Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is a fatal neurodegenerative disorder that is characterized by the selective loss of motor neurons in the spinal cord, brain stem, and motor cortex. An estimated 30,000 Americans are living with ALS, which often arises spontaneously and afflicts otherwise healthy adults. More than half of ALS patients die within 2.5 years following the onset of symptoms.
At present, there is an absence of clinical trials investigating the use of cannabinoids as a disease-modifying therapy for ALS. However, preclinical models indicate that cannabinoids may hold the potential to delay ALS progression, lending support to anecdotal reports by some patients that cannabinoids may be efficacious in moderating the disease’s development and in alleviating certain ALS-related symptoms such as pain, appetite loss, spasticity, depression and drooling.
For example, investigators at the California Pacific Medical Center in San Francisco reported in the journal Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders that the administration of THC both before and after the onset of ALS symptoms staved disease progression and prolonged survival in animals compared to untreated controls. University of Arkansas researchers reported that the administration of the cannabinoid agonist AM-1241 more than doubled survival rates compared to controls. “[T]he magnitude of effect produced by AM-1241 initiated at symptom onset rivals the best yet reported for any pharmaceutical agent, even those given pre-symptomatically,” authors concluded. A study of plant-derived cannabis extracts also documented delayed ALS progression during early stages of the disease.
As a result, some experts are calling for clinical trials to assess the efficacy of cannabinoids in modulating the treatment of ALS progression. Writing in the American Journal of Hospice & Palliative Medicine in 2010, a team of investigators reported, “Based on the currently available scientific data, it is reasonable to think that cannabis might significantly slow the progression of ALS, potentially extending life expectancy and substantially reducing the overall burden of the disease.” They concluded, “There is an overwhelming amount of preclinical and clinical evidence to warrant initiating a multicenter randomized, double-blind, placebo-controlled trial of cannabis as a disease-modifying compound in ALS.” Authors of a 2016 review in the journal Neural Regeneration Research echoed these findings, opining: “[T]here is a valid rationale to propose the use of cannabinoid compounds in the pharmacological management of ALS patients.”
MEDICAL MARIJUANA PATIENT WITH ALS OUTLIVES HER DOCTORS
Published in full in The Examiner.
In April, Cathy Jordan sat on a panel at the Cannabis Therapeutics Conference in Arizona. Before taking the stage, she discussed the medical use of cannabis for ALS with Jahan Marcu, the Philadelphia Medical Marijuana Examiner.
Cathy Jordan first noticed something was wrong in summer of 1985 when she couldn’t pick things up. Her muscles weren’t responding. In 1986, she was diagnosed with ALS (Amyotrophic Lateral Sclerosis). ALS, also known as Lou Gehrig’s disease, is characterized by the death of motor neurons leading to loss of limb control, breathing, swallowing, speech and widespread cellular dysfunction. Most cases of ALS are sporadic; it is not a viral or autoimmune disease.
“Most people start using a feeding tube because they are afraid of choking to death”, says Cathy.
In 1986, she was given 3 – 5 years to live according to her neurologist. Nearly 3 decades later, she is still alive and living with ALS.
“All my docs are retiring or dead. I’ve outlived 5 support groups and 4 neurologists,” said Cathy. This actually posed a problem for Cathy who lost her social security benefits because she lived passed her expiration date. The state of Florida said her ID and regular documentation wasn’t good enough to prove she was alive and to continue to receive benefits. She had to ask her neurologist to fill out paperwork to prove she was still alive.
Mrs. Jordan began using Cannabis from a Florida grower to treat her ALS in the late 80’s. “Donny Clark provided my medicine, grown in the Myakka River Valley…he was busted and sentenced to life in prison, and that strain of Cannabis was lost.”
“You know, they say the fountain of youth is in Florida. Maybe it was something in the soil that made this plant helps me…and I don’t understand why doctors wouldn’t study me. But I still would like to know why this is helping me.”
At first, doctors wouldn’t accept thatcould be responsible for Cathy’s extended life span. Other doctors thought that smoking anything would impair her lung function and even threatened to have this paralyzed women committed, simply based on the fact that she thought Cannabis was actually helping her.
“I visited a neurologist at Duke University. When I told him that I was smoking Cannabis, he didn’t know what to do with me. He was afraid. He wouldn’t even take my blood pressure because I was using an illegal drug.” Cathy adds: “I asked my docs if they would take a drug if it was neuroprotective, an antioxidant and an anti-inflammatory. They say ‘yes’ and ask me if I know of one. Cannabis, I tell them.”
Nearly three decades later, the science has caught up with this miracle patient. Scientists created a mouse with ALS, which was very exciting for Cathy. Research has shown that THC and other cannabinoids can benefit mice with ALS. The mounting evidence of cannabinoids halting the progression of ALS has started to change the attitudes of doctors and prominent researchers have recently called for ALS clinical trials with Cannabis or cannabinoids.
“They all agree today that I should smoke Cannabis,” says Cathy. “Twenty six years later, my original neurologist fought [successfully] to make sure Cannabis is legal for patients in Delaware.”
Researchers think Cannabis may help ALS patients relieving pain, spasticity, drooling, appetite loss and has minimal drug-drug interactions and toxicity.
“There are ALS patients associations that fight for the right of patients to die with dignity. But what about my right to life?” asks Cathy. “Keeping my medicine illegal removes my right to life.”
Neurological Aspects of Medical Use of Cannabidiol.
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.
- Department of Biotechnology and Legal Medicine, University of Palermo, Palermo, Italy.
- Unit of Forensic Toxicology, Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy.
- National Center of Epidemiology, National Institute of Health, Rome, Italy.
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy. Via Consolare Valeria 1, 98125 Messina, Italy.
Cannabidiol (CBD) is among the major secondary metabolites of Cannabis devoid of the delta-9-tetra-hydrocannabinol psychoactive effects. It is a resorcinol-based compound with a broad spectrum of potential therapeutic properties, including neuroprotective effects in numerous pathological conditions. CBD neuroprotection is due to its antioxidant and antiinflammatory activities and the modulation of a large number of brain biological targets (receptors, channels) involved in the development and maintenance of neurodegenerative diseases.
The aim of the present review was to describe the state of art about the pre-clinical research, the potential use and, when existing, the clinical evidence related to CBD in the neurological field.
Collection of all the pre-clinical and clinical findings carried out investigating the effects of CBD alone, not in combination with other substances, in the neurological arena with the exclusion of studies on neuropsychiatric disorders.
Laboratory and clinical studies on the potential role of CBD in Parkinson’s disease (PD), Alzheimer’s disease (AD), multiple sclerosis (MS), Huntington’s disease (HD), amyotrophic lateral sclerosis ALS), cerebral ischemia, were examined.
Pre-clinical evidence largely shows that CBD can produce beneficial effects in AD, PD and MS patients, but its employment for these disorders needs further confirmation from well designed clinical studies. CBD pre-clinical demonstration of antiepileptic activity is supported by recent clinical studies in human epileptic subjects resistant to standard antiepileptic drugs showing its potential use in children and young adults affected by refractory epilepsy. Evidence for use of CBD in PD is still not supported by sufficient data whereas only a few studies including a small number of patients are available.
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[Self-medication with cannabidiol oil in a patient with primary lateral sclerosis].
Many patients with neurological disorders have symptoms which are difficult to treat with conventional medication. In this case report we present a 40-year-old male patient with primary lateral sclerosis who used cannabidiol oil as therapy. We discuss the evidence of the effects of cannabidiol in the treatment of patients with neurological disease, and we raise the question: “Should patients who use illegal cannabis products as self-medication be diagnosed as drug abusers?”
Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials.
- Muscular Dystrophy Association/Amyotrophic Lateral Sclerosis Center, University of Washington Medical Center, Seattle, WA, USA. firstname.lastname@example.org
Significant advances have increased our understanding of the molecular mechanisms of amyotrophic lateral sclerosis (ALS), yet this has not translated into any greatly effective therapies. It appears that a number of abnormal physiological processes occur simultaneously in this devastating disease. Ideally, a multidrug regimen, including glutamate antagonists, antioxidants, a centrally acting anti-inflammatory agent, microglial cell modulators (including tumor necrosis factor alpha [TNF-alpha] inhibitors), an antiapoptotic agent, 1 or more neurotrophic growth factors, and a mitochondrial function-enhancing agent would be required to comprehensively address the known pathophysiology of ALS. Remarkably, cannabis appears to have activity in all of those areas. Preclinical data indicate that cannabis has powerful antioxidative, anti-inflammatory, and neuroprotective effects. In the G93A-SOD1 ALS mouse, this has translated to prolonged neuronal cell survival, delayed onset, and slower progression of the disease. Cannabis also has properties applicable to symptom management of ALS, including analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction. With respect to the treatment of ALS, from both a disease modifying and symptom management viewpoint, clinical trials with cannabis are the next logical step. Based on the currently available scientific data, it is reasonable to think that cannabis might significantly slow the progression of ALS, potentially extending life expectancy and substantially reducing the overall burden of the disease.
 Amtmann et al. 2004. Survey of cannabis use in patients with amyotrophic lateral sclerosis. The American Journal of Hospice and Palliative Care 21: 95-104.
 Raman et al. 2004. Amyotrophic lateral sclerosis: delayed disease progression in mice by treatment with a cannabinoid. Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders 5: 33-39.
 Shoemaker et al., 2007. The CB2 cannabinoid agonist AM-1241 prolongs survival in a transgenic mouse model of amyotrophic lateral sclerosis when initiated at symptom onset. Journal of Neurochemistry 101: 87.
 Moreno-Martet et al. 2014. Changes in endocannabinoid receptors and enzymes in the spinal cord of SOD1(G93A) transgenic mice and evaluation of Sativex-like combination of phytocannabinoids: Interest for future therapies in amyotrophic lateral sclerosis. CNS Neuroscience and Therapeutics 20: 809-815.
 Carter et al. 2010. Cannabis and amyotrophic lateral sclerosis: hypothetical and practical applications, and a call for clinical trials. American Journal of Hospice & Palliative Medicine 27: 347-356.
 Giacoppo and Mazzon. 2016. Can cannabinoids be a potential therapeutic tool in amyotrophic lateral sclerosis?Neural Regeneration Research 11: 1896-1899.