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.

Sunday, March 03, 2019

Autism & Sleep and ADD Anxiety Behavior Elopement Social Skills

There is #NoZZZinAutism ! 

 2018 May 3;7(5). pii: E102. doi: 10.3390/jcm7050102.

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Object name is jcm-07-00102-g001.jpgThe Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities.


Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described.

Insomnia and Autism How and Why ?

Why is the assessment of sleep important in children with autism?

Assessment of Sleep in Children with Autism Spectrum Disorder

Paul R. Carney, Academic Editor and James D. Geyer, Academic Editor
The importance of properly assessing children with ASD for sleep disorders cannot be overstated, as inadequate sleep can have detrimental effects on memory, attention, cognition, daytime behavior, and even language acquisition [,,,,].

 Additional reports suggest that chronic sleep disturbance increases the risk of physical health problems, including changes in cardiovascular, immune, endocrine, nervous system function, and, for children with ASD in particular, increased weight status and poorer overall health-related quality of life [,,,]. 

Furthermore, chronic sleep disturbances experienced by children with ASD are less likely to remit with age, and continue even into adulthood [,,]. T

herefore, early identification and intervention may help to offset some of the potentially detrimental effects that may occur secondary to prolonged sleep inadequacy.

Saturday, March 02, 2019

Epilepsy Autism Cannabis - My professional experience

 I am performing a quality assurance review of my epilepsy practice.  As a pediatric epilepsy specialist I treat many patients who suffer from refractory epilepsy.  That is, they continue to have seizures despite adequate trials of two anticonvulsants.   Refractory epilepsy is a disabling condition that strikes approximately 20% of people with epilepsy. 

Since last year I have been a member of the state of Texas Compassionate Use Program. As such I have recommended low THC cannabis for my patients with the State of Texas Compassionate use program.   This program the state of Texas authorizes dispensaries to sell patients with epilepsy an oil containing 100 mg of Cannabadiol per ml and no more than .5% tetrahydrocannabinol. 

 I have over 60 of my patients in the registry.  The effects on epilepsy are similar to other publications and I will bring those forward any future posting. 

 Because there are current legislative considerations regarding the use of this product in autism, I want to post my observations which have not yet been published. 

I am performing a de-identified retrospective review based on parent/patient report. 

There is a need for more literature about the risks and benefits about this treatment especially focussing on autism. 

Insomnia and aggression are major problems for people with autism and their families. Their are no medications that are FDA approved for insomnia in children. There are two medications approved for behavioral problems in autism. These agents frequently fail. 

I have data on a subgroup of these patients who have co-morbid autism. The N is 11.


Sleep Improvement 
  • 9% - No Improvement
  • 27.2% - No or slight Improvement
  • 73% - 25-100% Improvement. 

  •  54% have a 25 -100% improvement.
Texas low-THC cannabis appears to improve sleep and aggression in autism

Of all the kids with epilepsy 54% had their quality of life at least much improved. 

Of kids with epilepsy and autism 58% had their quality of life at least much improved

Side effects were minimal and I will share this data in future posts.  


CBD with under .5% THC appears to have a positive effect on sleep in children with refractory epilepsy and autism.

CBD with under .5% THC appears to have a positive effect on reducing aggression in children with refractory epilepsy and autism.

Certainly thee are weaknesses in a retrospective, descriptive report. 

Further, I have not controlled for success of epilepsy treatment. Is the sleep improvement due to restoration of circadian rhythms with successful treatment? Is the sleep improvement due to medication interactions?

Yet, this data should be public to inform public debate. 

Insomnia impairs development. Treatment of insomnia improves social function and behavior in children with autism.

Insomnia is a family crushing problem in kids with autism.  The US Army published data on the effects of chronic insomnia on behavior.  How can a family sleep well with a child wandering the house? They do not. 

There are no medications FDA-approved for insomnia in children.  The anti-psychotic medications used off-label for insomnia cause significant side effects such as morbid obesity.  Some antihistamines may provoke seizures. Antidepressants are often used off label. Melatonin is frequently prescribed and fails in this setting. 

Using CBD for insomnia in children with autism would be a "compassionate use" if ever there was one. 

Dr. Rotenberg