Multiple Sclerosis

Multiple sclerosis is a disease of the brain and spinal cord caused by demyelination (loss of the insulating sheath) of nerve fibres, believed to be caused by some substance dissolving or breaking-up fatty tissue of the nerve-sheath. The condition is progressive but varies in intensity, with remission of symptoms and relapse commonly reported. Common symptoms include fatigue, balance problems, muscle weakness, incontinence, muscle spasms, pain and tremor.

Current treatments for MS are of little benefit, expensive, and with risks of side effects. alpha & beta-interferon, and corticosteroids have been found to have some value, but symptoms are poorly-controlled by existing medications, and no cure has been found. Many patients are unable to tolerate the side-effects of conventional medication

Anecdotal evidence. Grinspoon reports a number of anecdotal reports of dramatic improvement in MS symptoms attributed to marijuana (cannabis) use. Initially, these were unexpected findings following social use of the drug. In one account, Greg Paufler described a progressive degeneration, following onset of MS in 1973, to bedridden status, and severe side effects (dramatic weight gain, addiction to benzodiazepines) from prescribed medicines. Following several social “joints” one evening, he astonished family and friends by standing spontaneously for the first time in months. He subsequently found that his symptoms deteriorated without the drug, but improved dramatically during periods when he was smoking cannabis. Grinspoon reviewed further cases showing improvements in muscle spasms, tremor, continence, ataxia (loss of muscle control) and insomnia. Clare Hodges, an MS patient giving oral evidence to the House of Lords enquiry, reported cannabis “greatly relieved” physical symptoms including discomfort of bladder and spine, nausea and tremors, and stated “Cannabis helps my body relax, I function and move much easier. The physical effects are very clear, it is not just a vague feeling of well-being.”

Animal studies – Scientists have developed animal models for MS in rats, mice and guinea-pigs in the form of an experimental autoimmune encephalomyelitis (EAE). In guinea-pigs, Lyman et al found 98% of animals treated with placebo died, whereas 95% of THC-treated animals survived the disease process, with much reduced inflammation of brain tissue. In rats, Wirguin et al found ” 8THC significantly reduced neurological deficits in two strains of EAE inoculated rats. More recently, Molina-Holgado et al found anandamide (endogenous CB1 cannabinoid receptor agonist) reduced the effects of encephalomyelitis in mice, suggesting a receptor-mediated mode of action in arresting or reducing the autoimmune response considered to be involved in the MS disease process.

Human studies: In a study of 112 MS patients self-medicating with cannabis in the US and UK, Consroe et al reported that 70% of more respondents reported improvement in the following symptoms:

Spasticity at sleep onset Pain in muscles
Spasticity when awaking at night Pain in legs at night
Tremor (arms/head) Depression
Anxiety Spasticity when waking in morning
Spasticity when walking Tingling in face/arms/head/trunk
Numbness of chest/stomach Pain in face
Weight loss Weakness in legs

The authors considered these reports “strongly suggested cannabinoids may significantly relieve symptoms of MS, particularly spasticity and pain”, and provided sufficient grounds for a properly controlled clinical trial to test such claims objectively and conclusively.

Meinck et al reported “The chronic motor handicaps of a 30-year-old multiple sclerosis patient acutely improved while he smoked a marihuana cigarette. This effect was quantitatively assessed by means of clinical rating, electromyographic investigation of the leg flexor reflexes and electromagnetic recording of the hand action tremor. It is concluded that cannabinoids may have powerful beneficial effects on both spasticity and ataxia that warrant further evaluation.”

Petro & Ellenberger, in a small double-blind clinical trial found 10mg THC significantly (p<.01) reduced spasticity in patients with MS or similar conditions, compared to placebo. In an earlier double-blind crossover trial, Ungerleider et al reported “At doses greater than 7.5 mg there was significant improvement in patient ratings of spasticity compared to placebo. These positive findings in a treatment failure population suggest a role for THC in the treatment of spasticity in multiple sclerosis.” Clifford, in a trial involving 8 patients severely disabled with tremor and ataxia, reported significant improvement in two patients.

The improvements in tremor reported by Meinck & Clifford are dramatically demonstrated in fig 1 below.

Fig 1 – Effects of THC on tremor in MS patients

Clifford (1983) Meinck et al (1989)

In a pilot study involving two patients, Brenneison et al reported “Oral and rectal THC reduced at a progressive stage of illness the spasticity, rigidity, and pain, resulting in improved active and passive mobility.” In a single case double-blind trial, Maurer et al found THC “showed a significant beneficial effect on spasticity. In the dosage of THC used no altered consciousness occurred.” Consroe et al reported cannabidiol (CBD) to produce dose-related improvements in dystonic movement disorders. Malec et al found spinal cord injured persons reported decreased spasticity with marijuana use. Other papers have also reported potential benefits of cannabinoids, including crude marijuana, and the synthetic Nabilone, where Martyn et al found clear improvement in well-being, reduced pain from muscles spasm, and reduced frequency of nocturia during the treatment condition (1mg Nabilone every other day) compared to worsening of symptoms in “no treatment” or placebo conditions.

Summary – Multiple Sclerosis is a disease for which conventional medication provides little benefit. There is a wealth of anecdotal evidence from MS patients reporting dramatic improvement in symptoms following illicit use of cannabis, and the limited clinical trials which have taken place to date have shown that, at least in some patients, symptoms such as pain, ataxia, spasticity and tremor can be dramatically improved. Recent animal research has suggested a direct CB1-receptor mediated immunosuppressive effect may delay the neurodegenerative process in MS-like animal models, although this may suggest longer term benefits, it would not explain the acute improvement in symptoms reported by many MS patients following cannabis use. The House of Lords Science & Technology Committee recommended that clinical trials of cannabinoids in the treatment of MS be undertaken as a matter of urgency, and that pending the award of product licences, doctors should be allowed to prescribe cannabis or cannabis resin as an unlicensed medicine on a named-patient basis for patients, including MS sufferers.

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