Cannabis for multiple sclerosis

Cannabis in multiple sclerosis - A closer look at MS therapy approaches

Worldwide, approximately 2.8 million people are affected by the neurological disease multiple sclerosis, or MS for short. In Germany, about 0.34% of the population lives with it1. Women are affected twice as often as men in adulthood. Multiple sclerosis rarely follows the same course. This makes therapy and treatment equally challenging for patients and doctors.

When conventional medications are not enough to alleviate the symptoms of the nerve disease, medical cannabis can be an alternative. Canify Clinics would like to support you on your journey with multiple sclerosis and first give you an overview of the prerequisites. What is multiple sclerosis, how is it diagnosed and what is the prognosis? There is no cure for the disease, but there are treatments that can positively influence its course.

Criteria for prescribing medical cannabis for multiple sclerosis

The "Cannabis as Medicine2 " law makes it possible for you to be prescribed cannabis as medicine on a narcotic prescription under certain conditions.

These conditions include the presence of a serious illness that is classified as therapy-resistant, for which no standard therapy is available or for which the side effects of the standard therapy are unacceptable. According to a doctor's assessment, there must also be a chance that the symptoms will improve with medical cannabis.

As a private patient, you can have cannabis medicines prescribed for you. You have to pay for the treatment yourself. Canify Clinics stands for trust and transparency. Therefore, we offer you an overview of the costs you are likely to incur as a private payer. If you have any questions, please contact us so that we can coordinate your therapy together.

What is multiple sclerosis?

MS is an inflammatory disease of the central nervous system that usually progresses in relapses. The nerve structures in the brain and spinal cord form the central nervous system, or CNS for short. It regulates the central processing of stimuli in the body, including the following tasks:

  • Mediating and processing messages (stimuli) from the environment and from inside the body. For example, you get hungry when you see food.
  • Coordination of motor movements. For example, you can wave to someone while walking and greet the person.
  • Cognitive functions - This refers to everything to do with language, thinking, memory, drive and feeling.
  • Regulation of the healthy interaction of all vital systems in the human body. For example, your breathing speeds up during exertion or your body adjusts to the day-night rhythm.

The Latin term for multiple sclerosis is encephalomyelitis disseminata. This means disseminated inflammation of the brain and spinal cord and describes well what happens in the disease:

The immune system attacks and destroys parts of the nerve fibres of the CNS that are important for the transmission of impulses. The nerve fibres and cells themselves are also attacked. This damage is called demyelination3. Diseases in which the body's own immune system attacks the body are called autoimmune diseases. The process is like a rodent chewing on the insulation of the cables in your home. The insulation represents the myelin layer that surrounds most nerves and ensures that signals are passed on quickly. If the rodent continues to go unattended, it will probably go after the actual wiring – the nerve fibres – next. It is possible that your stereo system will then have a loose contact, but in the worst case the speakers will no longer work at all. The difference: unlike the wiring harnesses of a stereo system, nerve pathways and brain matter cannot be replaced.

What are the possible causes of MS?

Researchers have not yet been able to fully explain why people develop multiple sclerosis. According to current data, it is assumed that various factors promote the occurrence of multiple sclerosis. These factors include:

  • Hereditary predisposition (genetic disposition): This means that family members do not pass on the disease per se to their offspring, but they do pass on an increased tendency to the disease4.
  • External influences, so-called environmental factors: Experts suspect that smoking, too much vitamin D and viral infections (e.g. Epstein-Barr virus) can promote the occurrence of the disease5.

What MS symptoms can occur?

The symptoms of MS are varied and different for each individual: no two conditions are alike. Because the range of functions of the central nervous system is so broad, multiple sclerosis can affect any of them6,7.

Some symptoms are called early symptoms. These are signs that usually appear at the beginning of the neurological disease. These include8:

  • Spastic (convulsive) paralysis
  • Coordination problems
  • Sensory disturbances such as numbness or "ant tingling" all over the body, which often occur in spots
  • Visual disorders in which there is a loss of vision in the field of vision or vision is clouded. Occasionally, sufferers also describe double vision.
  • Rapid fatigue and exhaustion
  • Concentration problems

The early symptoms continue to occur in the advanced course of the disease.

If the autonomic nervous system is also attacked during an episode, patients often lose control over their bladder and bowel function. Often, the course of the disease also has an impact on mental health, and patients frequently develop depression as well.

Most of the symptoms usually disappear once the episode is over. However, if the damage caused is too great, permanent neurological impairments may remain.

MS Diagnosis - Things to know about diagnosis

There is no single clinical feature or diagnostic procedure to identify multiple sclerosis. Rather, the diagnosis of MS is based on a combination of clinical, imaging and laboratory findings7.

The diagnosis of MS is made by exclusion. This means that neurologists first exclude all differential diagnoses, i.e. diagnoses that cause similar symptoms.

A first indication of the presence of inflammatory disease can be increased inflammation levels (CRP) in the blood during a relapse. However, the value alone is too unspecific to draw any real conclusions; after all, many comparatively harmless diseases also cause the value to rise. An important part of the diagnosis9 is the examination of the fluid in the brain and spinal cord, the so-called cerebrospinal fluid. The cerebrospinal fluid is used to examine certain proteins and cells. In addition, an MRI (magnetic resonance imaging) is performed to detect any changes in the brain. Electrophysiological measurements, especially the determination of the capacity of the optic nerves, are also part of the diagnosis.

A useful tool for diagnosing MS is the McDonald criteria, which require that there is evidence of injury or dysfunction in at least two of four areas of the central nervous system at different points in time: On or adjacent to the cortex, around the cavities in the brain (ventricles), in the cerebellum and in the spinal cord10.

Progressions in multiple sclerosis

When MS-typical changes are detected for the first time via MRI or CSF examination, neurologists speak of a clinically isolated syndrome (CIS). CIS can develop into MS, but it can also occur only once.

Once the diagnosis is confirmed, neurologists classify the disease into different courses11. Canify Clinics can explain the differences:

  • Relapsing-remitting MS (RRMS): This type of multiple sclerosis is characterized by episodes of symptoms, with the effects of the MS episode resolving completely or at least partially within a few weeks.
  • Secondary progressive multiple sclerosis (SPMS): The majority of people with MS develop secondary progressive MS as the disease progresses. The main feature is a slow clinical deterioration of the patient's condition independent of relapses.
  • Primary progressive multiple sclerosis (PPMS): Primary progressive MS is characterized by the fact that patients are affected by a gradual disability right at the beginning. This form of multiple sclerosis often progresses without relapses.
  • Benign multiple sclerosis: A small proportion of MS patients are spared any significant impairments for several decades after diagnosis. In this form of the disease, it is important to monitor cognitive abilities and concentration.

MS therapy and treatment options - these are the options

Multiple sclerosis cannot be cured according to current medical knowledge. However, holistic therapy can slow down the progression and alleviate the symptoms. Neurologists currently treat patients according to a three-stage therapy model that takes individual courses into account. The three stages are called acute relapse therapy12 , course-modifying therapy13 and symptomatic therapy14.

  • During a relapse, the use of cortisone to treat acute symptoms has proven effective. Cortisone has an anti-inflammatory effect and can thus help to relieve the symptoms. However, the treatment also has side effects. If cortisone does not help, so-called plasmapheresis (blood washing) is considered an alternative relapse therapy. The procedure is similar to dialysis – during plasmapheresis, some components of the blood plasma are isolated and the purified blood flows back through the attached access.
  • Progression-modifying drugs can prevent relapses and are intended to have a positive effect on the course of the disease. The aim is thus to slow down the progression of the disease.For course-modifying therapy, drugs are used that influence the immune system.
  • Symptomatic therapies treat the symptoms of multiple sclerosis with occupational therapy, physiotherapy and speech therapy. Rehabilitation is an important part of the therapy, and in some cases medication is also used here, for example to treat depression or bladder weakness.

MS therapies without medication are not effective. Here, only symptomatic therapy remains, which cannot slow down the course of the disease. Although a diet adapted to the disease can have a positive effect on the course of the disease under certain circumstances, it is not influential enough on its own.


Cannabis in multiple sclerosis

The (endogenous) endocannabinoid system is part of the nervous system in the human body. It includes the so-called cannabinoid receptors CB1 and CB2. While the CB1 receptors are mainly found in the nerve cells in different parts of the brain and in the peripheral (surrounding) nervous system, the CB2 receptors are mainly found in the immune system, but also in other parts of the body. In patients suffering from spastic disorders due to multiple sclerosis, the endocannabinoid system may be altered. It is suspected that there is a deficiency of the body's own cannabinoids (endocannabinoids), for example anandamide. These are important for signal transmission between nerve cells15. The system is involved in processes such as the inflammation of nerve tissue, neuronal repair mechanisms and the protection of nerve cells (neuroprotection), all of which are important processes in connection with multiple sclerosis.16 The effect of cannabis on the body is based on the fact that the cannabis plant also contains cannabinoids that can dock to the respective receptors. The best known of these active substances are THC (delta-9-tetrahydrocannabinol) and CBD (cannabidiol). THC can have a euphoric effect, but also, among other things, a pain-relieving effect. CBD, on the other hand, has no euphoric effect and can have an anti-inflammatory, anticonvulsant, sedative and anxiety-relieving effect.

Results of several studies point in particular to the antispasmodic effect of cannabis. Particularly interesting: In 2017, New Zealand researchers reported on subjects who did not respond adequately to standard multiple sclerosis medication. After the patients were given cannabis medication containing equal parts CBD and THC for three months, the research team reported a significant improvement in spasticity17.

A large number of multiple sclerosis patients also suffer from pain. This can be the result of spasticity or destroyed nerve fibres. Various studies have already investigated the effectiveness of cannabis as a medicine against nerve pain16,18,19.

It is not uncommon for those affected to develop depression as a result of their illness. Here, too, cannabis as a medicine can have a supportive effect alongside psychotherapy: In a study on the effect of medicinal cannabis on nausea and vomiting during chemotherapy, the researchers state that the mood-lifting effect of cannabis is a thoroughly desirable side effect.20

CBD for MS

In the future, therapy with high doses of CBD could also alleviate the suffering of MS patients. Although research is not yet mature enough to make definitive statements, initial studies give hope: Israeli researchers administered highly concentrated CBD to mice with MS-like symptoms. The mice showed less inflammation and were able to move their legs again21.

How Canify Clinics can help you with your MS diagnosis

Canify Clinics wants to support you as best as possible on your path to medical cannabis. Therefore, it is important to us to make the treatment as accessible as possible and in your best interest, so that you can organise your everyday life as symptom-free as possible. To make your path to medical cannabis easier, Canify Clinics works according to the principle of telemedicine.

After you have registered on our portal www.canifyclinics.com without any obligation, our doctors will check your documents and contact you promptly to discuss the next steps.If therapy with medical cannabis is an option for you, you will have an appointment with one of our cooperation doctors in one of our cooperation practices or in one of the practices of the Canify Clinics. The follow-up appointments can take place from the comfort of your own home. During a video appointment, you discuss everything important with your doctor. An on-site appointment is only scheduled once a calendar year – we will be happy to help you prepare for this.

FAQ

What causes MS?

The exact causes of the neurological autoimmune disease are not yet clear. However, there are some circumstances that favour the occurrence of MS. One of these is a so-called genetic disposition. This means that people have an inherited predisposition to multiple sclerosis - but there are also people in whom the predisposition does not influence their health. Experts suspect that smoking, vitamin D and viral infections (e.g. Epstein-Barr virus) can promote the onset of the disease.

Where does MS cause pain?

Since multiple sclerosis is a disease in which the immune system damages the nerves, the symptoms can affect the whole body. This means that pain can be a symptom that occurs everywhere and is sometimes very severe. Painkillers can help, and medicinal cannabis, among others, can be an option for therapy that can provide relief and restore quality of life.

When to use cannabis for MS?

Several studies have shown that the cannabinoids THC and CBD contained in cannabis can have a pain-relieving, antispasmodic and mood-lifting effect. The inflammatory disease brings painful muscle cramps and spasms as its main symptoms. Thus, while medical cannabis cannot cure multiple sclerosis, it can be effective against its symptoms. As many people suffer from depressive moods over time, the effect of cannabis can also be an issue here. However, cooperation with specialists in neurology and psychiatry remains irreplaceable.

Disclaimer and legal notice

This article is for information purposes only and does not replace medical advice from a doctor. The content is not intended to motivate self-diagnosis or self-treatment, nor to tempt people to change their own medical treatment. Canify Clinics does not make any recommendations or promote any diagnostic methods or treatments. If you wish to change your treatment, this should always be discussed with a doctor. Furthermore, Canify Clinics cannot guarantee the accuracy, timeliness and balance of the content. Therefore, neither the authors of the texts nor Canify Clinics accept any liability for damages resulting from the independent use of the information described here.


References

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2. Gesetz ‘Cannabis als Medizin’ in Kraft getreten - Bundesgesundheitsministerium. https://www.bundesgesundheitsministerium.de/ministerium/meldungen/2017/maerz/cannabis-als-medizin-inkrafttreten.html.

3. Zalc, Bernard. “One hundred and fifty years ago Charcot reported multiple sclerosis as a new neurological disease.” Brain : a journal of neurology vol. 141,12 (2018).

4. Patsopoulos, Nikolaos A et al. “Fine-mapping the genetic association of the major histocompatibility complex in multiple sclerosis: HLA and non-HLA effects.” PLoS genetics vol. 9,11 (2013).

5. Olsson, T., Barcellos, L. & Alfredsson, L. Interactions between genetic, lifestyle and environmental risk factors for multiple sclerosis. Nat Rev Neurol 13, 25–36 (2017).

6. Was ist MS? | DMSG. https://www.dmsg.de/multiple-sklerose/was-ist-ms.

7. Brownlee, Wallace J et al. “Diagnosis of multiple sclerosis: progress and challenges.” Lancet (London, England) vol. 389,10076 (2017).

8. Rommer, Paulus Stefan et al. “Symptomatology and symptomatic treatment in multiple sclerosis: Results from a nationwide MS registry.” Multiple sclerosis (Houndmills, Basingstoke, England) vol. 25,12 (2019).

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10. Thompson, Alan J et al. “Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria.” The Lancet. Neurology vol. 17,2 (2018).

11. Kip Tonio Schönfelder Hans-Holger Bleß Hrsg, M. Weißbuch Multiple Sklerose.

12. Schubtherapie | DMSG.  https://www.dmsg.de/multiple-sklerose/ms-behandeln/therapiesaeulen/schubtherapie.

13. Verlaufmodifizierende Therapie | DMSG. https://www.dmsg.de/multiple-sklerose/ms-behandeln/therapiesaeulen/verlaufmodifizierende-therapie.

14. Symptomatische Therapie | DMSG. https://www.dmsg.de/multiple-sklerose/ms-behandeln/therapiesaeulen/symptomatische-therapie.

15. Centonze, D. et al. The endocannabinoid system is dysregulated in multiple sclerosis and in experimental autoimmune encephalomyelitis. Brain 130, 2543–2553 (2007).

16. Mecha, M., Carrillo-Salinas, F. J., Feliú, A., Mestre, L. & Guaza, C. Perspectives on Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review. Front Cell Neurosci 14, 34 (2020).

17. Keating, Gillian M. “Delta-9-Tetrahydrocannabinol/Cannabidiol Oromucosal Spray (Sativex®): A Review in Multiple Sclerosis-Related Spasticity.” Drugs vol. 77,5 (2017).

18. Lakhan, Shaheen E, and Marie Rowland. “Whole plant cannabis extracts in the treatment of spasticity in multiple sclerosis: a systematic review.” BMC neurology vol. 9 59. (2009).

19. Iskedjian, Michael et al. “Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain.” Current medical research and opinion vol. 23,1 (2007).

20. Tramèr, M. R. et al. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 323, 16 (2001).

21. Kozela, Ewa et al. “Cannabidiol inhibits pathogenic T cells, decreases spinal microglial activation and ameliorates multiple sclerosis-like disease in C57BL/6 mice.” British journal of pharmacology vol. 163,7 (2011).