Skip to main content
SpringerLink
Log in

Role of Cannabinoids in Multiple Sclerosis

  • Review Article
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

Although extracts from the cannabis plant have been used medicinally for thousands of years, it is only within the last 2 decades that our understanding of cannabinoid physiology and the provision of evidence for therapeutic benefit of cannabinoids has begun to accumulate. This review provides a background to advances in our understanding of cannabinoid receptors and the endocannabinoid system, and then considers how cannabinoids may help in the management of multiple sclerosis (MS).

The relative paucity of treatments for MS-related symptoms has led to experimentation by patients with MS in a number of areas including the use of cannabis extracts. An increasing amount of evidence is now emerging to confirm anecdotal reports of symptomatic improvement, particularly for muscle stiffness and spasms, neuropathic pain and sleep and bladder disturbance, in patients with MS treated with cannabinoids. Trials evaluating a role in treating other symptoms such as tremor and nystagmus have not demonstrated any beneficial effects of cannabinoids. Safety profiles of cannabinoids seem acceptable, although a slow prolonged period of titration improves tolerability. No serious safety concerns have emerged.

Methodological issues in trial design and treatment delivery are now being addressed. In addition, recent experimental evidence is beginning to suggest an effect of cannabinoids on more fundamental processes important in MS, with evidence of anti-inflammation, encouragement of remyelination and neuroprotection. Trials are currently under way to test whether cannabinoids may have a longer term role in reducing disability and progression in MS, in addition to symptom amelioration, where indications are being established.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II

Similar content being viewed by others

References

  1. Mahlberg PG, Kim ES. Secretory vesicle formation in glandular trichomes of Cannabis sativa L. (Cannabaceae). Am J Bot 1992; 79: 166–73

    Article  Google Scholar 

  2. Work TS, Bergel F, Todd AR. The active principles of Cannabis indica resin: I. Biochem J 1939 Jan; 33(1): 123–7

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Adams R, Pease DC, Cain CK, et al. Conversion of cannabi-diol to a product with marihuana activity: a type reaction for synthesis of analogous substances: conversion of cannabidiol to cannabinol. J Am Chem Soc 1940; 62(8): 2245–6

    Article  CAS  Google Scholar 

  4. Ghosh R, Todd AR, Wilkinson S. Cannabis indica, part IV: the synthesis of some tetrahydrodibenzopyran derivatives. J Chem Soc 1940; 1121-5

  5. Adams R, Baker BR. Structure of cannabinol, V: a second method of synthesis of cannabinol. J Am Chem Soc 1940; 62(9): 2401

    Article  CAS  Google Scholar 

  6. Gaoni Y, Mechoulam R. Isolation, structure and partial synthesis of an active constituent of hashish. J Am Chem Soc 1964; 86: 1646–7

    Article  CAS  Google Scholar 

  7. Mechoulam R, Shvo Y. The structure of cannabidiol. Tetrahedron 1963; 19: 2073–8

    Article  CAS  PubMed  Google Scholar 

  8. Matsuda LA, Lolait SJ, Brownstein MJ, et al. Structure of a cannabinoid receptor and functional expression of the cloned cDNA. Nature 1990; 346: 561–4

    Article  CAS  PubMed  Google Scholar 

  9. Munro S, Thomas KL, Abu-Shaar M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993; 365: 61–5

    Article  CAS  PubMed  Google Scholar 

  10. Ryberg E, Larsson N, Sjogren S, et al. The orphan receptor GPR55 is a novel cannabinoid receptor. Br J Pharmacol 2007; 152: 984–6

    Google Scholar 

  11. Pertwee R. Cannabinoid receptors and pain. Prog Neurobiol 2001;63: 569–611

    Article  CAS  PubMed  Google Scholar 

  12. Begg M, Dale N, Llaudet E, et al. Modulation of the release of endogenous adenosine by cannabinoids in the myenteric plexus-longitudinal muscle preparation of the guineapig ileum. Br J Pharmacol 2002 Dec; 137(8): 1298–304

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Howlett AC, Barth F, Bonner TI, et al. International Union of Pharmacology, XXVII: classification of cannabinoid receptors. Pharmacol Rev 2002; 54: 161–202

    Article  CAS  PubMed  Google Scholar 

  14. Glass M, Faull RL, Dragunow M. Cannabinoid receptors in the human brain: a detailed anatomical and quantitative autoradiographic study in the fetal, neonatal and adult human brain. Neuroscience 1997; 77(2): 299–318

    Article  CAS  PubMed  Google Scholar 

  15. Galiègue S, Mary S, Marchand J, et al. Expression of central and peripheral cannabinoid receptors in human immune tissues and leukocyte subpopulations. Eur J Biochem 1995 Aug 15; 232(1): 54–61

    Article  PubMed  Google Scholar 

  16. Devane WA, Hanus L, Breuer A, et al. Isolation and structure of a brain constituent that binds to the cannabinoid receptor. Science 1992 Dec 18; 258(5090): 1946–9

    Article  CAS  PubMed  Google Scholar 

  17. Mechoulam R, Ben-Shabat S, Hanus L, et al. Identification of an endogenous 2-monoglyceride, present in canine gut, that binds to cannabinoid receptors. Biochem Pharmacol 1995; 50: 83–90

    Article  CAS  PubMed  Google Scholar 

  18. Sugiura T, Kondo S, Sukagawa A, et al. 2-Arachido-noylglycerol: a possible endogenous cannabinoid receptor ligand in brain. Biochem Biophys Res Commun 1995; 215: 89–97

    Article  CAS  PubMed  Google Scholar 

  19. Jhaveri MD, Richardson D, Chapman V. Endocanna-binoid metabolism and uptake: novel targets for neuropathic and inflammatory pain. Br J Pharmacol 2007; 152: 624–32

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bohme GA, Laville M, Ledent C, et al. Enhanced long-term potentiation in mice lacking cannabinoid CB1 receptors. Neuroscience 2000; 95: 5–7

    Article  CAS  PubMed  Google Scholar 

  21. Reibaud M, Obinu MC, Ledent C, et al. Enhancement of memory in cannabinoid CB1 receptor knock-out mice. Eur J Pharmacol 1999; 379: R1–2

    Article  CAS  PubMed  Google Scholar 

  22. Zimmer A, Zimmer AM, Hohmann AG, et al. Increased mortality, hypoactivity, and hypoalgesia in cannabinoid CB1 receptor knockout mice. Proc Natl Acad Sci U S A 1999 May 11; 96(10): 5780–5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Ledent C, Valverde O, Cossu G, et al. Unresponsiveness to cannabinoids and reduced addictive effects of opiates in CB1 receptor knockout mice. Science 1999; 283: 401–4

    Article  CAS  PubMed  Google Scholar 

  24. Di Marzo V, Goparaju SK, Wang L, et al. Leptin-regulated endocannabinoids are involved in maintaining food in take. Nature (London) 2001 Apr 12; 410: 822–5

    Article  Google Scholar 

  25. Louw DF, Yang FW, Sutherland GR. The effect of delta-9-tetrahydrocannabinol on forebrain ischemia in rat. Brain Res 2000 Feb 28; 857(1–2): 183–7

    Article  CAS  PubMed  Google Scholar 

  26. Zhang M, Martin RB, Adler WM, et al. Modulation of cannabinoid receptor activation as a neuroprotective strategy for EAE and stroke. J Neuroimm Pharmacol 2009 Jun; 4(2): 249–59

    Article  Google Scholar 

  27. Maresz K, Pryce G, Ponomarev ED, et al. Direct suppression of CNS autoimmune inflammation via the cannabinoid receptor CB1 on neurons and CB2 on autoreactive T cells. Nat Med 2007 Apr; 13(4): 492–7

    Article  CAS  PubMed  Google Scholar 

  28. Pryce G, Ahmed Z, Hankey DJ, et al. Cannabinoids inhibit neurodegeneration in models of multiple sclerosis. Brain 2003 Oct; 126 (Pt 10): 2191–202

    Article  PubMed  Google Scholar 

  29. Palazuelos J, Aguado T, Pazos MR, et al. Microglial CB2 cannabinoid receptors are neuroprotective in Huntington’s disease excitotoxicity. Brain 2009 Nov; 132 (Pt 11): 3152–64

    Article  PubMed  Google Scholar 

  30. Hampson AJ, Grimaldi M, Axelrod J, et al. Cannabidiol and (−)delta9-tetrahydrocannabinol are neuroprotective antioxidants. Proc Natl Acad Sci U S A 1998; 95: 8268–73

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kreitzer AC, Regehr WG. Retrograde inhibition of presynaptic calcium influx by endogenous cannabinoids at excitatory synapses on to Purkinje cells. Neuron 2001; 29: 717–27

    Article  CAS  PubMed  Google Scholar 

  32. Twitchell W, Brown S, Mackie K. Cannabinoids inhibit N-and P/Q-type calcium channels in cultured rat hippocampal neurons. J Neurophysiol 1997; 78: 43–50

    Article  CAS  PubMed  Google Scholar 

  33. Molina-Holgado E, Vela JM, Arévalo-Martín A, et al. Cannabinoids promote oligodendrocyte progenitor survival: involvement of cannabinoid receptors and phosphatidylinositol-3 kinase/Akt signaling. J Neurosci 2002 Nov 15; 22(22): 9742–53

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Aréevalo-Martén A, Vela JM, Molina-Holgado E, et al. Therapeutic action of cannabinoids in a murine model of multiple sclerosis. J Neurosci 2003 Apr 1; 23(7): 2511–6

    Article  Google Scholar 

  35. van Oosten BW, Killestein J, Mathus-Vliegen EM, et al. Multiple sclerosis following treatment with a cannabinoid receptor-1 antagonist. Mult Scler 2004 Jun; 10(3): 330–1

    Article  PubMed  Google Scholar 

  36. UNODC (United Nations Office on Drugs and Crime). Why should we care about cannabis? [online]. Available from URL: http://www.unodc.org/unodc/en/frontpage/why-should-we-care-about-cannabis.html [Accessed 2010 Oct 10]

  37. Zajicek J, Freeman, Porter B. Multiple sclerosis care: a practical manual. Oxford: Oxford University Press, 2007: 164

    Book  Google Scholar 

  38. Clark AJ, Ware MA, Yazer E, et al. Patterns of cannabis use among patients with multiple sclerosis. Neurology 2004 Jun 8; 62(11): 2098–100

    Article  CAS  PubMed  Google Scholar 

  39. Page SA, Verhoef MJ, Stebbins RA, et al. Cannabis use as described by people with multiple sclerosis. Can J Neurol Sci 2003 Aug; 30(3): 201–5

    Article  CAS  PubMed  Google Scholar 

  40. Baker D, Pryce G. The endocannabinoid system and multiple sclerosis. Curr Pharm Des 2008; 14(23): 2326–36

    Article  CAS  PubMed  Google Scholar 

  41. Hosking RD, Zajicek JP. Therapeutic potential of cannabis in pain medicine. Br J Anaesth 2008 Jul; 101(1): 59–68

    Article  CAS  PubMed  Google Scholar 

  42. Pertwee RG. Emerging strategies for exploiting cannabinoid receptor agonists as medicines. Br J Pharmacol 2009 Feb; 156(3): 397–411

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Medicines and Healthcare products Regulatory Agency. Public assessment report [online]. Available from URL: http://www.mhra.gov.uk/home/groups/par/documents/websiteresources/con084961.pdf [Accessed 2011 Jan 4]

  44. McGilveray IJ. Pharmacokinetics of cannabinoids. Pain Res Manage 2005; 10 Suppl. A: 15A–22A

    Article  Google Scholar 

  45. Huestis MA. Pharmacokinetics and metabolism of the plant cannabinoids, delta9-tetrahydrocannabinol, cannabidiol and cannabinol. Handb Exp Pharmacol 2005; (168): 657-90

  46. McDonald WI, Compston A, Edan G, et al. Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis. Ann Neurol 2001 Jul; 50(1): 121–7

    Article  CAS  PubMed  Google Scholar 

  47. Consroe P, Musty R, Rein J, et al. The perceived effects of smoked cannabis on patients with multiple sclerosis. Eur Neurol 1997; 38(1): 44–8

    Article  CAS  PubMed  Google Scholar 

  48. Heltberg A. A double-blind trial with baclofen (Lioresal) and diazepam in spasticity due to multiple sclerosis. Acta Neurol Scand 1975; 51: 158–66

    PubMed  Google Scholar 

  49. Cartlidge NE, Hudgson P, Weightman D. A comparison of baclofen and diazepam in the treatment of spasticity. J Neurol Sci 1974; 23: 17–24

    Article  CAS  PubMed  Google Scholar 

  50. A double-blind, placebo-controlled trial of tizanidine in the treatment of spasticity caused by multiple sclerosis: United Kingdom Tizanidine Trial Group. Neurology 1994; 44 (11 Suppl. 9): S70-8

  51. Smith C, Birnbaum G, Carter JL, et al. Tizanidine treatment of spasticity caused by multiple sclerosis: results of a doubleblind, placebo-controlled trial. US Tizanidine Study Group. Neurology 1994; 44(11 Suppl. 9): S34–42

    CAS  PubMed  Google Scholar 

  52. Cutter NC, Scott DD, Johnson JC, et al. Gabapentin effect on spasticity in multiple sclerosis: a placebo-controlled, randomized trial. Arch Phys Med Rehabil 2000 Feb; 81(2): 164–9

    Article  CAS  PubMed  Google Scholar 

  53. Petro DJ, Ellenberger Jr C. Treatment of human spasticity with delta 9-tetrahydrocannabinol. J Clin Pharmacol 1981 Aug-Sep; 21(8-9 Suppl. ): 413S–6S

    Article  CAS  PubMed  Google Scholar 

  54. Ungerleider JT, Andyrsiak T, Fairbanks L, et al. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Adv Alcohol Subst Abuse 1987; 7(1): 39–50

    Article  CAS  PubMed  Google Scholar 

  55. Killestein J, Hoogervorst EL, Reif M, et al. Safety, tolerability and efficacy of orally administered cannabinoids in MS. Neurology 2002 May 14; 58(9): 1404–7

    Article  CAS  PubMed  Google Scholar 

  56. Zajicek J, Fox P, Sanders H, et al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): multicentre randomised placebo-controlled trial. Lancet 2003 Nov 8; 362(9395): 1517–26

    Article  CAS  PubMed  Google Scholar 

  57. Zajicek JP, Sanders HP, Wright DE, et al. Cannabinoids in Multiple Sclerosis (CAMS) study: safety and efficacy data for 12 months follow up. J Neurol Neurosurg Psychiatry 2005 Dec; 76(12): 1664–9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Vaney C, Heinzel-Gutenbrunner M, Jobin P, et al. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Mult Scler 2004 Aug; 10(4): 417–24

    Article  CAS  PubMed  Google Scholar 

  59. Zajicek J, Reif M, Schnelle M. Cannabis extract in the treatment of muscle stiffness and other symptoms in multiple sclerosis: results of the MUSEC study [abstract no. P881]. Mult Scler 2009; 15: S274

    Google Scholar 

  60. Wade DT, Makela P, Robson P, et al. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Mult Scler 2004 Aug; 10(4): 434–41

    Article  CAS  PubMed  Google Scholar 

  61. Collin C, Davies P, Mutiboko IK, et al., Sativex Spasticity in MS Study Group. Randomized controlled trial of cannabis-based medicine in spasticity caused by multiple sclerosis. Eur J Neurol 2007 Mar; 14(3): 290–6

    Article  CAS  PubMed  Google Scholar 

  62. Ambler Z, Davies P, Gasperini C, et al. A two-phase study of Sativex in the relief of spasticity due to multiple sclerosis: phase A single-blind response assessment followed by phase B double-blind, randomised, placebo-controlled, parallel-group study [abstract no. P844]. Mult Scler Sep 2009; 15: S258

    Article  Google Scholar 

  63. Wissel J, Haydn T, Müller J, et al. Low dose treatment with the synthetic cannabinoid nabilone significantly reduces spasticity-related pain: a double-blind placebo-controlled cross-over trial. J Neurol 2006 Oct; 253(10): 1337–41

    Article  CAS  PubMed  Google Scholar 

  64. Freeman RM, Adekanmi O, Waterfield MR, et al. The effect of cannabis on urge incontinence in patients with multiple sclerosis: a multicentre, randomised placebo-controlled trial (CAMS-LUTS). Int Urogynecol J Pelvic Floor Dysfunct 2006 Nov; 17(6): 636–41

    Article  CAS  PubMed  Google Scholar 

  65. Fox P, Bain PG, Glickman S, et al. The effect of cannabis on tremor in patients with multiple sclerosis. Neurology 2004 Apr 13; 62(7): 1105–9

    Article  CAS  PubMed  Google Scholar 

  66. Svendsen KB, Jensen TS, Bach FW. Does the cannabinoid dronabinol reduce central pain in multiple sclerosis? A randomised double blind placebo controlled crossover trial. BMJ 2004 Jul 31; 329(7460): 253

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Notcutt W, Price M, Miller R, et al. Initial experiences with medicinal extracts of cannabis for chronic pain: results from 34 ‘N of 1’ studies. Anaesthesia 2004 May; 59(5): 440–52

    Article  PubMed  Google Scholar 

  68. Rog DJ, Nurmikko TJ, Friede T, et al. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 2005 Sep 27; 65(6): 812–9

    Article  PubMed  Google Scholar 

  69. Gross RA, Johnston KC. Levels of evidence: taking neurology to the next level. Neurology 2009; 72: 8–10

    Article  PubMed  Google Scholar 

  70. Wilner AN. Lost in a jungle of evidence: we need a compass. Practice parameters and technology assessments —what they are, what they are not, and why you should care [letter]. Neurology 2009 Oct 20; 73(16): 1337; author reply 1337-8

    PubMed  Google Scholar 

  71. Pincus MM. Lost in a jungle of evidence: we need a compass [letter]. Neurology 2009 Oct 20; 73(16): 1338; author reply 1338-9

    Article  PubMed  Google Scholar 

  72. French J, Gronseth G. Lost in a jungle of evidence: we need a compass. Neurology 2008 Nov 11; 71(20): 1634–8

    Article  PubMed  Google Scholar 

  73. Fowler CJ, Panicker JN, Drake M et al. A UK consensus on the management of the bladder in multiple sclerosis. Postgrad Med J 2009; 85: 552–9

    Article  CAS  PubMed  Google Scholar 

  74. Gajewski JB, Awad SA. Oxybutynin versus propantheline in patients with multiple sclerosis and detrusor hyperreflexia. J Urol 1986 May; 135(5): 966–8

    Article  CAS  PubMed  Google Scholar 

  75. Ethans KD, Nance PW, Bard RJ, et al. Efficacy and safety of tolterodine in people with neurogenic detrusor over-activity. J Spinal Cord Med 2004; 27(3): 214–8

    Article  PubMed  Google Scholar 

  76. Brady CM, DasGupta R, Dalton C, et al. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Mult Scler 2004 Aug; 10(4): 425–33

    Article  CAS  PubMed  Google Scholar 

  77. Koller WC. Pharmacologic trials in the treatment of cerebellar tremor. Arch Neurol 1984 Mar; 41(3): 280–1

    Article  CAS  PubMed  Google Scholar 

  78. Koch M, Mostert J, Heersema D, et al. Tremor in multiple sclerosis. J Neurol 2007 Feb; 254(2): 133–45

    Article  PubMed  PubMed Central  Google Scholar 

  79. Charles PD, Esper GJ, Davis TL, et al. Classification of tremor and update on treatment. Am Fam Physician 1999 Mar 15; 59(6): 1565–72

    CAS  PubMed  Google Scholar 

  80. Striano P, Coppola A, Vacca G, et al. Levetiracetam for cerebellar tremor in multiple sclerosis: an open-label pilot tolerability and efficacy study. J Neurol 2006 Jun; 253(6): 762–6

    Article  PubMed  Google Scholar 

  81. Feys P, D’hooghe M, Nagels G, et al. The effect of levetiracetam on tremor severity and functionality in patients with multiple sclerosis. Mult Scler 2009 Mar; 15(3): 371–8

    Article  CAS  PubMed  Google Scholar 

  82. Meinck HM, Schönle PW, Conrad B. Effect of cannabinoids on spasticity and ataxia in multiple sclerosis. J Neurol 1989 Feb; 236(2): 120–2

    Article  CAS  PubMed  Google Scholar 

  83. Clifford DB. Tetrahydrocannabinol for tremor in multiple sclerosis. Ann Neurol 1983 Jun; 13(6): 669–71

    Article  CAS  PubMed  Google Scholar 

  84. Stahl JS, Rottach KG, Averbuch-Heller L, et al. A pilot study of gabapentin as treatment for acquired nystagmus. Neuroophthalmology 1996 Apr; 16(2): 107–13

    CAS  PubMed  Google Scholar 

  85. Thurtell MJ, Joshi AC, Leone AC, et al. Crossover trial of gabapentin and memantine as treatment for acquired nystagmus. Ann Neurol 2010 May; 67(5): 676–80

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Bandini F, Castello E, Mazzella L, et al. Gabapentin but not vigabatrin is effective in the treatment of acquired nystagmus in multiple sclerosis: how valid is the GABA-ergic hypothesis? J Neurol Neurosurg Psychiatry 2001 Jul; 71(1): 107–10

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  87. Schon F, Hart PE, Hodgson TL, et al. Suppression of pendular nystagmus by smoking cannabis in a patient with multiple sclerosis. Neurology 1999; 53: 2209–10

    Article  CAS  PubMed  Google Scholar 

  88. Zajicek JP, Ingram WM, Vickery J, et al. Patient-orientated longitudinal study of multiple sclerosis in south west England (The South West Impact of Multiple Sclerosis Project, SWIMS) 1: protocol and baseline characteristics of cohort. BMC Neurol 2010 Oct 7; 10: 88

    Article  PubMed  PubMed Central  Google Scholar 

  89. Pöllmann W, Feneberg W. Current management of pain associated with multiple sclerosis. CNS Drugs 2008; 22(4): 291–324

    Article  PubMed  Google Scholar 

  90. Brichetto G, Messmer Uccelli M, Mancardi GL, et al. Symptomatic medication use in multiple sclerosis. Mult Scler 2003 Oct; 9(5): 458–60

    Article  CAS  PubMed  Google Scholar 

  91. Solaro C. Epidemiology and treatment of pain in multiple sclerosis subjects. Neurol Sci 2006 Sep; 27 Suppl. 4: s291–3

    Article  Google Scholar 

  92. Breuer B, Pappagallo M, Knotkova H, et al. A randomized, double-blind, placebo-controlled, two-period, crossover, pilot trial of lamotrigine in patients with central pain due to multiple sclerosis. Clin Ther 2007 Sep; 29(9): 2022–30

    Article  CAS  PubMed  Google Scholar 

  93. Silver M, Blum D, Grainger J, et al. Double-blind, placebo-controlled trial of lamotrigine in combination with other medications for neuropathic pain. J Pain Symptom Manage 2007 Oct; 34(4): 446–54

    Article  CAS  PubMed  Google Scholar 

  94. Solaro C, Brichetto G, Battaglia MA, et al. Antiepileptic medications in multiple sclerosis: adverse effects in a three-year follow-up study. Neurol Sci 2005 Feb; 25(6): 307–10

    Article  CAS  PubMed  Google Scholar 

  95. Solaro C, Uccelli MM, Guglieri P, et al. Gabapentin is effective in treating nocturnal painful spasms in multiple sclerosis. Mult Scler 2000 Jun; 6(3): 192–3

    Article  CAS  PubMed  Google Scholar 

  96. Solaro C, Boehmker M, Tanganelli P. Pregabalin for treating paroxysmal painful symptoms in multiple sclerosis: a pilot study. J Neurol 2009 Oct; 256(10): 1773–4

    Article  PubMed  Google Scholar 

  97. Rossi S, Mataluni G, Codecà C, et al. Effects of levetiracetam on chronic pain in multiple sclerosis: results of a pilot, randomized, placebo-controlled study. Eur J Neurol 2009 Mar; 16(3): 360–6

    Article  CAS  PubMed  Google Scholar 

  98. DMKG Study Group. Misoprostol in the treatment of trigeminal neuralgia associated with multiple sclerosis. J Neurol 2003 May; 250(5): 542–5

    Article  CAS  Google Scholar 

  99. Rog DJ, Nurmikko TJ, Young CA. Oromucosal delta9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clin Ther 2007 Sep; 29(9): 2068–79

    Article  CAS  PubMed  Google Scholar 

  100. Iskedjian M, Bereza B, Gordon A, et al. Meta-analysis of cannabis based treatments for neuropathic and multiple sclerosis-related pain. Curr Med Res Opin 2007 Jan; 23(1): 17–24

    Article  CAS  PubMed  Google Scholar 

  101. Greenberg HS, Werness SA, Pugh JE, et al. Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers. Clin Pharmacol Ther 1994 Mar; 55(3): 324–8

    Article  CAS  PubMed  Google Scholar 

  102. Wade DT, Makela PM, House H, et al. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms in multiple sclerosis. Mult Scler 2006 Oct; 12(5): 639–45

    Article  CAS  PubMed  Google Scholar 

  103. Wang T, Collet JP, Shapiro S, et al. Adverse effects of medical cannabinoids: a systematic review. CMAJ 2008; 178(13): 1669–78

    Article  PubMed  PubMed Central  Google Scholar 

  104. Papathanasopoulos P, Messinis L, Lyros E, et al. Multiple sclerosis, cannabinoids, and cognition. J Neuropsychiatr Clin Neurosci 2008 Dec; 20(1): 36–51

    Article  Google Scholar 

  105. Langdon DW, Thompson AJ, Johnson KP, et al. The psychological effects of cannabis in MS: impact on cognition, pain, mood and fatigue [abstract]. Mult Scler ECTRIMS 2003; 9: S27

    Google Scholar 

  106. Kurzthaler I, Bodner T, Kemmler G, et al. The effect of nabilone on neuropsychological functions related to driving ability: an extended case series. Hum Psychopharmacol 2005; 20: 291–3

    Article  CAS  PubMed  Google Scholar 

  107. Hobart JC, Riazi A, Thompson AJ, et al. Getting the measure of spasticity in multiple sclerosis: the Multiple Sclerosis Spasticity Scale (MSSS-88). Brain 2006 Jan; 129 (Pt 1): 224–34

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

No funding has been provided to prepare this review. There has been no involvement of any funding organisation or sponsor in any of the following: collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. Prof. J.P. Zajicek has previously received consultancy fees from IKF and Bayer-Schering. Dr V. Apostu has no conflicts of interest to declare. No other persons have made any substantial contributions to the work.

Author information

Authors and Affiliations

  1. Clinical Neurology Research Group, Peninsula College of Medicine and Dentistry, Peninsula Medical School, Room N16, ITTC Building 1, Tamar Science Park, 1 Davy Road, Plymouth, PL6 8BX, UK

    John P. Zajicek (Chair Clinical Neuroscience)

  2. Clinical Neurology Research Group, Peninsula Medical School, Plymouth, UK

    Vicentiu I. Apostu

Authors
  1. John P. Zajicek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vicentiu I. Apostu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John P. Zajicek.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Zajicek, J.P., Apostu, V.I. Role of Cannabinoids in Multiple Sclerosis. CNS Drugs 25, 187–201 (2011). https://doi.org/10.2165/11539000-000000000-00000

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/11539000-000000000-00000

Keywords

Search

Navigation