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| Marijuana & Multiple Sclerosis |
Marijuana & Multiple Sclerosis Talking Points and References
Compiled by Paul Armentano
Source: NORML
Posted Friday, Dec. 19, 2003
NORML's Marijuana & Multiple Sclerosis Talking Points
Clinical and anecdotal data indicate that marijuana can provide therapeutic relief to various symptoms associated with multiple sclerosis, including pain, spasticity, bladder dysfunction, tremor, and appetite loss.
A recent survey of multiple sclerosis patients found that 43 percent used marijuana therapeutically. Among current users, nearly three quarters said marijuana alleviated their spasms, and more than half said it relieved their pain.
-- Reuters Health News Wire. "Marijuana helps MS patients alleviate pain, spasms." August 19, 2002.
A 1997 survey of MS patients published in the Journal of European Neurology found that 97 percent of respondents reported marijuana improved their symptoms, including spasticity, chronic pain and tremor.
-- Consroe P et al. 1997. The perceived effects of smoked cannabis on patients with multiple sclerosis. Eur Neurol 38: 44-8.
Recent clinical trials examining cannabinoids on an animal model of multiple sclerosis demonstrated that the cannabinoid system is neuroprotective. Authors concluded, "In addition to symptom management, cannabis may also slow the neurodegenerative process that ultimately lead to chronic disability in multiple sclerosis and probably other diseases."
-- Pryce G et al. 2003. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain 0: 2241-0.
A recent clinical trail examining the efficacy of cannabis on patients with multiple sclerosis found that whole-plant extracts of the drug improved pain relief, bladder control, and spasticity.
-- Wade D et al. 2003. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clin Rehabil 17: 21-9.
After a year-long Parliamentary inquiry on the therapeutic utility of marijuana, the House of Lord's (U.K.) Science and Technology Committee concluded, "We have seen enough evidence to convince us that a doctor might legitimately want to prescribe cannabis to relieve pain, or the symptoms of multiple sclerosis (MS), and that the criminal law ought not stand in the way."
-- House of Lords Press Information. "Lords Say, Legalise Cannabis for Medical Use." November 11, 1998.
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Marijuana & Multiple Sclerosis: What The Experts Say
"People with MS have claimed that [marijuana] has helped them to relieve a number of the symptoms of MS including pain, stiffness and bladder problems. .. We urge the courts to deal sympathetically with people with MS who are charged with cannabis use when seeking relief from their symptoms."
-- The Multiple Sclerosis (MS) Society (United Kingdom). Public Policy Statement: Use of cannabis for alleviation of MS symptoms. August 2003
"The anticonvulsive properties of marijuana that help control epileptic seizures and the antispasm properties that are useful in treating multiple sclerosis are well known in Canada. ... The Committee is of the opinion that the potential therapeutic uses of marijuana have been sufficiently documented to permit its use for therapeutic purposes."
-- Canadian Special Senate Committee on Illegal Drugs. Cannabis: Our Position for a Canadian Public Policy. September 2002
"The MS Society of Canada welcomes Health Canada's initiative in providing a more compassionate system of possession and production for individuals who feel they may benefit from the use of marijuana for medicinal purposes."
-- The Multiple Sclerosis (MS) Society Canada. Viewpoint. July 2001
"We have seen enough evidence to convince us that a doctor might legitimately want to prescribe cannabis to relieve pain, or the symptoms of multiple sclerosis (MS), and that the criminal law ought not stand in the way."
-- Lord Walter Perry, Chairman of the House of Lords (United Kingdom) Select Committee on Science and Technology: Inquiry on the Medical Use of Marijuana (aka Ninth Report: Cannabis: The Scientific and Medical Evidence), November 1998
"Marijuana/cannabis has a wide margin of safety for use under prescribed supervision, and it is effective for numerous conditions. ... Therefore, be it resolved that the American Nurses Association will ... support legislation to remove criminal penalties including arrest and imprisonment for bonafide patients and prescribers of therapeutic marijuana/cannabis."
-- American Nurses Association. Actions of the 2003 House of Delegates: Providing Patients Safe Access to Therapeutic Marijuana/Cannabis (adopted June 2003)
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SCIENTIFIC REFERENCES
Can J Neurol Sci. 2003 Aug;30(3):201-5.
Cannabis use as described by people with multiple sclerosis.
Page SA, Verhoef MJ, Stebbins RA, Metz LM, Levy JC.
Office of Medical Bioethics, University of Calgary, Calgary, AB, Canada.
BACKGROUND: Multiple sclerosis (MS) is one of the most common neurological diseases affecting young adults. The prevalence of MS in Alberta has been described as among the highest reported in the world, estimated at 217 per 100,000. Numerous anecdotal reports, and a few small empirical investigations have suggested that cannabis use may relieve the symptom experience of those with MS. The present study was undertaken to describe cannabis use by this patient group. Information on peoples' beliefs, practices and experiences related to use were investigated. METHODS: A questionnaire was mailed to a sample of 780 adults with MS in southern Alberta, Canada. RESULTS: Completed questionnaires were returned by 420/673 eligible subjects (response rate 62%). Mean sample age was 48 years and 75% were women. Respondents ranged from mildly to severely impaired. The majority of respondents (96%) was aware cannabis was potentially therapeutically useful for MS and most (72%) supported legalization for medicinal purposes. Forty-three percent had tried cannabis at some point in their lives, 16% for medicinal purposes. Symptoms reported to be ameliorated included anxiety/depression, spasticity and chronic pain. Reasons given for not trying cannabis were the fact that it is an illegal substance, concern about side effects and lack of knowledge on how to obtain it. CONCLUSIONS: Subjective improvements in symptom experience were reported by the majority of people with MS who currently use cannabis. Further evaluation of this substance is warranted.
PMID: 12945941 [PubMed - in process]
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Brain. 2003 Jul 22 [Epub ahead of print].
Cannabinoids inhibit neurodegeneration in models of multiple sclerosis.
Pryce G, Ahmed Z, Hankey DJ, Jackson SJ, Croxford JL, Pocock JM, Ledent C, Petzold A, Thompson AJ, Giovannoni G, Cuzner ML, Baker D.
Department of Neuroinflammation, Institute of Neurology, University College London, London, UK.
Multiple sclerosis is increasingly being recognized as a neurodegenerative disease that is triggered by inflammatory attack of the CNS. As yet there is no satisfactory treatment. Using experimental allergic encephalo myelitis (EAE), an animal model of multiple sclerosis, we demonstrate that the cannabinoid system is neuroprotective during EAE. Mice deficient in the cannabinoid receptor CB1 tolerate inflammatory and excito toxic insults poorly and develop substantial neurodegeneration following immune attack in EAE. In addition, exogenous CB1 agonists can provide significant neuroprotection from the consequences of inflammatory CNS disease in an experimental allergic uveitis model. Therefore, in addition to symptom management, cannabis may also slow the neurodegenerative processes that ultimately lead to chronic disability in multiple sclerosis and probably other diseases.
PMID: 12876144 [PubMed - as supplied by publisher]
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J Neuroimmunol. 2003 Apr;137(1-2):140-3.
Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis.
Killestein J, Hoogervorst EL, Reif M, Blauw B, Smits M, Uitdehaag BM, Nagelkerken L, Polman CH.
Department of Neurology, VU Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands. J.Killestein@vumc.nl
Cannabinoids can modulate the function of immune cells. We here present the first human in vivo study measuring immune function in 16 MS patients treated with oral cannabinoids. A modest increase of TNF-alpha in LPS-stimulated whole blood was found during cannabis plant-extract treatment (p=0.037), with no change in other cytokines. In the subgroup of patients with high adverse event scores, we found an increase in plasma IL-12p40 (p=0.002). The results suggest pro-inflammatory disease-modifying potential of cannabinoids in MS.
PMID: 12667658 [PubMed - indexed for MEDLINE]
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Expert Opin Investig Drugs. 2003 Apr;12(4):561-7.
The therapeutic potential of cannabis in multiple sclerosis.
Baker D, Pryce G.
Department of Neuroinflammation, Institute of Neurology, University College London, 1 Wakefield Street, London, WC1N 1PJ, UK. d.baker@ion.ucl.ac.uk
There has been renewed interest in the therapeutic applications of cannabis, and people, particularly those with multiple sclerosis, claim that it may offer benefit in symptom control. Cannabis exerts many of its effects because it taps into an endogenous cannabinoid system. Recent advances have begun to shine light on the biology of this system and may support some of the anecdotal medical claims. The problem with cannabis as a drug is that both the positive and negative aspects are largely the work of the same receptor. However, it may be possible to avoid these through modulation of the endogenous system. Cannabinoids provide a novel therapeutic target, not only for controlling symptoms, but also slowing disease progression through inhibition of neurodegeneration, which is the cause of accumulating irreversible disability.
PMID: 12665412 [PubMed - indexed for MEDLINE]
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Clin Rehabil. 2003 Feb;17(1):21-9.
A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms.
Wade DT, Robson P, House H, Makela P, Aram J.
Oxford Centre for Enablement, Windmill Road, Oxford, UK. derick.wade@dial.pipex.com
OBJECTIVES: To determine whether plant-derived cannabis medicinal extracts (CME) can alleviate neurogenic symptoms unresponsive to standard treatment, and to quantify adverse effects. DESIGN: A consecutive series of double-blind, randomized, placebo-controlled single-patient cross-over trials with two-week treatment periods. SETTING: Patients attended as outpatients, but took the CME at home. SUBJECTS: Twenty-four patients with multiple sclerosis (18), spinal cord injury (4), brachial plexus damage (1), and limb amputation due to neurofibromatosis (1). INTERVENTION: Whole-plant extracts of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), 1:1 CBD:THC, or matched placebo were self-administered by sublingual spray at doses determined by titration against symptom relief or unwanted effects within the range of 2.5-120 mg/24 hours. Measures used: Patients recorded symptom, well-being and intoxication scores on a daily basis using visual analogue scales. At the end of each two-week period an observer rated severity and frequency of symptoms on numerical rating scales, administered standard measures of disability (Barthel Index), mood and cognition, and recorded adverse events. RESULTS: Pain relief associated with both THC and CBD was significantly superior to placebo. Impaired bladder control, muscle spasms and spasticity were improved by CME in some patients with these symptoms. Three patients had transient hypotension and intoxication with rapid initial dosing of THC-containing CME. CONCLUSIONS: Cannabis medicinal extracts can improve neurogenic symptoms unresponsive to standard treatments. Unwanted effects are predictable and generally well tolerated. Larger scale studies are warranted to confirm these findings.
PMID: 12617376 [PubMed - indexed for MEDLINE]
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Pharmacol Ther. 2002 Aug;95(2):165-74.
Cannabinoids and multiple sclerosis.
Pertwee RG.
Department of Biomedical Sciences, Institute of Medical Sciences, University of Aberdeen, Foresterhill, Scotland, UK. rgp@aberdeen.ac.uk
There is a growing amount of evidence to suggest that cannabis and individual cannabinoids may be effective in suppressing certain symptoms of multiple sclerosis and spinal cord injury, including spasticity and pain. Anecdotal evidence is to be found in newspaper reports and also in responses to questionnaires. Clinical evidence comes from trials, albeit with rather small numbers of patients. These trials have shown that cannabis, Delta(9)-tetrahydrocannabinol, and nabilone can produce objective and/or subjective relief from spasticity, pain, tremor, and nocturia in patients with multiple sclerosis (8 trials) or spinal cord injury (1 trial). The clinical evidence is supported by results from experiments with animal models of multiple sclerosis. Some of these experiments, performed with mice with chronic relapsing experimental allergic encephalomyelitis (CREAE), have provided strong evidence that cannabinoid-induced reductions in tremor and spasticity are mediated by cannabinoid receptors, both CB(1) and CB(2). Endocannabinoid concentrations are elevated in the brains and spinal cords of CREAE mice with spasticity, and in line with this observation, spasticity exhibited by CREAE mice can be ameliorated by inhibitors of endocannabinoid membrane transport or enzymic hydrolysis. Research is now needed to establish whether increased endocannabinoid production occurs in multiple sclerosis. Future research should also be directed at obtaining more conclusive evidence about the efficacy of cannabis or individual cannabinoids against the signs and symptoms of these disorders, at devising better modes of administration for cannabinoids and at exploring strategies that maximize separation between the sought-after therapeutic effects and the unwanted effects of these drugs.
PMID: 12182963 [PubMed - indexed for MEDLINE]
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J Neuroimmunol. 2000 Jan 3;102(1):26-31.
Dexanabinol (HU-211) effect on experimental autoimmune encephalomyelitis: implications for the treatment of acute relapses of multiple sclerosis.
Achiron A, Miron S, Lavie V, Margalit R, Biegon A.
Multiple Sclerosis Center, Sheba Medical Center, Ramat Gan, Israel. achiron@post.tau.ac.il
Dexanabinol (HU-211) is a synthetic non-psychotropic cannabinoid which suppresses TNF-alpha production in the brain and peripheral blood. The effects of dexanabinol in rat experimental autoimmune encephalomyelitis (EAE) were studied using different doses, modes of administration and time regimes. Dexanabinol, 5 mg/kg i.v. given once after disease onset (day 10), significantly reduced maximal EAE score. Increasing the dose or treatment duration resulted in further suppression of EAE. Drug administration at earlier phases during disease induction was not effective. Histological studies supported the clinical findings demonstrating reduction in the inflammatory response in the brain and spinal cord in animals treated with dexanabinol. The results suggest that dexanabinol may provide an alternative mode of treatment for acute exacerbations of multiple sclerosis (MS).
PMID: 10626663 [PubMed - indexed for MEDLINE]
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Nature. 2000 Mar 2;404(6773):84-7.
Cannabinoids control spasticity and tremor in a multiple sclerosis model.
Baker D, Pryce G, Croxford JL, Brown P, Pertwee RG, Huffman JW, Layward L.
Department of Neurochemistry, Institute of Neurology, University College London, UK. D.Baker@ion.ucl.ac.uk
Chronic relapsing experimental allergic encephalomyelitis (CREAE) is an autoimmune model of multiple sclerosis. Although both these diseases are typified by relapsing-remitting paralytic episodes, after CREAE induction by sensitization to myelin antigens Biozzi ABH mice also develop spasticity and tremor. These symptoms also occur during multiple sclerosis and are difficult to control. This has prompted some patients to find alternative medicines, and to perceive benefit from cannabis use. Although this benefit has been backed up by small clinical studies, mainly with non-quantifiable outcomes, the value of cannabis use in multiple sclerosis remains anecdotal. Here we show that cannabinoid (CB) receptor agonism using R(+)-WIN 55,212, delta9-tetrahydrocannabinol, methanandamide and JWH-133 (ref. 8) quantitatively ameliorated both tremor and spasticity in diseased mice. The exacerbation of these signs after antagonism of the CB1 and CB2 receptors, notably the CB1 receptor, using SR141716A and SR144528 (ref. 8) indicate that the endogenous cannabinoid system may be tonically active in the control of tremor and spasticity. This provides a rationale for patients' indications of the therapeutic potential of cannabis in the control of the symptoms of multiple sclerosis, and provides a means of evaluating more selective cannabinoids in the future.
PMID: 10716447 [PubMed - indexed for MEDLINE]
###
Eur Neurol. 1997;38(1):44-8.
The perceived effects of smoked cannabis on patients with multiple sclerosis.
Consroe P, Musty R, Rein J, Tillery W, Pertwee R.
Department of Pharmacology/Toxicology, University of Arizona Health Sciences Center, Tucson 85721-0207, USA. consroe@pharmacy.arizona.edu
Fifty-three UK and 59 USA people with multiple sclerosis (MS) answered anonymously the first questionnaire on cannabis use and MS. From 97 to 30% of the subjects reported cannabis improved (in descending rank order): spasticity, chronic pain of extremities, acute paroxysmal phenomenon, tremor, emotional dysfunction, anorexia/weight loss, fatigue states, double vision, sexual dysfunction, bowel and bladder dysfunctions, vision dimness, dysfunctions of walking and balance, and memory loss. The MS subjects surveyed have specific therapeutic reasons for smoking cannabis. The survey findings will aid in the design of a clinical trial of cannabis or cannabinoid administration to MS patients or to other patients with similar signs or symptoms.
PMID: 9252798 [PubMed - indexed for MEDLINE]
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Int J Clin Pharmacol Ther. 1996 Oct;34(10):446-52.
The effect of orally and rectally administered delta 9-tetrahydrocannabinol on spasticity: a pilot study with 2 patients.
Brenneisen R, Egli A, Elsohly MA, Henn V, Spiess Y.
Institute of Pharmacy, University of Bern, Switzerland.
Multiple doses of delta 9-tetrahydrocannabinol (THC) capsules (Marinol) and THC hemisuccinate suppositories were administered in 24-hour intervals to 2 patients with organically caused spasticity. After oral doses of 10-15 mg THC, peak plasma levels from 2.1 to 16.9 ng/ml THC and 74.5 to 244.0 ng/ml 11-nor-9-carboxy-delta 9-tetrahydrocannabinol (THC-COOH, major THC metabolite) were measured by GC/MS within 1-8 h and 2-8 h, respectively. After rectal doses of 2.5-5 mg THC, peak plasma levels from 1.1 to 4.1 ng/ml THC and 6.1 to 42.0 ng/ml THC-COOH were measured within 2-8 h and 1-8 h, respectively. The bioavailability resulting from the oral formulation was 45-53% relative to the rectal route of administration, due to a lower absorption and higher first-pass metabolism. The effect of THC on spasticity, rigidity, and pain was estimated by objective neurological tests (Ashworth scale, walking ability) and patient self-rating protocols. Oral and rectal THC reduced at a progressive stage of illness the spasticity, rigidity, and pain, resulting in improved active and passive mobility. The relative effectiveness of the oral vs. the rectal formulation was 25-50%. Physiological and psychological parameters were used to monitor psychotropic and somatic side-effects of THC. No differences in the concentration ability, mood, and function of the cardiovascular system could be observed after administration of THC.
PMID: 8897084 [PubMed - indexed for MEDLINE]
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Eur Arch Psychiatry Clin Neurosci. 1990;240(1):1-4.
Delta-9-tetrahydrocannabinol shows antispastic and analgesic effects in a single case double-blind trial.
Maurer M, Henn V, Dittrich A, Hofmann A.
PSIN - Psychologisches Institut fur Beratung und Forschung, Zurich, Switzerland.
A double-blind study was performed comparing 5 mg delta-9-tetrahydrocannabinol (THC) p.o., 50 mg codeine p.o., and placebo in a patient with spasticity and pain due to spinal cord injury. The three conditions were applied 18 times each in a randomized and balanced order. Delta-9-THC and codeine both had an analgesic effect in comparison with placebo. Only delta-9-THC showed a significant beneficial effect on spasticity. In the dosage of THC used no altered consciousness occurred.
PMID: 2175265 [PubMed - indexed for MEDLINE]
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J Neuroimmunol. 1989 Jun;23(1):73-81.
Delta 9-tetrahydrocannabinol: a novel treatment for experimental autoimmune encephalomyelitis.
Lyman WD, Sonett JR, Brosnan CF, Elkin R, Bornstein MB.
Department of Pathology, Albert Einstein College of Medicine, Bronx, NY 10461.
Since multiple sclerosis (MS) is believed to be an immune-mediated disease, it follows that its therapies should be directed towards modulating the immune system. Current MS treatments, which include the use of exogenous steroids that are immunosuppressive, do not meet therapeutic objectives. delta 9-Tetrahydrocannabinol (THC), an active component of marijuana, has been shown to be immunosuppressive. To test THC's ability to suppress an immune-mediated disease, experimental autoimmune encephalomyelitis (EAE), the laboratory model of MS, was used. Lewis rats and strain 13 guinea pigs were administered THC either before inoculation for EAE or treated with THC after injection. Control animals received placebo. The effect of dose, in addition to the timing of treatment, was also investigated. All animals treated with placebo developed severe clinical EAE 10-12 days post-injection (d.p.i.) and more than 98% died by 15 d.p.i. THC-treated animals had either no clinical signs or mild signs with delayed onset (13-15 d.p.i.) with survival greater than 95%. Examination of central nervous system tissue revealed a marked reduction of inflammation in the THC-treated animals. Therefore, as THC has been shown to inhibit both clinical and histologic EAE, it may prove to be a new and relatively innocuous agent for the treatment of immune-mediated diseases.
PMID: 2542370 [PubMed - indexed for MEDLINE]
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J Neurol. 1989 Feb;236(2):120-2.
Effect of cannabinoids on spasticity and ataxia in multiple sclerosis.
Meinck HM, Schonle PW, Conrad B.
Department of Clinical Neurophysiology, University of Gottingen, Federal Republic of Germany.
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.
PMID: 2709054 [PubMed - indexed for MEDLINE]
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Adv Alcohol Subst Abuse. 1987;7(1):39-50.
Delta-9-THC in the treatment of spasticity associated with multiple sclerosis.
Ungerleider JT, Andyrsiak T, Fairbanks L, Ellison GW, Myers LW. Department of Psychiatry, U.C.L.A. School of Medicine 90024.
Marijuana is reported to decrease spasticity in patients with multiple sclerosis. This is a double blind, placebo controlled, crossover clinical trial of delta-9-THC in 13 subjects with clinical multiple sclerosis and spasticity. Subjects received escalating doses of THC in the range of 2.5-15 mg., five days of THC and five days of placebo in randomized order, divided by a two-day washout period. Subjective ratings of spasticity and side effects were completed and semiquantitative neurological examinations were performed. 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.
PMID: 2831701 [PubMed - indexed for MEDLINE]
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Ann Neurol. 1983 Jun;13(6):669-71.
Tetrahydrocannabinol for tremor in multiple sclerosis.
Clifford DB.
Based on one patient's enthusiastic report, eight patients with multiple sclerosis, seriously disabled with tremor and ataxia, were given oral tetrahydrocannabinol. Two demonstrated improved motor coordination.
PMID: 6309074 [PubMed - indexed for MEDLINE]
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J Clin Pharmacol. 1981 Aug-Sep;21(8-9 Suppl):413S-416S.
Treatment of human spasticity with delta 9-tetrahydrocannabinol.
Petro DJ, Ellenberger C Jr.
Spasticity is a common neurologic condition in patients with multiple sclerosis, stroke, cerebral palsy or an injured spinal cord. Animal studies suggest that THC has an inhibitory effect on polysynaptic reflexes. Some spastic patients claim improvement after inhaling cannabis. We tested muscle tone, reflexes, strength and performed EMGs before and after double-blinded oral administration of either 10 or 5 mg THC or placebo. The blinded examiner correctly identified the trials in which the patients received THC in seven of nine cases. For the group, 10 mg THC significantly reduced spasticity by clinical measurement (P less than 0.01). Quadriceps EMG interference pattern was reduced in those four patients with primarily extensor spasticity. THC was administered to eight other patients with spasticity and other CNS lesions. Responses varied, but benefit was seen in three of three patients with "tonic spasms." No benefit was noted in patients with cerebellar disease.
PMID: 6271839 [PubMed - indexed for MEDLINE]
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Additional References Regarding Cannabinoids and Multiple Sclerosis
Croxford JL, Miller SD. 2003. Immunoregulation of a viral model of multiple sclerosis using the synthetic cannabinoid R+WIN55,212. J Clin Invest. 111:1231-40.
Smith P. 2002. Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. Curr Opin Investig Drugs 3: 859-64
Mechoulam R, Hanu L. 2001. The cannabinoids: an overview. Therapeutic implications in vomiting and nausea after cancer chemotherapy, in appetite promotion, in multiple sclerosis and in neuroprotection. Pain Res Manag 6: 67-73.
Schon F, Hart PE, Hodgson TL, Pambakian AL, Ruprah M, Williamson EM, Kennard C. 2000. Suppression of pendular nystagmus by smoking cannabis in a patient with multiple sclerosis. Neurology 53: 2209-10.
Muller-Vahl KR, Kolbe H, Schneider U, Emrich HM. 1999. Cannabis in movement disorders. Forsch Komplementarmed 6 Suppl 3: 23-7.
Wirguin I, Mechoulam R, Breuer A, Schezen E, Weidenfeld J, Brenner T. 1994. Suppression of experimental autoimmune encephalomyelitis by cannabinoids. Immunopharmacology 28: 209-14.
Martyn C. 1995. Naboline in the treatment of multiple sclerosis. The Lancet 345: 579.
Ungerleider J, Andyrsiak T, Fairbanks L, Ellison G, Mayers L. 1988. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. In: Pharmacological Issues in Alcohol and Substance Abuse. Haworth Press: 39-50
Hanigan W, Destree R, Truong X. 1986. The effect of delta-9-THC on human spasticity. Clin Pharmacol Ther 39: 198.
Truong H, Hanigan W. 1986. Effect of delta-9-THC on EMG measurements in human spasticity. Clin Pharmacol Ther 39: 198.
Consroe P, Snider S. 1986. Therapeutic potential of cannabinoids in neurological disorders. In: Cannabinoids as Therapeutic Agents. CRC Press: 21-49.
Petro D. 1980. Marijuana as a therapeutic agent for muscle spasm or spasticity. Psychosomatics 21: 81-85.
Check W. 1979. Marijuana may lessen spasticity of MS. JAMA 241: 2476
Created on 07/28/2005 10:36 AM by mspuadmin
Updated on 10/11/2006 09:14 AM by mspuadmin
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