Project Description

Definition

iStock_000005407442XSmallMultiple sclerosis (MS), also known as disseminated sclerosis or encephalomyelitis disseminata, is an inflammatory disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. MS takes several forms, with new symptoms either occurring in isolated attacks (relapsing forms) or building up over time (progressive forms). Between attacks, symptoms may disappear completely; however, permanent neurological problems often occur, especially as the disease advances.

While the cause is not clear, the underlying mechanism is thought to be either destruction by the immune system or failure of the myelin-producing cells. Proposed causes for this include genetics and environmental factors such as infections. MS is usually diagnosed based on the presenting signs and symptoms and the results of supporting medical tests.

There is no known cure for multiple sclerosis. Treatments attempt to improve function after an attack and prevent new attacks. Medications used to treat MS while modestly effective can have adverse effects and be poorly tolerated. Many people pursue alternative treatments, despite a lack of evidence. The long-term outcome is difficult to predict, with good outcomes more often seen in women, those who develop the disease early in life, those with a relapsing course, and those who initially experienced few attacks. Life expectancy is on average 5 to 10 years lower than that of an unaffected population.

Multiple sclerosis is the most common autoimmune disorder affecting the central nervous system. As of 2008, between 2 and 2.5 million people are affected globally with rates varying widely in different regions of the world and among different populations. The disease usually begins between the ages of 20 and 50 and is twice as common in women as in men. The name multiple sclerosis refers to scars (sclerae—better known as plaques or lesions) in particular in the white matter of the brain and spinal cord. MS was first described in 1868 by Jean-Martin Charcot. A number of new treatments and diagnostic methods are under development.

Medical Marijuana Efficacy

Clinical and anecdotal reports of cannabinoids’ ability to reduce MS-related symptoms such as pain, spasticity, depression, fatigue, and incontinence are plentiful in the scientific literature. Specifically, investigators at the University of California at San Diego reported in 2008 that inhaled cannabis significantly reduced objective measures of pain intensity and spasticity in patients with MS in a placebo-controlled, randomized clinical trial. They concluded that “smoked cannabis was superior to placebo in reducing spasticity and pain in patients with multiple sclerosis and provided some benefit beyond currently prescribed treatment.”

Inhaled cannabis yielded similar results in a 2012 randomized, placebo-controlled trial involving MS subjects who were unresponsive to conventional therapy. That study, published in the Journal of the Canadian Medical Association, concluded, “Smoked cannabis was superior to placebo in symptom and pain reduction in patients with treatment-resistant spasticity.” Not surprisingly, patients with multiple sclerosis typically report engaging in cannabis therapy, with one survey indicating that nearly one in two MS patients use the drug therapeutically.

Other studies suggest that cannabinoids may also inhibit MS progression in addition to providing symptom management. Writing in the July 2003 issue of the journal Brain, investigators at the University College of London’s Institute of Neurology reported that administration of the synthetic cannabinoid agonist WIN 55,212-2 provided “significant neuroprotection” in an animal model of multiple sclerosis.

Spanish researchers in 2012 reported similar findings, documenting that “the treatment of EAE mice with the cannabinoid agonist WIN55,512-2 reduced their neurological disability and the progression of the disease.”

Official Research Reports

Effect of dronabinol on progression in progressive multiple sclerosis (CUPID): a randomised, placebo-controlled trial. (Zajicek J, Ball S, Wright D, Vickery J, Nunn A, Miller D, Gomez Cano M, McManus D, Mallik S, Hobart J, 2013)

Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. (Corey-Bloom J, Wolfson T, Gamst A, Jin S, Marcotte TD, Bentley H, Gouaux B., 2012)

Multiple Sclerosis and Extract of Cannabis: results of the MUSEC trial. (Zajicek JP, Hobart JC, Slade A, Barnes D, Mattison PG, 2012)

A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study of nabiximols*(Sativex), as add-on therapy, in subjects with refractory spasticity caused by multiple sclerosis. (Novotna A, Mares J, Ratcliffe S, Novakova I, Vachova M, Zapletalova O, Gasperini C, Pozzilli C, Cefaro L, Comi G, Rossi P, Ambler Z, Stelmasiak Z, Erdmann A, Montalban X, Klimek A, Davies P, 2011)

Randomized controlled trial of Sativex to treat detrusor overactivity in multiple sclerosis. (Kavia RB, De Ridder D, Constantinescu CS, Stott CG, Fowler CJ, 2010)

Psychopathological and cognitive effects of therapeutic cannabinoids in multiple sclerosis: a double-blind, placebo controlled, crossover study. (Aragona M, Onesti E, Tomassini V, Conte A, Gupta S, Gilio F, Pantano P, Pozzilli C, Inghilleri M, 2009)

Cannabinoid-induced effects on the nociceptive system: a neurophysiological study in patients with secondary progressive multiple sclerosis. (Conte A, Bettolo CM, Onesti E, Frasca V, Iacovelli E, Gilio F, Giacomelli E, Gabriele M, Aragona M, Tomassini V, Pantano P, Pozzilli C, Inghilleri M, 2009)

Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol. (Deutsch SI, Rosse RB, Connor JM, Burket JA, Murphy ME, Fox FJ, 2008)

Oromucosal ∆9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. (Rog DJ, Nurmikko TJ, Young CA, 2007)

Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis (Collin C, Davies P, Mutiboko IK, Ratcliffe S, 2007)

Randomised controlled study of cannabis-based medicine (Sativex®) in patients suffering from multiple sclerosis associated detrusor overactivity (de Ridder D, Constantinescu CS,Fowler C, Kavia R, Sarantis N, 2006)

Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. (Wade DT, Makela PM, House H, Bateman C, Robson P, 2006)

Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. (Rog DJ, Nurmikko TJ, Friede T, Young CA, 2005)

Cannabinoid influence on cytokine profile in multiple sclerosis. (S Katona, E Kaminski, H Sanders, and J Zajicek, 2005)

An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. (Brady CM, DasGupta R, Dalton C, Wiseman OJ, Berkley KJ, Fowler CJ, 2004)

Efficacy of tetrahydrocannabinol in patients refractory to standard antiemetic therapy.Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. (Vaney C, Heinzel-Gutenbrunner M, Jobin P, Tschopp F, Gattlen B, Hagen U, Schnelle M, Reif M, 2004)

Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? Randomised double blind placebo controlled crossover trial (Svendsen KB, Jensen TS, Bach FW, 2004)

Cannabis use as described by people with multiple sclerosis. (Page SA, Verhoef MJ, Stebbins RA, Metz LM, Levy JC, 2003)

Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. (Zajicek J, Fox P, Sanders H, Wright D, Vickery J, Nunn A, Thompson A; UK MS Research Group, 2003)

Randomised controlled trial of cannabis based medicine (CBM, Stativex) to treat detrusor overactivity in multiple sclerosis. (Kavia R, De Ridder D, Sarantis N, Constantinescu C, Fowler, 2000)

Analgesic effect of the cannabinoid analogue nabilone is not mediated by opioid receptors. (Hamann W, di Vadi PP, 1999)

Nabilone in the treatment of multiple sclerosis. (Martyn CN, Illis LS, Thom J, 1995)

Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. (Meinck HM, Schönle PW, Conrad B, 1989)

Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. (Ungerleider JT, Andyrsiak T, Fairbanks L, Ellison GW, Myers LW, 1987)

Tetrahydrocannabinol for tremor in multiple sclerosis. (Clifford DB, 1983)

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