CBD in Multiple Sclerosis Treatment | cannabisMD

CBD in Multiple Sclerosis Treatment

CBD for Multiple Sclerosis Treatment

Etymologically, the word sclerosis comes from the Greek “sklirosis” which means “hardening,” in such a way that this type of sclerotic diseases is related to the hardening of tissues or organs.

From the pathological point of view, Sclerosis is a hardening or thickening of organs, tissues, or vessels from an inflammation, abnormal growth tissue or degeneration of nerve fibers. This hardening of a tissue or organism is usually due to scarring or fibrosis (creation of new connective tissue fibers) that occurs after inflammation. The hardening or rigidity of tissues or organs affects due to abnormally increased connective tissues that are caused by a given disease. In this sense, it is indicated that the sclerosis is not an autonomous disease, but that is derived from another. Another reason why sclerosis arises is due to an autonomous disease, because of an uncontrolled increase in connective tissue leads to the hardening of tissues or organs leading eventually to the loss of their elasticity. Therefore, the main symptom of sclerosis is the hardening and healing of body tissue.

The main types of sclerosis

Tuberous sclerosis (TS)

It is also called Tuberous Sclerosis Complex. It is a rare and multisystem genetic disease. It originates with the creation of tubers in the brain (tumors) and causes damage to the brain and other vital organs. According to the medical information website, Right Diagnosis, TS is a genetic disorder affecting cellular differentiation, proliferation, and migration early in development; This results in a variety of lesions that may affect every organ in the human body. This disease can arise at birth without realizing it because the changes or disorders are subtle in such a way that the symptoms develop gradually over time. Among the main symptoms are:

  • Neurological findings: These findings depend on the location, size, and growth of the tubers and the presence of subependymal nodules and subependymal giant cell astrocytoma.
  • Cutaneous findings: the most common cutaneous manifestation of TSC is the sebaceous adenoma, which often does not appear until late childhood or early adolescence.
  • Cardiac findings: This affectation can be maximum at birth and are mainly rhabdomyomas.
  • Ophthalmic findings: Is estimated that at least 50% of patients have ocular abnormalities.
  • Lung findings: Pulmonary cystic abnormalities have been found in up to 40% of women with this disease.
  • Renal findings: These findings are presented in 4 types of lesions: lesions of autosomal dominant polycystic kidney disease, isolated renal cysts, angiomyolipoma’s and renal cell carcinomas
  • Dental findings
  • Gastrointestinal findings: In the case, they can occur as hamartomas and polyposis of the stomach, intestine, and colon.
  • Hepatic findings
  • skeletal findings.

This disease is not frequent, in such a way that according to the National Organization for Rare Disorders (NORD) 1 of every 6,000 newborns suffer from this disease in the United States. It is estimated that 40,000 to 80,000 people in the United States have tuberous sclerosis.

System sclerosis (SS) or Scleroderma

Etymologically Scleroderma means “hardening of the skin.” This disease consists of an alteration of the collagen that causes hardening and a loss of the elasticity of the skin and other organs or tissues that can be affected. It is also characterized by vascular insufficiency and diseases in the digestive system, kidneys, lungs, and heart. Some types of this disease affect specific parts of the body, while other types affect the entire body. In general terms, three stages are established in which this disease develops:

1) Edematous: is characterized by a bulging of the fingers, and it’s difficult to grasp the hand.

2) Indurative: The skin becomes hardened and tight which does not allow skin folds.

3) Atrophic: The skin atrophies with areas of hyperpigmentation. There are also losses of the folds of the forehead, of the external angles of the eyes, of the malar region and the nasal bridge.

The symptoms of Scleroderma vary considerably from person to person, and its effects can be from very mild to life-threatening. This disease begins with the Raynaud phenomenon. Normally, SS has the following symptoms: thickening and hardening of the skin and internal organs, vascular abnormalities, and abnormalities of the immune system. Additional symptoms might include:

  • the loss of hair
  • Calcium deposits
  • Blood vessels being dilated underneath the skin
  • Pain of the joints
  • Dry cough
  • Short of breath
  • Constipation
  • Diarrhea

When not being able to establish the causes of the disease it is difficult to find a solution. However, the treatments for this disease are aimed at helping with some symptoms. In this regard, Scleroderma Foundation indicates that for example, heartburn can be controlled by medications called Proton Pump Inhibitors (PPI’s) or medicine to improve the bowel motion.

Amyotrophic Lateral Sclerosis (ALS)

ALS is a neuromuscular disease that consists of a gradual decrease in the functions of the motor neurons until they die, which causes progressive muscle paralysis. It is characterized by the progressive degeneration of nerve cells in the brain, brainstem, and spinal cord. The main result of the disease is the loss of the ability to control voluntary movements. In the end, ALS can lead to respiratory failure because the person loses the ability to control the muscles of the chest and diaphragm.

Among the first signs of this type of MS are muscle weakness, clumsy hand movements and difficulty performing delicate tasks. The muscle weakness might lead to tripping and falling. Additionally, some people have trouble swallowing and speech may be slowed. The causes of this disease are unknown, NORD mentions that some possible factor that might cause this illness include virus infection, an abnormal immune response, and toxic exposure to certain minerals.

Lichen sclerosis

Lichen Sclerosis consists of the inflammation of the tissues and its subsequent atrophy. It is considered a rare disease and mainly affects the genital and anal areas, but also arms, torsos, and sinuses. It mainly affects adult women after menopause. Although there is no cure, there are treatments to control the symptoms. In this regard, the Mayo Clinic indicates that an overactive immune system or an imbalance of hormones may play a role in this sclerosis. Previous skin damage at an area may increase the likelihood of suffering Lichen Sclerosis in that area. Among the main symptoms are white spots, skin thinning, wrinkled skin, skin tears easily and itching.

Multiple Sclerosis

Multiple sclerosis (MS) is a chronic neuroimmunologic disorder of the central nervous system involving the brain, spinal cord, and optic nerves. The disease begins with lesions in the myelin sheath, material that covers and protects the nerve cells. When the sheath is damaged, scars are created, and the tissues harden. These lesions slow down or block messages between the brain and the body. NORD notes that patients with the disease may have attacks (relapses or exacerbations) or have a gradual (progressive) deterioration or become stable. The variability and location of the damage also cause many neurological symptoms, which may vary from one person to another.

There is no certainty about the causes of the disease. However, the American Academy of Family Physicians (AAFP) points out that it can be a combination of environmental, viral and genetic factors. Multiple Sclerosis is also indicated that it may be an autoimmune disease. There are several types of this disease, among the main stand out, Relapsing-Remitting Multiple Sclerosis (RRMS) and Secondary Progressive Multiple Sclerosis (SPMS).

Multiple Sclerosis

Multiple Sclerosis symptoms vary depending on each patient evolution, the type of MS and the ability of the organism to recover. There are several types of Multiple Sclerosis.

Relapsing-Remitting Multiple Sclerosis (RRMS)

This type of MS occurs in about 85% of patients. It is estimated that the first signs of the disease appear around the age of 20. Relapsing-Remitting Multiple Sclerosis is characterized by attacks of symptoms, called relapses, from time to time followed by recovery time, called remission, that could last for years. The nerves that are affected, the intensity of the attacks, the degree of recovery and the time between relapses depends on each person. People suffering from relapsing-remitting MS tend to have a later secondary progressive phase of MS.

Primary Progressive Multiple Sclerosis (PPMS)

PPMS gradually gets worse over time. It is indicated that there are no clearly defined symptoms attacks and virtually no recovery. It is estimated that about 10% of people with MS suffer from this type. Some differences of this type concerning others types are:

  • People with primary progressive MS are usually older when they’re diagnosed. The average age when people are diagnosed is 40 years old.
  • It affects men and women roughly in equal percentages.
  • It usually leads to disability earlier than the most common type, relapsing-remitting MS.

Secondary Progressive Multiple Sclerosis (SPMS)

Patients who have RRMS for a long time usually move to an SPMS type. Symptoms begin without relapse, and changes occur between 10 and 20 years after RRMS has been diagnosed. There is no a certainty on the reason on why it changes from RRMS to SPMS. However, the investigations reflect that the older the person is when first diagnosed, the shorter the time it has before the disease becomes secondary progressive. This because people who don’t fully recover from relapses, generally move to SPMS sooner. Additionally, the ongoing nerve damage changes, there is less inflammation and more of a slow decline in the nerve function.

Progressive-Relapsing MS (PRMS).

Although it is a disease of little frequency (around 5%), it is characterized by a steadily worsening of the disease, with acute relapses but no remissions, it can be with or without recovery. ALS and PRMS are neurodegenerative diseases; both are usually confused and think that they are the same disease. They are several distinct differences between them.

One of the main differences is that in the case of Progressive-Relapsing MS the damage is caused in the protective myelin sheath of neurons and that causes the decrease or absence of the nerve impulse. On the contrary, the damage of the ALS is concentrated in the motor neurons which are gradually dying causing the healing process.

The symptoms identified in PRMS are visual disturbances, balance problems, speech problems, tremors or handshaking, muscle weakness in arms or legs, and loss of muscle strength. Other symptoms that occur are cognitive impairments in memory, encoding and retrieval of information, and emotional problems such as anxiety and depression. On the other hand, in the case of ALS, the symptoms are confined to motor symptoms, as voluntary muscle actions becoming affected, weakness in arms and legs and speech difficulties and trouble swallowing. Another difference is in the severity of the disease, while a patient with MS can live many years with a good quality of life, while an ALS patient only 1 of four patients live more than five years after diagnosis. MS and ALS affect gender differently. In effect, MS mainly affects women between the ages of 20 and 40, and in its progressive primary form, it mainly affects men between the ages of 50 and 60 years. On the contrary, ALS mainly affects men (in a ratio of 3 to 1) to men between 40 and 70 years old.

Multiple Sclerosis Symptoms

The early symptoms of MS are a Blurred or double vision, Thinking problems, Clumsiness or a lack of coordination, Loss of balance, Numbness, Tingling, Weakness in an arm or leg, Spasticity. After the initial symptoms, the main symptoms affecting patients with MS are:

Bladder: MS damages the nerves that send messages to the different muscles, which makes them more difficult to control. One of the most common ones is the bladder, which with the right approach it can be taken care. The most common bladder problems are:

  • Urinary urgency: refers to the need to urinate frequently and urgently, having an intense sensation of urinating.
  • Incontinence: It is the loss of bladder control. MS interrupts nerve signals that affect the movement of urine when it is not the time indicated in such a way that the patient is not able to control urinary movement.
  • Nocturia refers to an unusual frequency to urinate during the night shift.
  • Urinary Hesitancy: refers to the difficulty to urinate.

Spasticity: It is defined as a condition in which determinate muscles are contracted continuously, causing stiffness or tightness that can interfere with normal movement. Spasticity is caused by damage to the portion of the brain or spinal cord that controls voluntary movement. The damage affects the communication system between the nervous system and the muscles creating greater muscular activity. It is estimated that 80% of patients with MS are affected by this symptom.

Depression: Due to the discomfort caused by MS to patients, they are vulnerable to depression. MS can destroy the protective layer around the nerves that facilitate the sending of signals to the brain that affect the mood of the patient. A patient with depression may also experience trouble concentrating, uncontrollable crying, hard time making decisions, urge to sleep a lot, trouble falling or staying asleep at night, aches and pains you can’t explain, upset stomach and digestive problems, low sex drive or other sexual problems, headache, change in appetite that causes weight loss or gains.

Fatigue: It is defined as a daily lack of energy, or unusual or excessive body tiredness not relieved by sleep. The fatigue can be acute or chronic.

Vision Loss: The disease causes inflammation of the optic nerve (which connects the eye to the brain). It is estimated that half of the people with MS have suffered more than once from this symptom.

Dysesther: MS causes several pains and one of the most intensive and acute is the Dysesthesia. According to Medical News Today, Dysesthesia is when a person experiences painful, itchy, burning or restrictive sensation. Normally, is caused by nerve damage and associated with neurological conditions. When MS breaks the protective covering of the nerves, it interrupts the communication system between the brain and the rest of the body, in such a way that the brain does not correctly interpret what is happening in the rest of the body.

Additionally, MS patients may suffer:

  • Trouble with coordination and balance.
  • Issues with vision, ranging from mild to severe.
  • Weakening of the muscles causing tremors
  • Numbness or complete weakness of parts of your body
  • Lack of bowel control
  • Tingling and numbing sensations
  • Feeling as though you have been electrocuted when you move suddenly

Multiple Sclerosis Treatments

Multiple Sclerosis treatments have an eminently preventive character since the disease has not yet been found a remedy. The different treatments have as the main purpose to accelerate the recovery after the exacerbations, in pausing the advance of the disease and in treating the different symptoms. According to NORD, the main medications are antispasmodics to treat spasmodic pain and anticonvulsants or antidepressants for neurogenic pain. To determine the appropriate treatment for each patient, it is necessary to consider mainly the type of MS, the side effects, and profile of the patient. This involves establishing a diagnosis during the outbreak, which refers to the onset of symptoms or some neurological dysfunction. An effective diagnosis will allow the ideal treatment for the patient. Among the treatments that are available to treat attacks or exacerbations are:

Corticosteroids: They are any of the steroids hormones made by the outer portion of the adrenal gland. The two sets of these hormones are the glucocorticoids that are produced in reaction to stress and help in the metabolism of fat, carbohydrates and proteins, and the mineralocorticoids, that regulate the balance of salt and water within the body. It is intended to reduce inflammation of the nerves, although it can have side effects: insomnia, increased blood pressure, fluid retention, etc.

Plasma exchange (plasmapheresis) which is the process of replacing the plasma in a person’s blood. It is used mainly when the symptoms are new and acute, and the patient does not respond positively to steroids.

Among the treatments to delay the progression of the disease, especially in the case of PPMS, ocrelizumab is the only medicine approved as a disease-modifying therapy. Its main property is that it decreases the worsening of the patient’s disability.

Several rehabilitative treatments seek to treat some of the symptoms and that seek to improve the quality of life of the patient, Physiotherapy, Psychology, Neuropsychology, and Occupational therapy among several others. Also specific treatments to treat the different symptoms as bladder, depression, and dysesthesia. As a complement to traditional treatments, it is common to use alternative treatments to control some symptoms, such as fatigue and pain. Some of these treatments include exercise, yoga, and acupuncture. Natural medicine is also used to treat some symptoms including the use of cannabis which is recommended by the American Academy of Neurology (AAN) for the treatment of MS.

The main purpose of drugs is to pause the progressivity of the disease or to control periods of attacks. In this sense, the earlier the diagnosis is made, and the drugs are used, the more effective they will be. Currently, some drugs modify the disease approved by the US Food and Drugs Administration (FDA) mainly to treat RRMS and PPMS, and one of them is also used for SPMS. None of the medications prevents recurrent symptoms such as fatigue or numbness. Beta interferons are used to treat the RRMS type, glatiramer acetate can help block to avoid attacks on the immune system of myelin; fingolimod Reduce the rate of falls; teriflunomide helps to reduce the rate of falls; dimethyl fumarate helps to reduce the rate of falls; Mitoxantrone is a chemotherapeutic agent used to reduce neurologic disability and the frequency of clinical exacerbations; And Natalizumab, whose purpose is to barricade the movement of potentially harmful immune cells from the bloodstream and to the brain and spinal cord.

Cannabinoids

The CBD or Cannabinoids is one of the components found in cannabis. CBD does not have psychoactive properties; this means that contrary to Tetrahydrocannabinoids (THC) it has no hallucinogenic effects. CBD is valued for its medicinal properties. According to studies, the fact that CBD is non-psychoactive, patients would prefer this option who are seeking help from symptoms such as inflammation, anxiety, pain, seizures and spasms among others. CBD can also be found in the hemp plant but in smaller proportions which makes the CBD of cannabis more effective.

The properties of CBD make it be demanded as an ingredient in therapeutic treatments. The medicinal properties of CBD are based primarily on its ability to influence the central nervous system and other parts of the body. Its importance is that when it interacts with the body’s cannabinoid receptors, it activates and stimulates the body’s natural response to pain and other body conditions. CBD causes the nervous system to reduce inflammation and ignore pain. These properties of the CBD causes it to influence conditions such as mood, memory, motor control, immune function, reproduction, pain perception, appetite, sleep, bone development.

CBD and THC are the main components of cannabis, due to the hallucinatory effects of cannabis, cannabis is not allowed in many places. This prohibition did not allow analysis and investigation of the CBD until recently, where already scientific studies show the properties, mainly medicinal CBD what differentiates it from its “relative” THC. Thus, a CBD acceptance process has been taking place as a mainly medicinal ingredient; it is already used as an ingredient in other industries such as the cosmetic industry, which stimulates the production of cannabis for medicinal purposes. The qualities of the CBO have caused governments to evaluate the legalization of cannabis commercialization.

The British Journal of Clinical Pharmacology published an article that synthesizes the main medicinal properties of the CBD. The article states that:

CBD acts in some experimental model as an anti-inflammatory, anticonvulsant, anti-oxidant, anti-emetic, anxiolytic and antipsychotic agent, therefore, CBD is a potential medicine for the treatment of several diseases such as neuroinflammation diseases, epilepsy, oxidative injury, vomiting and nausea, anxiety and schizophrenia

Based on the properties already indicated, CBD is commonly recommended in the relief of certain diseases: arthritis, alcoholism, multiple sclerosis, schizophrenia, chronic pain, post traumatic stress disorder, depression, epilepsy, including numerous neurological disorders. Also, CBD has a neutralizing effect of THC which helps in some detoxifying treatments as well as in memory loss and paranoia.

According to research, CBD has properties that allow it to protect nerve cells from degenerative diseases such as MS. This characteristic of CBD scientists have called it “neuroprotective effect” and is one of the aspects where scientists expect positive results from the cannabinoid. The American Academy of Neurology (AAN), after having reviewed a series of studies that “met AAN quality standards” and that “were produced with the highest quality,” concluded that there is evidence that demonstrates the efficacy of marijuana (CBD) for the treatment of various symptoms of MS. According to the studies, CBD can help spasticity, which is a chronic muscular tension that causes muscular rigidity.

Additionally, the AAN states that there is evidence that OCE pills (Oral cannabis extract, made from CBD or a mixture of BD and THC) can help: reduce central pain in the case of patients with spasticity in the short term as well as with symptoms of “pins and needles,” and numbness. Other studies show that CBD is also effective in reducing spasms and helps you fall asleep (which are symptoms that characterize MS).

CBD In Multiple Sclerosis treatment

The first type of CBD is derived from the plant of origin, in such a way that there are two types of CBD: the CBD derived from cannabis and the one that originates from the hemp plant. The High Times states that the buds of the cannabis plant have a richer and wider complement of cannabinoids compared to hemp leaves. CBD-DOCS expands on that statement by defining three types of cannabinoids:

  • Synthetic cannabinoids: They are made in the laboratory. They have diluted and inconsistent effects compared to the natural phytocannabinoids and endocannabinoids. According to National Institute on Drug Abuse (NIH), They are artificial chemicals that alter the mind and combine with dry material to be smoked.
  • The endocannabinoids: They are endogenous chemical products of natural origin in the body that have effects like those of the cannabinoids of the plant. The European Organization, Fundación Canna, refers to them as natural endogenous ligands produced by a human and animal organism that join the cannabinoid receptors. The endocannabinoid system is made up by endocannabinoids and cannabinoid receptors; this system is involved in a large variety of physiological processes such as the control of the neurotransmitters release the pain perception, and cardiovascular, gastrointestinal and liver functions.
  • Phytocannabinoids: They are the cannabinoids that are produced in the natural plant either from marijuana or hemp. Fundación Canna refers to them as the kind of compounds characterized by 21 carbon atoms that are only shown in nature in the plant Cannabis Sativa. There are around 70 phytocannabinoids that have been found, including their acidic and neutral forms, analogous and other transformation. The cannabis plant can synthesize the phytocannabinoids directly in their non-psychoactive form.

The use of CBD in MS treatments is still under investigation. However, studies have already been done that show the effectiveness of CBD in the relief of MS symptoms. In this regard, the Alpha-Cat Organization indicates that the use of CBD as one of the two active ingredients (together with THC) in Sativex, a drug used in patients with Multiple Sclerosis. Sativex has been authorized in the United Kingdom since 2011 and is used in the treatment of Multiple Sclerosis for symptom improvement in adult patients with moderate to severe spasticity that has not responded adequately to other medications, and that demonstrated clinically significant improvement ins spasticity related symptoms during an initial trial of therapy.

Another relatively recent study shows that CBD may also be effective in controlling symptoms of MS. The study was conducted to investigate the efficacy of a new formulation of pure and purified cannabidiol (CBD) (> 98%), the main non-psychotropic cannabinoid Cannabis sativa, as a topical treatment in an experimental model of autoimmune encephalomyelitis (EAE). It was evaluated whether the administration of a 1% topical CBD cream, administered at the time of the onset of the symptomatic disease, could affect the progression of EAE and if this treatment could also recover the paralysis of the hind limbs, eligible topical CBD for the symptomatic treatment of MS. The results showed that CBD could be introduced in the clinical management of MS and its associated symptoms in association with current conventional therapy.

CBD has also been gaining importance as an ingredient in medications that alleviate some conditions in such a way that CBD is used as a secondary ingredient in analgesic, antidepressant, anti-inflammatory, etc. These conditions, which are not directly in the symptoms of MS, show the contribution of CBD in MS relief.

The Sensi Seed program describes five major benefits of CBD in the treatment of MS.

  • Anti-inflammatory: The main characteristic of the MS is the inflammation of the neural tissue. MS being an autoimmune disease, the body’s own immune cells attack the cells of the central nervous system, affecting the myelin sheaths that protect the nerves. This disease causes “loss of motor control, muscle weakness, and spasms, unstable mood, and fatigue.” In this sense, the property of CBD has been demonstrated and indicated as an anti-inflammatory. The organization concludes that research has shown that CB1-receptor exert a neuroprotective effect in individuals suffering from MS by reducing the immune response and therefore reducing inflammation.
  • Analgesic: Pain is another of the most common symptoms of MS. The pain is the result of inflammation or neural tissue or because of muscle spasms and spasticity that exert pressure on the musculoskeletal system. Studies have shown the properties of CBD to relieve pain associated with MS. Indeed, a cannabis-based medicine in the form of spray was demonstrated to be significantly more effective than placebo at reducing pain and sleep disorders in MS patients.
  • Antispasmodic: According to Sensi seed, 80% of MS patients suffer from sudden muscle spasms, defined as involuntary contractions of one or more muscles. It is estimated that CBD reduces the frequency of muscle spasms and the severity of muscle spasticity.
  • Antidepressant: It is estimated that up to 50% of patients with MS suffer from this symptom. Although there are no conclusive studies, Sensi seed cites a study conducted in the United Kingdom where patients expressed that CBD improved their depression symptoms.
  • Abdominal discomfort: The Sensi seed organization report shows that CBD can help reduce gastrointestinal problems. According to study, Cannabis has been associated with gastrointestinal dysfunction. It is believed that the effects cannabinoids on the receptors in the peripheral nervous system that controls gastrointestinal functions are due to the CB2 Receptors.

It is important to highlight that still the investigations on the properties of the CBD and its possible help in the treatment Relief of the symptoms of the MS are beginning, so it is expected, that with the process of deregulation of the cannabis, positive results will be seen in the future for the benefit of MS patients given their therapeutic properties.

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