Multiple sclerosis and medical cannabis: a scientific exploration

In an extract taken from the Principles of Cannabinology Handbook, Viola Brugnatelli and Fabio Turco, explore the relationship between multiple sclerosis and medical cannabis.

In the world of modern medicine, there is a growing interest in exploring alternative treatments for a wide range of ailments; one area that has sparked considerable attention is the potential use of Medical Cannabis.

To fully unlock the potential of cannabis to treat a wide range of diseases and conditions, the Principles of Cannabinology Handbook serves as an invaluable resource. The handbook is a comprehensive guide authored by Viola Brugnatelli and Fabio Turco, co-founder and CSO of Cannabiscientia SA, respectively.

The Handbook provides a comprehensive overview of the science, regulations, medicine, and products related to medical cannabis in Europe. It goes deep into the physiology of the Endocannabinoid System, the pharmacology of cannabis, and its clinical relevance for various pathologies.

With this article, we present an extract from the handbook regarding Multiple sclerosis (MS) and its relationship with Medical Cannabis.

Understanding multiple sclerosis

MS is a chronic autoimmune disease that affects the central nervous system. It is characterised by widespread areas of demyelination in the brain and spinal cord, leading to a wide array of debilitating symptoms, depending on the site of the lesions, such as: (1)

• spasticity
• weakness
• sensory disturbances
• painful spasms
• ataxia
• tremor
• optic neuritis and complex ophthalmoplegia
• fatigue and dysphagia

These symptoms can significantly impact a person’s quality of life, making it crucial to find effective treatments.

While there are several pharmaceutical options available for managing MS symptoms, they may not always provide satisfactory relief and can come with undesirable side effects. 

Current treatment options for MS

Traditional treatments for MS aim to reduce inflammation, slow the progression of the disease, and alleviate symptoms. These include immunomodulatory drugs, supportive therapies, and treatments for specific symptoms. (2)

Immunomodulatory drugs, such as Glatiramer and Interferon beta, aim to reduce the frequency of relapses and delay disability progression. Other medications, like Baclofen and Tizanidine, target spasticity, while antidepressants and Gabapentin address pain and sensory disturbances.

However, these treatments can come with a range of side effects, from digestive issues and high blood pressure to excessive immunosuppression and an increased risk of certain neurological, cardiovascular and other complications. It is not so uncommon for patients to not tolerate these side effects, which leads them to discontinue treatment.

This has led patients and healthcare professionals to explore alternative therapies, including Medical Cannabis.

The role of the Endocannabinoid System

The Endocannabinoid System (ECS), a complex cell-signaling system, plays a crucial role in regulating various physiological processes. This system is involved in several processes of the body, including immune function, inflammation, and neural function.

In the context of MS, the ECS is believed to have several important roles: (3)

Immune Modulation: One of the key functions of the ECS is to regulate the immune system. In MS, the immune system becomes dysregulated and attacks the myelin sheath, leading to inflammation and demyelination. Activation of cannabinoid receptors, particularly CB2 receptors found on immune cells, can have immunomodulatory effects, potentially dampening the excessive immune response seen in MS.

Anti-Inflammatory Effects: Both endocannabinoids produced by the body and phytocannabinoids from cannabis, have demonstrated anti-inflammatory properties. Inflammation is a major driver of tissue damage in MS. Cannabinoids can reduce the production of pro-inflammatory cytokines and modulate immune cell activity, which may help reduce inflammation in the central nervous system.

Neuroprotection: MS is characterized by damage to nerve cells and their myelin sheaths. The ECS is involved in neuroprotection and repair processes. Cannabinoids can promote the survival of nerve cells, stimulate the formation of new neurons, and enhance the production of myelin, which may aid in repairing damaged nerves.

Pain and Spasticity Management: MS patients often experience neuropathic pain and muscle spasticity, which can be debilitating. Cannabinoids like THC have been shown to have analgesic (pain-relieving) and muscle relaxant properties, offering potential relief from these symptoms.

Symptom Control: The ECS can influence a range of symptoms commonly associated with MS, including fatigue, depression, and sleep disturbances. Activation of the ECS may help improve overall quality of life for MS patients

The cannabinoids found in cannabis can interact with the ECS, potentially offering relief from symptoms such as pain, muscle spasms, and inflammation.

Medical Cannabis as a promising alternative

From what has just been pointed out, the rationale behind the use of medical cannabis in MS treatment lies in its immunosuppressive properties, which can reduce the hyperproliferation of immune cells characteristic of MS. Cannabinoids, especially THC, may alleviate spasticity by acting on both CB1 and CB2 receptors.

Additionally, cannabis has shown potential in reducing neuropathic pain, a hallmark of MS, and has demonstrated anti-inflammatory and neuroprotective properties.

The main cannabinoids of interest for MS patients are tetrahydrocannabinol (THC) and cannabidiol (CBD), with the Nabiximols (a CBD:THC 1:1 spray) being a notable pharmaceutical option. These cannabinoids have been found to be effective in:
– reducing muscle spasms and pain,
– improving sleep quality,
– enhancing overall quality of life for MS patients.

Balancing benefits and risks

While medical cannabis offers promising benefits, it’s essential to consider potential side effects. Fortunately, compared to traditional pharmaceuticals, the side effects of cannabinoids are generally milder, better tolerated, and tend to disappear with cessation of use. Common side effects include: (4)

• dry mouth,
• red eyes,
• increased appetite,
• euphoria,
• increased heart rate,
• dizziness.

The path forward

In conclusion, Medical Cannabis represents a promising treatment for MS patients seeking relief from their debilitating symptoms. The interaction between cannabinoids and the endocannabinoid system holds significant potential in managing spasticity, pain, and inflammation associated with MS. A systematic review of 34 clinical studies on cannabis-based treatments for MS found that cannabis extract and pure THC effectively reduced subjective symptoms of spasticity and neuropathic pain. (5)

However, they showed limited impact on objective spasticity measurements and were ineffective for MS-induced tremors. Together with this, studies on Nabiximols have showed that it is effective in reducing the subjective symptoms of spasticity, the frequency of spasms and sleep problems. (6)

To go deeper into the role of Medical Cannabis in MS, the Handbook Principle of Cannabinology, authored by experts Viola Brugnatelli and Fabio Turco, provides a comprehensive resource for healthcare professionals and patients alike, giving a comprehensive overview of the science behind cannabis and its interaction with the ECS.

It also offers case studies and practical evidence from experienced prescribers, shedding light on the challenges and successes of incorporating Medical Cannabis into MS treatment regimens, as well as in other neurodegenerative conditions.

This extract was taken from the Principles of Cannabinology Handbook by Viola Brugnatelli and Fabio Turco, in collaboration with Cannabiscientia, Prohibition Partners and a consortium of clinicians. To find out more and order a copy visit www.cannabiscientia.com/handbook 

References
1. Oh J, Vidal-Jordana A, Montalban X. Multiple sclerosis: clinical aspects. Curr Opin Neurol. 2018 Dec;31(6):752-759.
2. Gold R, Hartung HP. Towards individualized multiple-sclerosis therapy. Lancet Neurol. 2005
Nov;4(11):693-4.
3. Karst M., Wippermann S., Ahrens J. (2010) Role of cannabinoids in the treatment of pain and
(painful) spasticity. Drugs 70: 2409-2438.
4. Kalant H. Adverse effects of cannabis on health: an update of the literature since 1996. Prog Neuropsychopharmacol Biol Psychiatry. 2004 Aug;28(5):849-63
5. Koppel BS, Brust JC, Fife T, et al. Systematic review: efficacy and safety of medical marijuana in selected neurological disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2014 Apr 29;82(17):1556-63.
6. Novotna A., Mares J., Ratcliffe S., et al. A randomised, 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. Eur J Neurol. 2011 Sep;18(9):1122-31.