What is Multiple Sclerosis?
Multiple sclerosis (hereinafter also “MS”) is a chronic autoimmune disease that affects the Central Nervous System (brain and spinal cord), the symptoms of which can affect the entire body. Its pathophysiology consists of an alteration of the Immune System, which attacks the nerve fibers causing an inflammatory outbreak that damages the myelin sheaths, the structures that cover and protect the neurons. As a result, the nerve impulses are altered, causing symptoms that depend on the affected part and the degree and frequency of the outbreaks, which can last for days, weeks or months; when an outbreak disappears, the symptoms usually improve gradually until a recovery can be complete or partial. Multiple Sclerosis can be of different types and also affect each person in a different way, for this reason it is known as “the disease of a thousand faces”. It is not a fatal disease (although it slightly reduces life expectancy) and it is not considered hereditary, although genetic factors influence its possible appearance, along with environmental risk factors such as infections, nutritional imbalances (vitamin D) and lifestyle (stress and rest). Diagnosis is most common between the ages of 20 and 40 and affects more women and populations with colder climates. Worldwide, around 2.5 million people suffer from multiple sclerosis, 770,000 of whom are in Europe and 55,000 in Spain. According to the Spanish Society of Neurology, MS is the second cause of disability among young people (after trauma caused by car accidents).Types of Multiple Sclerosis
- Clinically Isolated Syndrome : This consists of a first episode of inflammation and demyelination (i.e. affecting nerve fibres), with partial or complete recovery. It does not allow the diagnosis of MS to be established on its own.
- Relapsing-Remitting Multiple Sclerosis (RRMS) : accounts for 85% of diagnoses and consists of recurrent and unpredictable flare-ups lasting days or weeks with complete or near-complete recovery. In general, there is no significant progression of the disease.
- Secondary Progressive Multiple Sclerosis (SPMS) : More than half of people with RRMS develop SPMS, characterized by a progressive worsening of the disease alternating between phases of stability and relapses without recovery.
- Primary Progressive Multiple Sclerosis (PPMS) : represents 15% of diagnoses and is characterized by a progressive worsening that progresses gradually over time without relapses or recovery.
Symptoms of Multiple Sclerosis
Symptoms of different types and intensities may occur in each person.- Tremors: Postural tremors or tremors when using the extremities may occur.
- Ataxia: difficulty coordinating movements (especially fine ones)
- Problems with mobility, balance and muscle spasticity
- Changes in the way of speaking (not in the content): tone, rhythm and speed
- Difficulty swallowing
- General fatigue, dizziness and muscle weakness
- Alteration of sensitivity and tactile perception: numbness, tingling, burning
- Neuropathic and muscular pain
- Cognitive disorders: especially short-term memory, attention and concentration disorders
- Psychological and emotional disorders
- Sleep disorders
- Vision disorders: blurred or double vision, partial loss, involuntary eye movements and optic neuritis
- Bowel and bladder problems
- Sexuality problems
Diagnosis and Treatment for Multiple Sclerosis
Due to the high variability between people, the diagnosis is not so simple and is made through a neurological examination (including MRI) and an eye examination. There is currently no treatment to cure MS and those prescribed are intended to delay or stop the progression of the disease, relieve symptoms and improve quality of life. However, the drugs used are ineffective in almost half of patients, in addition to causing unwanted side effects. For this reason, drug treatment is often combined with physiotherapy sessions, physical and cognitive rehabilitation, psychological support, and changes in diet and lifestyle. (1)(2) (3) (4)(8)Multiple Sclerosis and Cannabis
Historically, anecdotal evidence has shown an improvement in a wide range of symptoms in MS patients using Cannabis and discoveries about the Endocannabinoid System (physiological system dedicated to maintaining the balance of the body) have shown that its main components are related to the pathophysiological mechanisms of MS, revealing its great potential both for symptomatic relief and for slowing down the disease. For this reason, several countries have recently approved a cannabinoid-based drug (THC and CBD) for the treatment of MS spasticity, Sativex, whose efficacy and safety have been confirmed in different clinical trials. However, in Spain, Sativex is still not eligible as a first-line drug and its prescription remains very complicated. In addition, it is an alcohol-based product for sublingual application, so it can cause problems in the mouth in the long term. (4)(5) (6) (7) (8) (9) Literature:- https://medlineplus.gov/spanish/ency/article/000737.htm
- https://esclerosismultiple.com/esclerosis-multiple/
- https://www.fundacion-canna.es/cannabis-y-esclerosis-multiple
- Oreja-Guevara C. Treatment of spasticity in multiple sclerosis: new perspectives with the use of cannabinoids. Rev Neurol. 2012;55:421—30.
- NovotnaA,MaresJ,RatcliffeS,NovakovaI,VachovaM, Zapletalova O,etal.,SativexSpasticityStudyGroup.A randomized, double-blind, placebo-controlled, parallel-group, enriched-design study ofnabiximols(Sativex ® ), asadd-ontherapy,insubjectswithrefractoryspasticitycausedbymultiple sclerosis. EurJNeurol.2011;18:1122—31
- Lorente Fernández, L., Monte Boquet, E., Pérez-Miralles, F., Gil Gómez, I., Escutia Roig, M., Boscá Blasco, I., Poveda Andrés, J. L., & Casanova-Estruch, B. (2014). Clinical experiences with cannabinoids in spasticity management in multiple sclerosis. Neurology (Barcelona, Spain), 29(5), 257–260. https://linkinghub.elsevier.com/retrieve/pii/S0213485313001606
- Mecha M, Carrillo-Salinas FJ, Feliú A, Mestre L and Guaza C (2020) Perspectives on
- Cannabis-Based Therapy of Multiple Sclerosis: A Mini-Review. Front. Cell. Neurosci. 14:34.
- doi: 10.3389/fncel.2020.00034
