What is Multiple Sclerosis?
Our nerves in the brain and spinal cord are often covered by an insulating layer, known as the myelin sheath. Electrical signals (action potential) can travel many times faster through myelinated nerves than unmyelinated ones. Therefore, the myelin sheath is extremely crucial for our normal nerve functions, including motor functions (walking, running…), sensory function (hearing, seeing, feeling of touch…), or cognitive functions (learning, recalling…).
In Multiple Sclerosis (MS), our body mistakes the myelin sheaths as enemies and orders our own immune system to destroy it. This can eventually lead to permanent damage or deterioration of the nerves.
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Symptoms of Multiple Sclerosis
Depending on which part of the nervous system is damaged, symptoms will be different from person to person, and can be different between attacks. If the damaged nerve is responsible for motor functions, then symptoms will often affect movements, such as tremor, or feeling numbness and weakness in our limbs, lack of coordination or unsteady gait. If the damaged nerve is related to our eyes, then it can cause blurry vision or even loss of vision. Tingling sensation or pain in parts of the body can also be a symptom. There are also cases with sexual issues or bowel and bladder function issues. Sometimes, symptoms can be noticeable and are overlooked.
MS symptoms can occur only once, come and go, or change severity over time. Thus, due to the symptoms being so unpredictable, no two people will experience the same symptoms, and some cases can be hard to diagnose.
Progression - types of Multiple Sclerosis
There are 3 main types of MS that are linked to disease progression.
Relapsing Remitting MS - Most common type of MS, consists of around 85% of the cases. This type of MS is characterized by flare ups of symptoms, followed by a period of remission.
Secondary Progressive MS - Is the secondary phase of relapsing remitting MS that can take years to decades to develop after the initial onset of symptoms. This time, instead of remission, it can be a progressive worsening of symptoms over time, and may lead to disability.
Primary Progressive MS - 10-15% of people with MS will experience no remission, but instead, a gradual, progressive worsening of symptoms and disability right from the beginning.
Knowing which type of MS a person has will be crucial for choosing the most appropriate drug treatment and other clinical decisions.
How is Multiple Sclerosis diagnosed
Doctors will look for lesions or scars in the nervous systems. This is evidence that the nerves were damaged in the past. Multiple attacks had to be at different locations in the nervous system, and occur at different times.
Clinical examinations, MRI scans, spinal tap or combination of those are often used in diagnosing MS.
Currently, there is no cure for MS. Though, treatments are aimed at speeding up recovery and managing symptoms, as well as disease progression.
Other Characteristics of Multiple Sclerosis
The average age is 20-40 years old, and MS patients are more often women than men.
Cannabis and Multiple Sclerosis
As there is no cure, symptom management is extremely important in MS patients. Many medical cannabis users claim that they are using cannabis for managing MS symptoms, such as pain and tremor, as well as to get better sleep and relieving stress, improving their quality of life. In Canada, a published survey in 2017 showed that over 90 percent of people with MS who responded, have either considered using it, have used it, or have spoken to their healthcare provider about it.
Currently, Sativex, a mucosal spray of 1:1 THC:CBD ratio is approved and is commercially available for MS patients in some countries, who are suffering from tremors and pain.
Cannabinoids in multiple sclerosis (CAMS) study is a randomized and placebo controlled trial, showing that even though there wasn’t any improvement in physician administered tests for spasticity, patients are reporting improvement in spasticity and sleep. This is quite interesting, because while the symptoms may not actually get better, the patients really feel better when they are using cannabis. This can be a mentally effect after all, but still have great benefits in improving the patient’s quality of life. And beside that, there were no major safety concerns.
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Another clinical trial, Multiple Sclerosis and Extract of Cannabis (MUSEC) on 279 individuals, randomzied to either taking cannabis extract orally or placebo, showed that those who took the cannabis extract received twice as much relief from muscle stiffness. They also reported improvements in muscle spasms and sleep.
Recently, the American Academy of Neurology (AAN) published a summary of systematic reviews for patients and their families, titled Medical marijuana in certain neurological disorders, including MS. You can click on the previous link and see what level of evidence is available regarding medical cannabis and managing symptoms of MS.
Consuming high THC cannabis products can cause adverse effects such as nausea, loss of balance, drowsiness, headaches, etc… In MS patients, this can combine with the symptoms that patients are already having to make problems worse, according to this study, titled "Effects of cannabis on cognitive function in patients with multiple sclerosis". Therefore, CBD preparations should be a better choice.
Thus, even though cannabis preparations used in various trials showed no major safety concerns, there is evidence that street cannabis use is associated with worsened cognitive function in individuals diagnosed with MS.
Therefore, please speak with your health care provider about using cannabis related products for MS, and report any side effects occurred in order to adjust the drug usage accordingly.
How to use Cannabinoids for Multiple Sclerosis
As mentioned, CBD preparations are more preferable since they don’t risk worsening cognitive functions in MS patients, while can help with pain and other symptom management.
Always start from the small dose of about 5-10mg CBD on the first day, then gradually increase the dose every two days by 5mg until you find the right dose that gives the desired effect. Since each person responds differently to cannabinoids, it is best to experiment with different delivery systems while gradually and slowly increasing the dose to find the best way of administration and the most optimal dosage.
Cofield, S. S., Salter, A., Tyry, T., Crowe, C., Cutter, G. R., Fox, R. J., & Marrie, R. A. (2017). Perspectives on marijuana use and effectiveness. Neurology: Clinical Practice, 7(4), 333–343. https://doi.org/10.1212/cpj.0000000000000383
Honarmand, K., Tierney, M. C., O'Connor, P., & Feinstein, A. (2011). Effects of cannabis on cognitive function in patients with multiple sclerosis. Neurology, 76(13), 1153–1160. https://doi.org/10.1212/wnl.0b013e318212ab0c
MS Australia. (2022, September 13). What is multiple sclerosis (MS). MS Australia. Retrieved September 30, 2022, from https://www.msaustralia.org.au/what-is-multiple-sclerosis-ms/
Patients families medical Mariuana in certain neurological disorders. (n.d.). Retrieved September 30, 2022, from https://www.aan.com/Guidelines/home/GetGuidelineContent/650
Zajicek, J. (2012). Multiple sclerosis and extract of cannabis (MUSEC): A randomised, double-blind, placebo-controlled phase III trial to determine the efficacy and safety of a standardised oral extract of cannabis sativa for the symptomatic relief of muscle stiffness and pain in multiple sclerosis (MS). Http://Isrctn.org/>. https://doi.org/10.1186/isrctn42223114
Zajicek, J. P. (2005). Cannabinoids in multiple sclerosis (CAMS) study: Safety and efficacy data for 12 months follow up. Journal of Neurology, Neurosurgery & Psychiatry, 76(12), 1664–1669. https://doi.org/10.1136/jnnp.2005.070136