Epilepsy has been around for thousands of years, but doctors still don't have a reliable medication for it, writes James McClure. In fact, roughly 30-40 percent of today's epilepsy patients don't respond to traditional medications, according to Dr. Amza Ali - a neurologist and neurophysiologist who specializes in epilepsy. 

Based on that percentage, approximately 26 million patients with epilepsy could benefit from an alternative medication like medical marijuana. Those include people who were born with epilepsy as well as people who develop it after suffering a stroke, trauma, certain infections or other conditions, Dr. Ali noted during a recent conference in Toronto hosted by the cannabis R&D, cultivation and manufacturing company Avicanna. 

Using medical marijuana to treat epilepsy isn't new. Researchers have known about cannabis' potential to combat seizures for centuries. One of the earliest case studies involved Irish physician William O'Shaughnessy, who administered a cannabis tincture to an infant with epilepsy in the early 19th century.

"A single drop of the spiritous tincture...was placed on the child's tongue at 10 PM," Dr. O'Shaughnessy wrote during the experiment. "No immediate effect was perceptible, and in an hour and a half, two drops more were given...In this drowsy state, she continued for four days, totally free from convulsive symptoms in any form." 

When the seizures returned on the fifth day, O'Shaughnessy adjusted the dosage of the tincture and the infant's condition improved dramatically. He noted that "the child is now in the enjoyment of robust health and has regained her natural plump and happy appearance."

So there's no shortage of anecdotal evidence to suggest that cannabis can treat epilepsy. The problem is that prohibition has prevented researchers from pursuing the rigorous studies needed to prove that medical marijuana is a safe and effective treatment. Safety is particularly important when dealing with epilepsy since many patients are children.

'Cannabis and its derivatives will eventually find their place' in epilepsy treatment

Perhaps the most famous child patient is Charlotte Figi - a child with a severe form of epilepsy called Dravet Syndrome. By the age of five, she was unable to walk, talk or eat because she was having 300 seizures a day. Every medication had failed, so the Figi family turned to a controversial treatment: the non-intoxicating cannabis compound CBD. Almost immediately after Charlotte tried CBD, the number of seizures she experienced plummeted drastically.

Some look at Charlotte's story and wonder why we need to debate the issue any further since cannabis has clearly helped her. But as Dr. Ali noted, it is "difficult to endorse usage of a substance not standardized nor available in a proper medicinal form."

Roughly 60 percent of patients with epilepsy and 63 percent of parents of young patients in Australia say they don't know which way to administer medical marijuana is best, according to a nationwide survey conducted in 2017.  Right now, people with epilepsy could treat their condition by smoking a joint, using a tincture or eating an infused cookie. There are also cannabis sprays, skin lotions, suppositories, pills and other methods of delivery that could be more or less effective for managing seizures. So there's no standard means to consume cannabis, let alone a standard dosage for patients with epilepsy.

On top of that, researchers are wary of recommending medical cannabis for epilepsy because they aren't sure why it works. Dr. Ali noted that CBD appears to help patients, but researchers haven't figured out how the drug's interaction with the human brain and nervous system is suppressing seizures. That means researchers aren't sure if CBD alone is helping or if it needs to be taken along with conventional medications. 

Meanwhile, some researchers are worried that cannabis is merely the latest in a long line of false hopes for epilepsy patients. As the 19th century physician Sir Edward Sieveking once said, "[T]here is scarcely a substance in the world, capable of passing through the gullet of man, that has not at one time or another enjoyed a reputation for being an anti-epileptic."

Sieveking wasn't addressing cannabis specifically when he said that, but his famous quote has been used to pour cold water on epilepsy studies for over 160 years as researchers have tried to prove that unconventional treatments like mistletoe, turpentine, and even dehydration can cure seizures. So cannabis researchers will have to tackle over a century of cynicism in order to prove that CBD specifically or medical marijuana in general can treat epilepsy.

For his part, Dr. Ali believes that cannabis will be recognized as a legitimate treatment for epilepsy one day, but it will never become the first-line of defense against seizures. It will always be a second or third option that will only be used when conventional treatments prove ineffective.

"Cannabis and its derivatives, in isolation or as combinations, will eventually find their place but should not be viewed as a replacement for already efficacious treatments," he said at the Avicanna conference.