Tuesday, June 26, 2018

Epilepsy and cannabis, by JD

The cases of Billy Caldwell and Alfie Dingley and the use of cannabis oil to relieve symptoms of epilepsy has had a lot of coverage in the news this past week. Their cases seem to have been turned into a political football with a great deal of heat but very little light being generated by those who oppose illegal drugs and those who advocate legalising such drugs.

Trying to establish some clarity is not easy because journalists, as usual, don't bother to present the facts but concentrate instead on the 'sensational' aspects of the story.

And because of all the fuss the Government has decided to rush through a 'review' of the medicinal benefits, if any, of the use of cannabinoids.

Here is a summary of the various types of cannabis oil currently on the market -

I can offer my own experiences on this subject because I have epilepsy (since 2011) although I have no desire nor need to use cannabis. This is what I wrote in 2012 about my epilepsy.

My first question to the neurologist in the hospital was the obvious one: what is the cause of epilepsy? The answer is that nobody knows. Doctors can tell us what can trigger a seizure, the best known to most people is the strobe effect in lighting. "Contains flash photography" is a familiar phrase in news bulletins. But what they cannot establish is the cause of epilepsy.

My medication is Leviteracetam and when I asked how it worked, nobody knows how it works. All they know is that it works. A further question to the epilepsy specialist in the hospital was "What would the effect be of taking this medication if I no longer need to take it?" Not known or not ever thought about, was the reply. The dosage I take has been reduced and there is a possibility that I may be able to reduce it further.

So that looks like three 'unknowns' so far. A further unknown is that the effects of any drug will not be consistent among all patients. As an example, I had an adverse reaction to one particular brand of Leviteracetam and the pharmacist knows not to give me that brand. All others have been fine so far.

So the use of a cannabis oil to alleviate the symptoms of epilepsy may well be effective in some patients and not in others; it may well be effective for severe cases of epilepsy but not for other types of epilepsy and there are many different types as listed here-

There has been the usual knee-jerk reaction to that word cannabis from those who think it should remain illegal and those on the opposite side who think it should be legalised. The former believe that only scientifically researched and proven remedies should be used; the latter group are the libertarians who believe it should be available as a medication (but in reality they are thinking only of their own indulgences.)

Both camps are wrong of course. Because something is illegal, that does not make it wrong and conversely if something is legal, that does not make it right. The law is by and large a matter of opinion and the law, any law, is constantly amended and modified by judges. The law is whatever a Judge says it is; until there be a subseqent challenge to that law.

Ironically a lot of what are now 'dangerous' illegal drugs were once perfectly legal and were available with or without prescription in chemists or elsewhere. Often such things were prescribed by doctors: morphine, cocaine and cannabis were included in a medication known as the Brompton Cocktail as described here by Professor Bruce Charlton-

So, once upon a time 'illegal' drugs were deemed to be beneficial which is what Paracelsus said almost 500 years ago - "Poison is in everything, and no thing is without poison. The dosage makes it either a poison or a remedy." (Paracelsus (1493-1541) is generally regarded as the 'father of modern medicine')

It should be remembered that care of those who are ill is not a science. It is an art and is described as such in the Hippocratic Oath -"With purity and with holiness I will pass my life and practice my Art."

And Paracelsus again in what is more or less a distillation of the Hippocratic Oath-
"Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided."

Note that phrase 'the very processes of life' - the body heals itself, all it needs is guidance from the physician.

Science plus the art of healing by a sympathetic physician with the old fashioned 'bedside manner' are the best medicine of all.

I suppose it is too much to hope for an outbreak of common sense to allow the use of the clearly effective cannabis oil which will let Billy Caldwell and Alfie Dingley  and others like them lead a normal life.

Image result for canada flag cannabis leaf
Uruguay, now Canada - who's next?     (Image)

... and for whose benefit? (Image)


A K Haart said...

Roughly twenty years ago there was an interesting article on pharmaceutical research published in the Royal Society of Chemistry magazine. Written by a pharmaceutical researcher, it explained that the precise reason why many drugs work is often not well understood.

In the case of psychoactive drugs he wrote that none of them are well understood when it comes to their detailed effects on the brain. He gave Serotonin Reuptake Inhibitors (SRIs) as an example. Although it is known that SRIs inhibit the uptake of serotonin, what subsequently happens to the serotonin was unknown at that time. Maybe it still is.

Things will have changed since that RSC article was written, but it is worth remembering that a lack of detailed understanding of their effects did not prevent the drugs being used.

Dan said...

I am reminded of an old story my PhD supervisor told about the sometimes weird effects of some drugs. His speciality was parasitology, and one antiparasitic drug commonly used in agriculture is Ivermectin.

This is a fungal-derived drug, and one which is an absolutely huge molecule. It is so big that in almost all mammals it cannot pass through the blood-brain barrier, which is a good thing because if it does, it causes paralysis and death.

Anyway, a farmer once decided that worming his prize border collie was a good idea, yet didn't like the cost of vet-bought worming tablets. Surely the bulk-bought ivermectin he used on his sheep would do?

Not being entirely stupid, he calculated the bodyweight-appropriate dose for a dog and experimented on the farm mongrel, a dog kept mostly as a security and rat control animal. It wasn't too sure about being wormed, but seemed not to suffer any ill effects even several days later, and seemed all the better for the worming.

So, the farmer tried the ivermectin on his prize collie. Five minutes later, rigid from muscle paralysis the collie died.

Collies have a genetic fault, a slightly leaky blood-brain barrier. No non-collies share this genetic fault, hence the farmer's precautions were as naught. Ever afterwards, he respected the knowledge of vets...