Cannabis derivative shows promise in dealing with spasticity
Spasticity or stiffness is a major cause of disability and decline in quality of life in patients with motor neuron disease. Cannabinoids have been approved for symptomatic treatment of spasticity in multiple sclerosis.
This study published in The Lancet Neurology investigated whether cannabinoids might also reduce spasticity in patients with motor neuron disease.
Motor Neuron Disease (MND) or amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease which damages the motor neurons in the brain and spinal cord leading to gradual weakness and thinning of muscles of arms, hands, legs, swallowing and ultimately muscles involved in breathing.
According to the Centre for Disease Control (CDC), USA about 20000 to 30000 people have ALS in USA, with around 5000 new cases diagnosed every year. Although Indian data is limited, the prevalence of ALS cases in India is 5 in 100000. Indians, however appear to have a younger age of onset.
This study published in The Lancet Neurology investigated whether cannabinoids might also reduce spasticity in patients with motor neuron disease.
Motor Neuron Disease (MND) or amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease which damages the motor neurons in the brain and spinal cord leading to gradual weakness and thinning of muscles of arms, hands, legs, swallowing and ultimately muscles involved in breathing.
According to the Centre for Disease Control (CDC), USA about 20000 to 30000 people have ALS in USA, with around 5000 new cases diagnosed every year. Although Indian data is limited, the prevalence of ALS cases in India is 5 in 100000. Indians, however appear to have a younger age of onset.
In this study nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile.
The most famous patient of ALS was probably physicist Stephen Hawking. A while back there was a Bucket Challenge to raise awareness about ALS.
In this clinical trial carried out at four tertiary motor neuron disease centres in Italy, patients aged 18–80 years with MND who had spasticity symptoms due to motor neuron disease for at least 3 months; and were taking an antispasticity medication that was maintained at a stable dose for 30 days were enrolled.
Participants were randomly divided into a standardised oromucosal spray (nabiximols) group containing a defined combination of delta-9-tetrahydrocannabinol and cannabidiol (each 100 μL actuation contained 2·7 mg delta-9-tetrahydrocannabinol and 2·5 mg cannabidiol) or to placebo for 6 weeks. The primary endpoint was the change in the score on the Modified Ashworth Scale, which was assessed at baseline and after 6 weeks. Safety and tolerability were also monitored.
Between Jan 19, 2013, and Dec 15, 2014, 60 participants were randomly assigned, and 59 participants were included in the final analysis (29 in the nabiximols group and 30 in the placebo group). Modified Ashworth Scale scores improved by a mean of 0·11 (SD 0·48) in the nabiximols group and deteriorated by a mean of 0·16 (0·47) in the placebo group (adjusted effect estimate. Nabiximols was well tolerated, and no participants withdrew from the double-blind phase of the study. No serious adverse effects occurred.
In this study nabiximols had a positive effect on spasticity symptoms in patients with motor neuron disease and had an acceptable safety and tolerability profile. Further evaluation in larger clinical trials is now planned.
