Tuesday, May 07, 2019

Medical Cannabis - CBD in Texas goes to the Senate After HB 1365 Passes House

Might Low THC cannabis help someone you love with  medical conditions like cancer, autism, PTSD, Alzheimer’s, Parkinson’s, Huntington’s, Tourettes, Crohn’s, multiple sclerosis and muscular dystrophy? 

Call your Texas senator, LtGovernor, Governor to express your opinion. - JR

By Natalie Hee, FOX 26 News
Posted May 07 2019 11:17AM CDTVideo Posted May 06 2019 10:23PM CDT Updated May 07 2019 11:28AM CDT

HOUSTON (FOX 26) - A rare type of epilepsy is the only way medical cannabis is prescribed in the state. One Houston family says it saved their daughter’s life and now they’re pushing for a bill to help people with other types of conditions.

Lora Taylor says her 37-year-old daughter, Julie, has intractable epilepsy and used to have an average of up to 95 seizures a month. Julie has tried 26 of the 28 medications suitable for her condition. Her options seemed to be running thin until she was prescribed CBD oil by her pediatric neurologist in September.

“I had never seen anything work that well, that effectively in really in 36 years. Most of her seizures were anywhere from 3 to 25 minutes. But after the first 30 days using the CBD oil, that was reduced to two 10-second seizures,” Taylor said.

Over the last eight months, Taylor said there's been dramatic improvement in the frequency and severity of Julie's seizures. She says not only has her mobility improved, Julie’s now able to sleep through the night.

“She used to not be able to move her arms or put her arms down at all,” Taylor said.

Julie's rare form of epilepsy is currently one of the only qualifying types of debilitating medical conditions eligible for medical cannabis under state law.

House Bill 1365, authored by Representative Eddie Lucio, would expand eligibility to include patients with other debilitating medical conditions like cancer, autism, PTSD, Alzheimer’s, Parkinson’s, Huntington’s, Tourettes, Crohn’s, multiple sclerosis and muscular dystrophy. The bill would also establish a Cannabis research program and review board.

Dr Joshua Rotenberg, a pediatric neurologist who specializes in epilepsy, said the low-THC cannabis isn't a one-size-fits-all answer for these conditions. He said the success rate can vary from patient to patient but rather, it's having the option available for families like the Taylors who feel like they're running out of time.

“Instead of being hung up about the diagnoses, it opens it up for discussion and application,” Dr. Rotenberg said.

HB 1365 was voted and approved by the House Monday. The bill will head to the Senate next for consideration.


Saturday, April 06, 2019

Treatment for Ataxia - TDCS

A treatment where there are none. JR

Cerebello-spinal tDCS in ataxia

A randomized, double-blind, sham-controlled, crossover trial


Conclusions A 2-week treatment with cerebello-spinal tDCS reduces symptoms in patients with ataxia and restores motor cortex inhibition exerted by cerebellar structures. Cerebello-spinal tDCS might represent a promising future therapeutic and rehabilitative approach in patients with neurodegenerative ataxia, still an orphan disorder of any pharmacologic intervention.


Friday, March 29, 2019

Cannabinoids and Sleep. What is the data?

A working list of  published TRIALS in peer reviewed publications related to cannabinoids /  CBD and insomnia

There are no FDA approved medications for insomnia in children. 

1 trial in clonidine  for autism and one for ADHD.

While I am not advocating CBD for every child with ADHD, I am linking   ONE relevant clinical article supporting the widespread use of CLONIDINE. its hardly a rich database of clinical data. 

Dr Josh 

Cannabidiol and Sleep

Barchel D, Stolar O, De-Haan T, Ziv-Baran T, Saban N, Fuchs DO, Koren G, Berkovitch M.
Front Pharmacol. 2019 Jan 9;9:1521. doi: 10.3389/fphar.2018.01521. eCollection 2018.
Free PMC Article

Shannon S, Lewis N, Lee H, Hughes S.
Perm J. 2019;23:18-041. doi: 10.7812/TPP/18-041.

4.  2018 Aug;33(9):565-571. doi: 10.1177/0883073818773028. Epub 2018 May 16.

Medical Cannabis for Pediatric Moderate to Severe Complex Motor Disorders.


A complex motor disorder is a combination of various types of abnormal movements that are associated with impaired quality of life (QOL). Current therapeutic options are limited. We studied the efficacy, safety, and tolerability of medical cannabis in children with complex motor disorder. This pilot study was approved by the institutional ethics committee. Two products of cannabidiol (CBD) enriched 5% oil formulation of cannabis were compared: one with 0.25% δ-9-tetrahydrocannabinol (THC) 20:1 group, the other with 0.83% THC 6:1 group. Patients aged 1 to 17 years (n = 25) with complex motor disorder were enrolled. The assigned medication was administered for 5 months. Significant improvement in spasticity and dystonia, sleep difficulties, pain severity, and QOL was observed in the total study cohort, regardless of treatment assignment. Adverse effects were rare and included worsening of seizures in 2 patients, behavioral changes in 2 and somnolence in 1.


CBD; THC; cannabis; cerebral palsy; dystonia; movement disorders; spasticity
Autism and Sleep

Mazzone L, Postorino V, Siracusano M, Riccioni A, Curatolo P.
J Clin Med. 2018 May 3;7(5). pii: E102. doi: 10.3390/jcm7050102. Review.
Free PMC Article
Johnson CR, Smith T, DeMand A, Lecavalier L, Evans V, Gurka M, Swiezy N, Bearss K, Scahill L.
Sleep Med. 2018 Apr;44:61-66. doi: 10.1016/j.sleep.2018.01.008. Epub 2018 Feb 1.
Köse S, Yılmaz H, Ocakoğlu FT, Özbaran NB.
Sleep Med. 2017 Dec;40:69-77. doi: 10.1016/j.sleep.2017.09.021. Epub 2017 Oct 13.
Moore M, Evans V, Hanvey G, Johnson C.
Children (Basel). 2017 Aug 8;4(8). pii: E72. doi: 10.3390/children4080072. Review.
Free PMC Article
Souders MC, Zavodny S, Eriksen W, Sinko R, Connell J, Kerns C, Schaaf R, Pinto-Martin J.
Curr Psychiatry Rep. 2017 Jun;19(6):34. doi: 10.1007/s11920-017-0782-x. Review.
Free PMC Article
Malow BA, Katz T, Reynolds AM, Shui A, Carno M, Connolly HV, Coury D, Bennett AE.
Pediatrics. 2016 Feb;137 Suppl 2:S98-S104. doi: 10.1542/peds.2015-2851H.
Free Article
Yang Z, Matsumoto A, Nakayama K, Jimbo EF, Kojima K, Nagata K, Iwamoto S, Yamagata T.
Brain Dev. 2016 Jan;38(1):91-9. doi: 10.1016/j.braindev.2015.04.006. Epub 2015 May 6.
 2014 Apr;15(4):472-5. doi: 10.1016/j.sleep.2013.10.018. Epub 2014 Feb 7.

Use of sleep medication in children with ADHD.



Sleep problems are common in children with attention-deficit/hyperactivity disorder (ADHD), yet little is known about sleep medication use in this population. The aim of this study was to describe sleep medication use, as well as associated child and family characteristics in school-aged children with ADHD.


Sleep medication use was ascertained using a prospective parent-completed seven-night sleep and medication log. Exposure variables included socio-demographic characteristics, total sleep problem severity (Children's Sleep Habits Questionnaire), ADHD severity and subtype (ADHD Rating Scale IV), ADHD medication use, internalising and externalising co-morbidities (Anxiety Disorders Interview Schedule for Children/Parent version IV) and parent mental health (Depression Anxiety Stress Scale).


Two hundred and fifty-seven children with ADHD participated and of these 57 (22%) were taking sleep medication (melatonin 14% and clonidine 9%). Sleep medication use was associated with combined-type ADHD and ADHD medication use. The presence of co-occurring internalising and externalising co-morbidities was also associated with sleep medication use in ad hoc analyses.


Sleep medication use is common in children with ADHD and is associated with combined-type ADHD and use of ADHD medication. Further research is needed on the broad functional benefits and long-term safety of sleep medication in this population.


Attention deficit hyperactivity disorder; Child; Medication therapy management; Melatonin; SleepSleep initiation and maintenance disorders

Sunday, March 17, 2019

Vayarin, Vayarin Plus, Vayacog - Vaya ConDios! No More Medical Food for ADHD !

Vayarin Vayacog and VayaPlus are not available in the USA anymore. 

I have emailed my unhappiness with this sudden news. I find it beyond callous to drop people (especially children) without alternatives.

I have no idea what can replace these products! I will start looking. 

Dr. Josh

IFF (@iff) owns Frutarom that owns Enzymotec that owns Vayarin.

Mr. Yehudai owns Frutarom.Vayarin Frutarom owner link



Dr. Josh


Friday, March 08, 2019

Autism & Cannabidiol Treatment Trial - What is the evidence?

Interesting - 53 kids & 68% improved in self-injury !

Oral Cannabidiol Use in Children With Autism Spectrum Disorder to Treat Related Symptoms and Co-morbidities.

Barchel D, et al. Front Pharmacol. 2018.


OBJECTIVE: Children with autism spectrum disorder (ASD) commonly exhibit comorbid symptoms such as aggression, hyperactivity and anxiety. Several studies are being conducted worldwide on cannabidiol use in ASD; however, these studies are still ongoing, and data on the effects of its use is very limited. In this study we aimed to report the experience of parents who administer, under supervision, oral cannabinoids to their children with ASD.

METHODSAfter obtaining a license from the Israeli Ministry of Health, parents of children with ASD were instructed by a nurse practitioner how to administer oral drops of cannabidiol oil. Information on co-morbid symptoms and safety was prospectively recorded biweekly during follow-up interviews. An independent group of specialists analyzed these data for changes in ASD symptoms and drug safety.

RESULTS: 53 children at a median age of 11 (4-22) year received cannabidiol for a median duration of 66 days

Self-injury and rage attacks (n = 34) improved in 67.6% and worsened in 8.8%. 
Hyperactivity symptoms (n = 38) improved in 68.4%, did not change in 28.9% and worsened in 2.6%. Sleep problems (n = 21) improved in 71.4% and worsened in 4.7%. 
Anxiety (n = 17) improved in 47.1% and worsened in 23.5%. 
Adverse effects, mostly somnolence and change in appetite were mild
CONCLUSION: Parents' reports suggest that cannabidiol may improve ASD comorbidity symptoms;

 however, the long-term effects should be evaluated in large scale studies.

Tuesday, March 05, 2019

PANDAS PANS Strep and REM Sleep Disorder

Fascinating. REM sleep disorder seen in 87% of patients with PANS. PSG may be helpful in PANDAS / PANS. Note this is a case series. -JR

" RBD has been reported to occur only rarely in children. However, in this consecutive case series of 15 children with PANS, we observed 4 children (27%) met RBD criteria and noted evidence of REM sleep motor disinhibition in 8 others (53%). Only two patients (13%) had a normal PSG, and PANS symptoms had remitted for one of those children."

Rapid Eye Movement Sleep Abnormalities in Children with Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS)


Current Knowledge/Study Rationale: REM sleep behavior disorder (RBD) has been demonstrated across all ages, but has been reported to occur only rarely in childhood. Among adults, RBD is associated with neurodegenerative conditions; its significance in pediatric patient populations is unknown. Demonstrating abnormalities of sleep architecture in children with PANS may provide additional insights into the etiopathogenesis of the neuropsychiatric syndrome.
Study Impact: This case series reports on sleep-related motor disturbances among children with PANS, particularly in the REM state. Pediatric RBD is likely not generated by the same mechanisms that often predict the onset of a neurodegenerative disorder among adults, and may instead be a useful marker of transient central nervous system disturbance in select cohorts.


Monday, March 04, 2019

Indica vs. Sativa - Are they different? Not consistently.

I often hear claims that there is a consistent CHEMICAL difference between indica vs sativa. That is, there are terpenes that have different psychoactive effects.

While particular products in certain areas, may be different in CHEMOTYPE (terpenes, essential oils etc.) . It appears that there i NO consistent chemical difference.

Webinar from U of Vt.

Monique McHenry, PhD is a botanist with a background in plant diversity and evolution. She is the co-director of the cannabis pharmacology course at the University of Vermont Medical School. She is also Co-Founder of the Phytoscience Institute, a plant-based pharmaceutical research center. Dr. McHenry completed her BA and MSc at the University of Colorado, and her PhD at the University of Vermont.