Medical Marijuana and Amyotrophic Lateral Sclerosis (ALS)

ALS is a disease, which affects the nerves that provide motor function to the muscles.  It typically presents in patients age 30-60 and affects the muscles of the limbs.  Patients can complain of muscle weakness, fasciculations and loss of coordination.  If it affects the muscles of the face and neck, patients can experience changes in speech, loss of control of tongue, drooling and drooping of facial muscles.  It typically is progressive and is fatal in 3-5 years.

Treatment options are limited.  There is no cure.  Most treatment centers offer supportive measures and physical therapy.  In this patient, he was using cannabis because he had been losing his appetite and was in constant pain from being wheelchair bound.  It also helped elevate his mood because he has been experiencing periodic episodes of depression.  After 15 minutes of speaking with him, it was clear CANNABIS IMPROVES THE QUALITY OF HIS LIFE and he plans to use it until he succumbs to his illness.  Typically, patients with ALS die from pulmonary infection (muscles of respiration become affected ultimately).

ALS is one of several conditions called ”motor neuron diseases” that are characterized by the degeneration and ultimate death of the nerves that control voluntary muscles.  It is a rapidly progressive, invariably fatal disease.  Motor neurons are located in the brain (upper motor neurons) and the spinal cord (lower motor neurons) and communicate with nerves supplying the voluntary muscles.  As the nerves degenerate, the muscles they supply gradually lose strength, waste away, and ultimately stop working.  When that happens to the nerves controlling the diaphragm and chest wall muscles, patients are no longer able to breathe and die of respiratory failure.  On average, this process can take 3 to 5 years, though an estimated 10% of patients may live with the condition for up to 10 years. 

The earliest symptoms of ALS may include muscle twitching, stiffness, spasms or weakness, or difficulty chewing and swallowing.  These symptoms worsen over time and may involve other muscle groups such as the arms and legs before the diagnosis is made.  The cause of ALS is not known, though the discovery of an abnormality in the gene that controls the production of a powerful antioxidant called “superoxide dismutase 1”, or SOD1,  in some familial forms of the disease was an important step forward in understanding it.  Since SOD1 scavenges free radicals that can damage cells, this suggests that ALS may be caused by damage to nerves from free radicals.  A neurotransmitter called glutamate may also play a role in the development of ALS via a mechanism called “excitotoxicity”.  Patients with ALS have been found to have high levels of glutamate in their spinal fluid, and in laboratory studies, neurons exposed to abnormally high levels of glutamate eventually die, suggesting that elevated glutamate levels may also be involved, as many as yet unknown autoimmune processes.

Conventional treatment of ALS is directed primarily at controlling the symptoms of ALS, including pain, loss of appetite, depression and muscle spasms and spasticity.  Only one prescription drug called riluzole has been approved by the FDA for the treatment of the disease itself and has been somewhat successful in delaying the final failure of the respiratory muscles by several months.  In animal studies and in a number of individual cases of ALS in humans, however, cannabis has been shown to slow the progression of the disease, in some cases dramatically.  Several patients have reported that using cannabis has enabled them to live from five to 15 years after the initial diagnosis was made and is much more successful in controlling the symptoms of ALS than prescription medications.  A survey of ALS patients conducted in 2004 provided additional support for those anecdotal reports.  Although no clinical trials have been conducted in humans on cannabis and ALS, animal studies indicate that the patient reports are likely to be based on real physiological effects.  Researchers at California Pacific Medical Center reported in 2004 that administering THC to mice with a genetic defect predisposing them to ALS delayed the onset of the disease and prolonged survival.  This same study showed that adding THC to cultures of spinal cord neurons significantly reduced damage from oxidative free radicals.  A British research group reported in 2006 that cannabinoids significantly extended survival in SOD1 deficient mice, and commented “…these results show that cannabinoids have significant neuroprotective effects in this model of ALS…”  These studies built on earlier reports published in the Proceedings of the National Academy of Sciences in 1999 indicating that cannabidiol and THC are neuroprotectant antioxidants.

Along with the anecdotal reports of ALS patients, these and other studies are so strongly suggestive of significant benefit from the use of cannabis in ALS that researchers at the University of Washington School of Medicine suggested in a study published in the American Journal of Hospice & Palliative Medicine.

Investigators 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.”

Writing in the March 2004 issue of the journal Amyotrophic Lateral Sclerosis & Other Motor Neuron Disorders, investigators at the California Pacific Medical Center in San Francisco reported 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.  To date, however, no clinical trials have assessed the use of marijuana or any of the plant’s cannabinoids on patients diagnosed with ALS.

Lou Gehrig’s disease is a fatal, progressive 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.  An estimated 70 to 80 percent of patients with ALS die within three to five years following the onset of disease symptoms.

Cannabis therapy may reduce symptoms and prolong survival in patients diagnosed with amyotrophic lateral sclerosis (ALS aka Lou Gehrig’s disease), according to a scientific review published online last week by the American Journal of Hospice & Palliative Medicine.

Investigators at the University of Washington Medical Center in Seattle and Temple University in Pennsylvania reviewed preclinical and anecdotal data indicating that marijuana appears to treat symptoms of ALS as well as moderate the course of the disease.

Authors wrote: “Preclinical data indicate that cannabis has powerful antioxidative, anti-inflammatory, and neuroprotective effects.Cannabis also has properties applicable to symptom management of ALS, including analgesia, muscle relaxation, bronchodilation, saliva reduction, appetite stimulation, and sleep induction.From a pharmacological perspective, cannabis is remarkably safe with realistically no possibility of overdose or frank physical addiction.  There is a valid, logical, scientifically grounded rationale to support the use of cannabis in the pharmacological management of ALS.”

They added, “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.”

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