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Medical Marijuana and Dystonia

American Academy of Neurology AAN.com

Symptoms of MS

The studies showed that medical marijuana in pill or oral spray form can help treat certain MS symptoms.

The studies examined here looked at four forms of medical marijuana:

  1. Oral cannabis extract (OCE), a pill made of either pure CBD or a combination of CBD and THC

  2. Synthetic THC, a human-made form of THC available as a pill

  3. Nabiximols (Sativex), a mixture of THC and CBD available in Oral Spray form

  4. Smoked marijuana in cigarettes of standard drug strength

Table: Evidence for Safety and Effectiveness of Medical Marijuana

Findings, by Disorder and Drug Formulation  

OCE

  1. Can reduce patients’ reported symptoms of spasticity
Strong

OCE

  1. Probably does not lead to improvement short-term (12-15 weeks) on tests for spasticity a doctor performs

Synthetic THC

  1. Can probably reduce patients’ reported symptoms of spasticity
  2. Can probably lessen cramp-like pain or painful spasms
  3. Probably does not lead to improvement short-term (15 weeks) on tests for spasticity a doctor performs

Oral Spray (Nabiximols)

  1. Can probably lessen patients’ reported symptoms of spasticity short-term (6 weeks)
  2. Probably does not lead to improvement short-term (6 weeks) on tests for spasticity a doctor performs
  3. Can probably lessen cramp-like pain or painful spasms
Moderate

OCE and Synthetic THC

  1. Might lessen patients’ reported symptoms of spasticity if continued for at least one year
  2. Might lead to improvement on tests for spasticity a doctor performs, if treatment continued for at least one year
Weak

Smoked Cannabis

  1. Not enough evidence to show if safe or helpful for pain related to spasticity
Unknown
MS: Central Pain  

OCE

  1. Can help lessen central pain (feelings of painful burning, “pins and needles,” and numbness)
Strong
MS: Bladder Problems  

OCE and Synthetic THC

  1. Probably do not help lessen frequent urination and bladder control problems

 

Moderate

Oral Spray (Nabiximols)

  1. Not enough evidence to show if helps lessen bladder problems overall
Unknown
MS: Tremor  

OCE and Synthetic THC

  1. Probably do not help lessen tremor in MS
Moderate

Oral Spray (Nabiximols)

  1. Might not help lessen tremor in MS
Weak
PD: Temporary, Uncontrolled Movements  

OCE

  1. Probably does not help lessen abnormal movements caused by levodopa
Moderate
HD: Motor Symptoms  

Synthetic THC

  1. Not enough evidence to show if helps lessen motor symptoms
Unknown
Tourette Syndrome: Tic Severity  

Synthetic THC

  1. Not enough evidence to show if helps lessen tic severity
Unknown
Cervical Dystonia (Abnormal Neck Movements)  

Synthetic THC

  1. Not enough evidence to show if helps lessen abnormal neck movements
Unknown
Epilepsy: Seizure Frequency  

Any Form of Cannabis

  1. Not enough evidence to show if helps lessen how often seizures occur
Unknown
   

Dystonia is a neurological movement disorder characterized by abnormal muscle tension and involuntary, painful muscle contractions. It is the third most common movement disorder after Parkinson's disease and tremor, affecting more than 300,000 people in North America.

A small number of case reports and preclinical studies investigating the use of cannabis and cannabinoids for symptoms of dystonia are referenced in the recent scientific literature. A 2002 case study published in the July issue of the The Journal of Pain and Symptom Management reported improved symptoms of dystonia after smoking cannabis in a 42-year-old chronic pain patient. Investigators reported that subject’s subjective pain score fell from 9 to zero (on a zero-to-10 visual analog scale) following cannabis inhalation, and that the subject did not require any additional analgesic medication for the following 48 hours. "No other treatment intervention to date had resulted in such dramatic overall improvement in [the patient's] condition," investigators concluded.

A second case study reporting “significant clinical improvement” following cannabis inhalation in a single 25-year-old patient with generalized dystonia due to Wilson’s disease was documented by an Argentinian research team in the August 2004 issue of the journal Movement Disorders.

Also in 2004, a German research team at the Hannover Medical School reported successful treatment of musician’s dystonia in a 38-year-old professional pianist following administration of 5 mg of THC in a placebo-controlled single-dose trial. Investigators reported “clear improvement of motor control” in the subject’s affected hand, and noted, “[Two] hours after THC intake, the patient was able to play technically demanding literature, which had not been possible before treatment.” Prior to cannabinoid treatment, the subject had been unresponsive to standard medications and was no longer performing publicly. “The results provide evidence that … THC intake … significantly improves [symptoms of] … focal dystonia,” investigators concluded.

By contrast, a 2002 randomized, placebo-controlled study investigating the use of the synthetic oral cannabinoid naboline (Cessamet) in 15 patients afflicted with generalized and segmental primary dystonia did not show a significant reduction in dystonic symptoms. Investigators speculated that this result may have been dose-related, and that administration of a higher dosage may have yielded a different outcome.

At least one recent preclinical trial indicates that both synthetic cannabinoids as well as high doses of the natural non-psychoactive cannabinoid cannabidiol (CBD) could moderate the disease progression of dystonia in animals.[5] Limited references regarding the use of cannabinoids for dystonia in humans[6] and animals[7] in the 1980s and the 1990s also appear in the scientific literature. It would appear that additional, larger clinical trials are warranted to investigate the use of cannabis and cannabinoids for this indication.

 

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