The Journal of the Arkansas Medical Society Med Journal June 2019 Final | Page 14

CASE REPORT
Cannabinoids in Pediatric Epilepsy
Debopam Samanta, MD; Gregory B. Sharp, MD
Division of Child Neurology, Department of Pediatrics, UAMS, Little Rock
Abstract
M
any states (including Arkansas)
have passed medical marijuana
legislation to allow for the sale
and use of cannabis-derived products (CBD)
for medical therapy of epilepsy and many
other medical and psychiatric disorders. A
class 1 evidence of CBD as an add-on therapy is
now available in Dravet syndrome and Lennox-
Gastaut syndrome. However, controlled studies
are required to determine the effectiveness of
CBD in other types of epilepsy. Moreover, CBD
is far from a miracle cure and it is of paramount
importance to have a reasonable expectation of
its usefulness as an antiepileptic medication. It is
also a misconception that CBD is free of adverse
effects attributed to its derivation from a natu-
ral source. Rather than spontaneous treatment
without medical supervision, adequate medical
oversight is indicated to monitor and manage
adequate dosage, side effects, the validity of the
product, and drug-to-drug interaction.
Key Words: cannabinoids; CBD;
epilepsy; Dravet syndrome;
Lennox-Gastaut syndrome
Much attention has been given to the use
of cannabidiol for the treatment of children
and adults with severe forms of epilepsy. Many
states (including Arkansas) have passed medical
marijuana legislation to allow the sale and use of
cannabis-derived products for medical therapy of
epilepsy and many other medical and psychiatric
disorders. Regardless of state law, all cannabinoid
components and products derived from cannabis
or, specifically, Cannabis Sativa, are considered
controlled substances classified as Schedule I
agents by the U.S. Drug Enforcement Agency.
Marijuana consists of a dried mixture of cannabis
leaves and flowers and is commonly used for
recreational or medical use. Hemp specifically
refers to the hearty fibers in the stalk and stems of
the plant. Delta-9-tetrahydrocannabinol (THC) and
cannabidiol (CBD) are the major cannabinoids, and
different marijuana strains have varying amounts
of THC and CBD. Scientific cultivation has led to
the development of strains that are extremely
high in THC, while other strains have high CBD
and low THC contents. THC is a psychoactive
agent, a drug of abuse, and equivocal in seizure
control. In some circumstances, THC has been
felt to increase seizure activity. CBD is a non-
psychoactive agent, and both anecdotal and
scientific evidence indicate it can be effective as
an antiepileptic medication, especially for some
specific epilepsy syndromes.
278 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
Dating back as far as 2700 BC, cannabis
has been used for a number of various medici-
nal purposes. 1 Before its removal as a medicinal
compound in 1941, cannabis preparations were
included in the U.S. Pharmacopeia (USP) since
1851. 2 The federal Controlled Substances Act la-
beled cannabis as a schedule 1 substance (no
accepted medical use and a high potential for
abuse) in 1970, as it was increasingly associ-
ated with recreational use. The use of cannabis
for the treatment of epilepsy declined in the 20 th
century due to the progressive introduction of
antiepileptic medicines and the change in legal
status. However, sporadic observations suggest-
ing the effectiveness of cannabis continued to
be reported. In comparison to FDA-approved
antiepileptic drugs, cannabidiol is structur-
ally unique and has potentially novel multimodal
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