There are more than 140 known phytocannabinoids in the cannabis plant; however, the best known are cannabidiol (CBD) and delta-9- tetrahydrocannabinol (THC). The first of these, CBD, has no negative psychotropic effects. In fact, it even works against unpleasant psychotropic, and other subjective and physical effects of THC, mediated by the CB1 receptor in humans.
Today, there is compelling evidence for cannabis-based products' effectiveness in the treatment of refractory childhood epilepsy and certain syndromes. Singlemolecule CBD is the first cannabis-derived medication that has approval from the US Food and Drug Administration (FDA), and will soon also be approved by the European Medicines Agency.
However, there are many recent studies proving the superiority of whole-plant extracts or CBD-rich extracts over singlemolecule CBD, because of the synergistic effect of all the substances in the cannabis plant (together with the cannabinoids, there are also flavonoids and terpenes), which is related to the so-called 'entourage effect'.
There are also other CBD that are currently in the process of becoming pharmaceutical products for the treatment of epilepsy, that are still in the pipeline, such as cannabidivarin (CBDV), delta 9-tetrahydrocannabivarin (TCBDV) and delta 9-tethrahydrocannabinolic acid (THCA), and it seems that their efficacy will also be proven.
CBDA is the CBD compound's precursor. Just like THCA turns into THC when heated or aged, CBDA decarboxylates to CBD. Found in raw cannabis, CBDA can provide numerous health benefits, thanks to its natural antiproliferative, antioxidant, antibacterial and anti-inflammatory properties. CBDA does not stimulate the endocannabinoid system quite like its precursor does, and until now there was no report of its anticonvulsive effects.
During the past year, the department has followed five children with extremely refractory forms of epilepsies, who have already tried from five to nine different standard anti-epileptic drugs (AEDs), were not candidates for epilepsy surgery and were not suitable for other forms of epilepsy treatment, like vagal nerve stimulation and the ketogenic diet.
Each child has had genetic epilepsies/ encephalopathies: two Dravet syndrome with confirmed SCN1A mutation, 1 PDHC19 mutation (so-called Dravet-like syndrome), one CDKL mutation and one Sturge-Weber syndrome. CBDA was added to their treatment because of a deterioration in cognition and motor abilities, as well as more frequent seizures.
All patients were treated with two standard AEDs and also received medicinal-grade cannabis products from the whole plant, such as Haleigh's Hope and Charlotte's Web. The CBDA product contained CBDA at 9%, CBD at 3.3%, CBG cannabigerol (CBG) at 0.1%, THC and THCA, each at 0.2%, cannabinol (CBN) and THCV, at 0.03% each, and cannabichromene (CBC) at 0.1%.
Within one to two weeks, the parents observed an improvement in mood (in three children), better motor abilities (in four children) and less-frequent (around 50%) and less-severe seizures (in all five children), and better sleep (in two children). One can postulate that the addon treatment with whole-plant cannabis, enriched with CBDA, can be beneficial to children with resistant epilepsies.
The author would like to thank the collaborating partner, PharmaHemp, for its support.