Multiple Sclerosis (MS) is a disease that has reportedly affected 2.3 million people worldwide, according to The National Multiple Sclerosis Society. This number may actually be even higher because the Center for Disease Control and Prevention (CDC) does not require U.S. physicians to disclose new cases.
MS can exhibit physical, mental, and even psychiatric symptoms in many patients who are affected. The quality of life of these patients can be severely impeded with some of them even wheelchair-bound and unable to ambulate. The life expectancy of these affected patients is generally five to ten years lower than that of the normal population.
Cannabis has been used for a few years to help manage the symptoms of these patients, but physicians are not completely on board to prescribe. Research, however, has shown that cannabis can help with MS symptoms.
To further understand how best to use cannabis in this debilitating disease, we first must delve into the pathology of the condition. Though there are several different types of MS, we will focus more on the general aspects of the disease to fully understand it.
What are some features of Multiple Sclerosis?
MS is considered a demyelinating disease of the brain and spinal cord because it affects the insulating covers, or the myelin sheath, of nerve cells. It is also classified as an autoimmune disease. The damage done to the myelin inhibits proper signaling to occur between the nervous system, causing a communication breakdown. This breakdown can essentially result in a multitude of multisystemic issues.
MS can provoke any neurological symptom including visual, motor, and sensory problems. Specific symptoms are determined by where the lesions are in the nervous system. They may include loss of sensitivity or changes in sensation such as tingling, pins and needles or numbness, muscle weakness, muscle spasms, and blurred vision. These are actually the most common complaints by many MS patients.
Other symptoms include pronounced reflexes, difficulty in moving, and difficulties with coordination and balance – also known as ataxia. Problems with speech or swallowing, visual problems like nystagmus, optic neuritis or double vision, fatigue, acute or chronic pain, and bladder and bowel difficulties can also persist.
Some patients may start in a relapsing and remitting course that then becomes progressive later on. Relapses are not predictable and usually happen with some type of a trigger.
There appears to be no cause for MS, rendering it idiopathic, but researchers have theorized genetic and environmental factors may play a role, however, more research needs to be done.
The pathophysiology behind Multiple Sclerosis
In terms of pathophysiology, MS is mainly characterized by the presence of lesions or plaques in the myelin sheath of neurons. These plaques, unfortunately, destroy the sheath and causes the ruckus of symptoms reported.
MS is also believed to be autoimmune, which means the body’s own immune system attacks the nervous system possibly due to environmental causes.
The lesions of on the myelin also attack the white matter of the brain. This renders the brain unable to communicate between grey matter areas, where processing generally occurs. The oligodendrocytes, which create the myelin sheath, are damaged and compromised.
When the myelin is lost, a neuron can no longer conduct electrical signals. A repair process known as remyelination takes place in the early part of the condition, but the oligodendrocytes are unable to completely rebuild the cell’s myelin sheath.
The more a patient suffers an attack, the more compromised the myelin sheath becomes, and the faster the disease progresses. Inflammation can also occur by T-cells, which are a type of immune cells that protect the body from foreign invaders. In MS, T-cells mistakenly attack the myelin sheath as a foreign body, causing inflammation to progress in the disease.
The Blood-Brain Barrier (BBB) is also compromised in MS. Usually, BBB is a barrier that disallows certain elements from gaining access to the brain and the central nervous system. In MS, however, the BBB It may become permeable to certain compounds, rendering it compromised.
Diagnosis and management of Multiple Sclerosis
MS can be diagnosed via magnetic imaging like MRI and laboratory testing. Once symptoms exhibit in a patient, neuroimaging via MRI and analysis of the cerebrospinal fluid (CSF) can be done to confirm the diagnosis, however, it can be invasive. Testing of the CSF obtained from a lumbar puncture can provide evidence of chronic inflammation in the central nervous system.
However, it should be noted that currently there is no single testing that can be done to confirm multiple sclerosis in patients.
As for treatment, it should first be noted that there is no known treatment for MS currently, but there some treatments which can be helpful in management.
In acute attacks, patients are given high doses of intravenous (IV) corticosteroids. However, studies have shown that these medications are not effective in treating the disease long term.
Currently, ten disease-modifying medications have been approved by the FDA for certain types of MS. Some of them are interferon beta-1a, natalizumab, and ocrelizumab. In the case of progressive MS, rituximab has been approved as a viable medication.
The issue with these medications is that there seem to be many side effects associated with them. These side effects can range from a developing rash to indentation in the skin from use. Interferons (IFN) can cause flu-like symptoms in some patients as well. Some patients have reported post-injection reaction with flushing, chest tightness, heart palpitations, liver damage, infertility, and anxiety from the use of these drugs.
Cannabis and Multiple Sclerosis
As with many other conditions, cannabis has been used to help manage the symptoms of MS by many patients who suffer from it.
Many users report that it helps to control their muscle spasms and allows them to move their arms and legs freely without inhibition. Cannabis can also help with the overactive bladder that comes with MS due to spasms that cause the frequent urge to pee.
It also helps with the chronic nerve pain experienced by many MS sufferers. Many patients report that cannabis helps to take the edge off their pain, but caution that this can take weeks of proper dosage and usage.
Furthermore, since cannabis does play a role in inflammation, and MS does have inflammatory symptoms, it can be used to help manage that through the endocannabinoid receptors.
Many MS patients who have used canes to ambulate find that they can better ambulate after using cannabis for an extended period of time. Many physicians recommend using cannabidiol (CBD) over tetrahydrocannabinol (THC) to help with their symptoms.
Studies have shown that supplementing with CBD may help people with MS reduce fatigue, pain, and spasticity as well as eventually improve mobility. Though there are risks to cannabis use, as with any medication, patients report that the benefits of using cannabis outweigh the risks.