LAUSR

Commentary Tetrahydrocannabinol (THC) and cannabidiol (CBD) are two of the chemicals found in the resin of the marijuana plant, Cannabis sativa. Both compounds interact with the cannabinoid receptors but produce different effects. The psychoactive component of marijuana is attributed to THC, the component that imitates the effects of the neurotransmitter anandamide, which modulates the perception of pain and helps regulate sleep and appetite. On the other hand, CBD, which shares the same chemical formula as THC and accounts for approximately 40% of cannabis extract, lacks psychoactive effects. Beneficial effects of CBD have been reported in reducing psychotic symptoms, anxiety, inflammation, nausea, and seizures. Dravet syndrome is a severe epilepsy with many seizure types that begins in the first year of life. About 80% of affected individuals have loss-of-function mutations in their SCN1A gene. In addition to intractable seizures, affected individuals exhibit developmental delay, movement and balance abnormalities, delayed language development, sleep disorders, and disruptions of the autonomic nervous system. In 2013, a media report of the remarkable therapeutic of medical marijuana in Dravet syndrome captured global attention (http://www.cnn. com/2013/08/07/health/charlotte-child-medical-marijuana/ index.html). The patient was a 6-year-old girl who was having 300 grand mal seizures per week and had a history of cardiac arrests necessitating cardiopulmonary resuscitation on more than one occasion. After trying cannabis oil, her seizure frequency dropped to two or three per month, and she was able to walk, ride her bicycle, and feed herself. In the same year, a survey of parents of 19 children with severe childhood epilepsies, including 13 children with Dravet syndrome, explored the use of cannabidiol-enriched cannabis (1). Complete seizure freedom was reported in two subjects (11%), and a greater than 80% seizure reduction in 8 (42%). Additionally, the treatment was perceived to have resulted in improved alertness, mood, and sleep. This was followed by an open-label trial of CBD in 214 patients, 20% of whom had Dravet syndrome (2), Trial of Cannabidiol for Drug-Resistant Seizures in the Dravet Syndrome