Issue link: https://www.e-digitaleditions.com/i/1403381
9 cannapatientcare.com august 2021 | cannabis patient care doctor focus patient s who found cannabis to be the answer to their medical problems." Seeing the Light Then a real-life "aha" moment that changed everything for Dr. Goldstein happened in 2013. CNN aired the documentary "Weed" featuring Dr. Sanjay Gupta (4) that highlighted the story of a Charlotte Figi, a five year old Colorado Springs girl who had been suffering from Dravet Syndrome since she was three (5). Dravet Syndrome is a rare, severe form of intractable epi- lepsy not controlled by medication (6). Charlotte was having 300 grand mal seizures a week. Doctors had no answers, no help for the family as they witnessed their child deteriorate. They told her parents, Paige and Matt, to say their goodbyes. That's when the Figis decided to try some cannabidiol (CBD) oil they got from a local Denver dispensary. The results were dramatic. Within a year, Charlotte's sei- zures slowed to 2-3 times a month. (Editor's note: read more about Charlotte Figi and her family on page 12 in this issue.) After the CNN documentary aired, Goldstein said, her office was "inundated with requests from parents of children with intractable seizures asking for help with cannabis and CBD." "Interestingly, at that time there were no CBD products readi- ly available in California, and the Colorado company mentioned in the documentary had a long waiting list," she said. "So, I was able to approve these ill children to use medical cannabis. But the par- ents initially had a very hard time finding any CBD products." In early 2014, Goldstein said, a number of companies focused on producing CBD preparations for pediatric use, and her pa- tients were able to start trying CBD. "One of my first pediatric epilepsy patients, who I first saw at the age of four years old, is now turning 11 and has had over 99% reduction of seizures with CBD," Dr. Goldstein said. "It took some time but now he is thriv- ing at school and at home with a fantastic quality of life." What She Has Learned One of the biggest surprises she has seen in treating patients with cannabis is how it can help to move the brain forward in so many cases. "What I mean by this is that some of my patients with the worst seizure disorders who have experienced severe developmental delays begin to advance developmentally while using cannabis medicine," she said. "For example, I have a young adult in my practice who began speaking in sentences at the age of 24. She struggled her whole life with seizures and once we were able to get the seizures under control with can- nabis, she went from using one word at a time to putting words together to form sentences." Another one of her patients with seizures who had not been able to read and write by the age of 9, learned to read and write while using cannabis. Yet another child with developmental delay who suffered multiple strokes at birth began to speak spontane- ously at the age of 6 while on CBD and cannabigerol (CBG) (7). "These are only a few of the many examples that show can- nabis is not detrimental to the brain when used as medicine," Dr. Goldstein said. If it appears that the child will benefit from cannabis, Dr. Goldstein makes recommendations on cannabinoids and dosing. "I guide them every step of the way as there is no standard protocol for cannabis medicine," she said. "Each per- son responds uniquely to the various cannabinoids at differ- ent doses, and the medical course must take into account someone's response." The Endocannabinoid System and Seizures Dr. Goldstein said that people with seizure disorders appear to have an underlying endocannabinoid system dysfunction that can lead to neuroexcitation, which is the over-firing of neurons, leading to seizures. The endocannabinoid system is a wide- spread neuro-modulatory system that plays important roles in central nervous system development (8). CBD and other cannabinoids are thought to be effective for treating seizures due to "polypharmacologic properties," meaning they have many different targets of action within the brain, all leading to a reduction of neuroexcitation. Dr. Goldstein explained that it is known that CBD has a very wide therapeutic range, meaning some people may respond to a low dose, such as 20 mg, and others may require 800 mg or more per day. "The only way to find an anti-epileptic dose CannMed Medical Practicum FOUNDED IN 2016 by Medicinal Genomics, the CannMed conference is dedicated to the understanding of canna- bis's complex science and its medical benefits for pa- tients in need. The upcoming 2021 event—taking place September 29–October 1 in Pasadena, California—will feature an exciting full-day CannMed Medical Practi- cum organized by Bonni Goldstein, MD; Dustin Sulak, DO; Kevin Spelman, PhD, MCPP; and Eloise Theisen, NP, AGP- CNP-BC. During this practicum, each of the presenters will share the latest research, their clinical experience, and practice guidelines related to cannabinoid thera- peutics, inclusive of types of extractions, products, and optimal dosing of cannabinoids for various therapeu- tic scenarios. This course is approved by the California Board of Registered Nursing for 9.5 contact hours.** Learn more about the practicum and Dr. Goldstein's role here: https://cannmedevents.com/practicum/ **CONTINUING EDUCATION CREDITS: This course is provider-approved by the California Board of Registered Nursing, provider number 16845, for 9.5 contact hours.