used to inform a proposed research project investigating the use of MM for the complications of CP, which has now been completed. Reviewer 4. The authors write “The first and second named authors of this paper both individually completed the entire search and screening process concluding with the same outcome.”. This is not how systematic reviews are completed. There is one search done, and then at least two authors need to conduct screening individually, and then come together at the end to resolve conflicts. Comment Thanks for picking this up we have changed to “The first and second authors of this paper both individually completed the entire search and screening process. If there were any conflicts for inclusion the third author was invited to resolve any conflicts. However, both the first and second author agreed with all inclusions, so the third author was not required to participate”. See literature search results. Reviewer 5. The inclusion or exclusion criteria listed are not appropriate in that they do not focus on the studies themselves. They are just focused on study type, but not what the study is about. Also what is listed in the text for inclusion (e.g., must have a keyword) is not what is talked about in Table 3. Comment Apologies this was not clear, we used the study type exclusion inclusion with keywords as a convenient way to student to include and exclude papers we have now modified the table to more consistent and accurate. Reviewer 6. The screening process was not conducted according to SR suggested processes. The authors indicate that they used the presence of a keyword in specific lines or parts of a paper to decide whether to include or not include. Again, this doesn’t align with their stated inclusion criteria and is not correct SR screening methodology. Comment Thank you for your comment we have tried to clarify the inclusion and exclusion and removed any mention of SR. Reviewer 7. The authors note that their study is unique in that is focused on an adult population. This is not strictly true, but the authors still could have included content or summaries now what the research on medical marijuana on children with cerebral palsy suggests Comment Understand your point however, we are clinicians and clinical researchers, we conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a research study, investigating medicinal marijuana for the treatment of adults with Cerebral Palsy. Therefore, we were not interested in studies investigating children. Reviewer 8. While I did not conduct an examination of every reference cited, there were several written in the text that are not accurate. For example, the authors write “Even though cannabis is the most commonly used illicit drug in the world today ( Zhand & Milin, 2018 ), […]. However, that article does not actually report that finding. Zhang & Milin instead link out to a different study. I would also argue that both of these articles are outdated (2018 and 2015 respectively), especially in light of recent legislative changes to cannabis in places like the US, Canada, and Australia. The authors should look for more updated references for their content. Comment Thanks for picking this up, this information is not relevant for the focus of this paper, we have now removed this. Reviewer 9. There are numerical errors in the PRISMA flow chart. I also note that there are grammatical and spelling errors throughout the text. Comment Thankyou for bringing this to our attention we have now attempted to make corrections. Sorry we can’t see the numerical in PRISMA flowchart can you clarify for us to make appropriate changes. Reviewer Ultimately, I think this article needs to be more clearly reclassified as a literature review. All instances of the word ‘systematic’ should be removed so as not to give casual readers a false sense of what they are looking at, and so as not to confuse indexing procedures. I would also urge the authors to both broaden their years (2-3 years is not even sufficient for a literature review) and where they are searching. The fact that they found no literature on the topic strongly suggests that they need to adjust their search parameters. I applaud the authors for attempting to use a more transparent and comprehensive process for their search but as it was conducted it is not sufficient or exhaustive enough for either a systematic review or a comprehensive literature review. Comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a research project which was also a part of his Master of Public Health. The first author has now completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our research. We have now submitted the findings of our research for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. Therefore, we appreciate your suggestion, but we feel this literature could be really helpful for other clinical researchers and unfortunately, we are not in the position to expand our search. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Lê ML. Peer Review Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.165390.r330974) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-825/v1#referee-response-330974 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Szejko N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 28 Oct 2024 | for Version 1 Natalia Szejko , University of Calgary, Calgary, Alberta, Canada 0 Views copyright © 2024 Szejko N. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for providing me the opportunity to review this interesting paper that concerns an interesting topic of CP and use of cannabis based medicine. Overall the paper is interesting and relevant to the field. However, I have some small suggestions that could be considered before the paper will be indexed. It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Please provide more information, maybe consider merging both? I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Are there any RCTs or meta analyses? As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results – are the studies included RCTs, case reports, retrospective studies? What are the main results? If CBM is effective to treat pain, which CBM specifically? At which dose? Any side effects? The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. I would also not say that one treats quality of life, but would rather name it as improvement of quality of life. Could the authors also clarify the abbreviation SEWB? Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Cannabis based medicine, neurology, psychiatry I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 06 Feb 2025 Daniel McDonough, Research, Telethon Kids Institute, Adelaide, Australia Thank you for taking the time to review our paper we have found your suggestion and comments informative and helpful please see our responses below. Reviewer - It is not clear to me why there is a separate paragraph entitled introduction, which is followed by the one entitled background. In my understanding they are essentially the same? Comment - Thank you for your suggestion, we have now combined background and Introduction together see new introduction. Reviewer - Please provide more information, maybe consider merging both? Comment - We have now merged both as suggested. Reviewer - I also think that there should be more emphasis on the treatment of spasticity with CBM in the introduction. Comment - We have added treatment of spasticity in the relation CBM see introduction paragraph two. Reviewer - Pain is important of course, but this is crucial in CP also. Also, a brief mention of previous studies about CBM and CP should be discussed at least mentioning the areas where it was used, are these basic science studies or clinical? Comment - Sorry if this wasn’t clear but our search did not find any papers in relation to MM for a treatment for adults with CP, although there was paper that claimed to focus on the treatment for CP for MM for adults on a closer analysis it focused on the treatment of adolescents see page 14 Reviewer - Are there any RCTs or meta-analyses? Comment - Our search strategy only found one paper that was a RCT i.e. Fairhurst et. al 2020 and there were several meta-analyses i.e. Zhand, N., & Milin, R. (2018). Dzierżanowski, T. (2019). Babson, K., Sottile, J., Morabito, D., & Babson, K. A. (2017). Now we have attempted to highlight this in the paper, see results section. Reviewer - As the authors clearly describe in the methodology, this is a systematic review, which should be stated in the title. Please add. Comment - The use of systematic in the body of the paper referred to systematic nature of our search for repeatability. On reflection we don’t believe we should have used the term “systematic literature review”. Therefore, we have decided to remove all references to systematic literature review, from this paper. Reviewer - Although I really like the Tables and Figures that the authors prepared, I suggest to put also a descriptive part in the results are the studies included RCTs, case reports, retrospective studies? Comment - We have added to the results section, see paragraph in main results section on the types of studies examined i.e. randomized control trials, cross sectional studies, prospective cohort studies, placebo-controlled randomized clinical trials, cohort studies, and retrospective studies, meta-analysis and longitudinal observational studies. Reviewer - What are the main results? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - If CBM is effective to treat pain, which CBM specifically? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - At which dose? Comment - Thank you for your comment we have added context to the results section see page 14 Reviewer - Any side effects? Comment - Side effects is described in the discussion section but have also added to the main results section as suggested Reviewer - The same goes for other symptoms, please describe in more detail. This is now part of the discussion, but I would suggest to move it to results section instead. Comment - We have attempted to describe in more detail the symptoms and have added it to the results section as suggested. Reviewer - I would also not say that one treats quality of life, but would rather name it as improvement of quality of life? Comment - Thanks for pointing this out, we have now modified the language to use terms like “improving quality of life”. Reviewer - Could the authors also clarify the abbreviation SEWB? Comment - Thanks for pointing this out, we have written this in full i.e. Social and emotional wellbeing, prior to using the acronym. Reviewer - Could the authors also clarify why only studies in adults were included? Are there no such studies in children? Comment - We conducted this literature review to provide evidence for the use of MM with adults, as we proposed to conduct a case study, investigating medicinal marijuana for the treatment of an adults with Cerebral Palsy. Additional comment Thank you for your suggestion, just to clarify the first author Daniel McDonough conducted this literature review as part of his thesis for his Master of Public Health. We are clinicians and clinical researchers, and the first author conducted to inform a case study which was also a part of his Master of Public Health. The first author has completed his Master of Public Health, and we found the literature very informative and helpful to be able to conduct our case study. We also believe other clinical researchers proposing to conduct research to treat symptoms with CP may also find it helpful. We have now submitted the findings of our case study for publication. Title: A case study investigating medicinal marijuana for the treatment of an adult with Cerebral Palsy. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Szejko N. Peer Review Report For: The use of medicinal marijuana for treating Cerebral Palsy: a literature review [version 2; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2025, 13 :825 ( https://doi.org/10.5256/f1000research.165390.r330978) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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