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 VOLUME 115