Multiple sclerosis affects over 25,600 Australians and there is currently no known cure.
Treatment typically involves symptomatic therapies or progression reduction strategies, but many symptoms can prove resistant to traditional treatment. Nabiximols for the treatment of muscle spasticity in MS patients is one of the few approved medicinal cannabis products in Australia. However, medicinal cannabis may also prove beneficial in managing other symptoms of MS.
What is multiple sclerosis (MS)?
Multiple sclerosis is a condition of the central nervous system. It is named for the scars that develop across the central nervous system, interfering with nerve impulses in the brain, spinal cord and optic nerves.
The disruption of these nerve impulses can create a myriad of symptoms both visible and invisible, which can greatly impact a patient’s quality of life.
What are the common symptoms of multiple sclerosis (MS)?
The symptoms of multiple sclerosis can be unpredictable and can vary significantly from one person to another.
This may be due to the way different scar or lesion patterns affect different nerves. Resulting symptoms can include:
- Difficulties with memory, concentration or reasoning.
- Slurring or slowing of speech.
- Visual disturbances such as blurred or double vision.
- Dizziness or vertigo.
- Emotional and mood changes.
- Chronic pain.
- Sensory symptoms such as numbness or pins and needles.
- Muscle weakness, spasms or stiffness.
- Difficulty walking or maintaining balance.
- Sensitivity to different temperatures.
Quality of life for patients with MS is estimated to be 31 percent lower than the average Australian population.
Common causes of Multiple Sclerosis
There are currently no known causes of multiple sclerosis. It is the most common acquired disease of the central nervous system in young adults, globally.
Theories about the cause of MS include that it’s an autoimmune disease, that it’s a result of genetic or environmental factors, or that it is caused by a virus.
Risk factors for developing multiple sclerosis include:
- Age: Onset typically occurs between ages 20 and 40.
- Sex: Women are three times more likely to be diagnosed with MS than men.
- Family history: Risk is increased if a patient has a close relative with MS.
- Climate / Latitude: The prevalence of MS is greater further away from the equator.
- Infection: Some viruses such as Epstein-Barr (mononucleosis) have been attributed to the development of MS.
Common treatments for multiple sclerosis
There are two key treatment strategies for multiple sclerosis:
Symptomatic therapies seek to ease specific symptoms of multiple sclerosis to improve a patient’s quality of life. Some examples of medications used in symptomatic therapy include:
- Botox® (botulinum toxin type A) may be injected directly into the muscle to treat localised spasticity.
- Fampridine may be taken as a tablet to improve walking.
- Nabiximols may be taken as an oral spray where other treatments of muscle spasticity have failed.
Disease modifying therapies focus on reducing the risk of relapses or progression of MS. MS Australia estimates 64 percent of people with MS use a disease modifying therapy.
- Teriflunomide may be taken as a tablet to stop immune cells involved in the damage associated with MS from multiplying.
The types of drugs used in treatment can vary significantly according to the specific symptoms of a patient, the severity of a relapse or the type of MS. It’s difficult to compare different treatments for MS, as many have not been directly tested against one another.
Individual circumstances and personal responses to medication can also greatly influence treatment of MS.
Physical therapies may also be recommended to support medicinal treatments, build muscle strength and reduce symptoms.
Using medicinal cannabis to treat multiple sclerosis (MS)
Already, a synthetic cannabis product called Nabiximols is one of the only approved medicinal cannabis treatments in Australia. It is commonly prescribed to treat muscle spasticity when other treatment options have failed.
Preliminary research suggests medicinal cannabis holds further promise for patients with MS:
THC/CBD Nabiximols for neuropathic pain associated with MS: This study by the Walton Centre of Neurology and Neurosurgery assessed the long-term tolerance and impacts of Nabiximols containing both tetrahydrocannabinol (THC) and cannabidiol (CBD) on patients with MS. Nabiximols were found to be effective with no evidence of tolerance build-up over two years of treatment. Adverse side effects were common (dizziness and nausea) but deemed mild too moderate. Source
Cannabinoid (extract and THC) for muscle spasticity and other MS symptoms: Peninsula Medical School in Plymouth, UK, assessed responses to treatment with cannabis extract, Tetrahydrocannabinol(THC) and a placebo. While treatment with cannabinoids did not prove effective when assessed on the Ashworth scale, patient opinion of an improvement in pain as well as objective improvements in mobility suggest cannabinoids may be clinically useful. Source
Central pain and sleep disturbance in MS patients: The Walton Centre of Neurology and Neurosurgery assessed the effectiveness of whole plant cannabis-based medicine as an analgesic for central pain associated with MS. They found oromucosal spray to be effective in reducing pain and sleep disturbance in patients with mild adverse effects. Source