What do Christina Applegate, Anne Romney and Montel Williams have in common? They have all been diagnosed with Multiple Sclerosis (MS). Most people have heard of MS, but not many really know what it is. According to the National MS Society, there are nearly one million Americans and millions of others worldwide who suffer from this debilitating disease.
MS is an autoimmune disease. It has a variety of presentations, but commonly shows up as neurological and musculoskeletal complaints such as numbness or tingling, difficulty with walking, or doing other physical tasks. Depression and fatigue are also associated with MS, but are not diagnostic.
Diagnosing Multiple Sclerosis
So how is MS diagnosed? It is complicated. A neurologist is usually the best person to make the diagnosis by reviewing the patient complaints in conjunction with specific imaging findings in the central nervous system. The criteria for diagnosis include at least two “episodes” spaced apart in time and two or more brain lesions.
Because other diseases such as lupus can have similar presentations, it can be difficult to make an MS diagnosis accurately. There is one condition known as iritis or uveitis, inflammation of a portion of the eye, which is highly associated with MS. Most symptoms are caused by auto-immune destruction of the myelin lining around nerves.
Once diagnosed with MS, there are as many as seven described subtypes of the disease to consider. By far the most common is relapsing-remitting MS (RRMS). Eighty percent of people with MS have RRMS. RRMS has a disease course that alternates between exacerbations that are highly symptomatic spaced between periods of remission without many symptoms.
The other types include slowly-progressive, and a rare, but rapidly-progressive subtype. While the disease itself is not considered fatal, many of those who suffer from MS also have other comorbidities such as hypertension, diabetes and fibromyalgia. Unfortunately, as many as seven to eight percent of those with MS commit suicide due to a combination of the physical ailments and the psychological implications of longterm illness.
There is cause for optimism regarding management of MS. First, there are many medications on the market to help. Some are disease-modifying drugs. They work by modulating the immune response which fuels MS. They can provide amazing results, but carry with them risks including development of certain infections and cancers. There are other ways to help with the disease itself, including physical therapy, massage, acupuncture, dietary changes, and brain stimulation. There are also medications to manage symptoms, but not aimed at altering the course of the disease.
Cannabis plays a unique role in MS care. There is a medication, called Sativex, which is an oral spray developed by GW Pharmaceuticals in the UK. It contains about 50 percent CBD and 50 percent THC and has been shown to help pain and spasticity in MS patients. In the United States, the drug is referred to as Nabiximols and has not yet been approved for use, though trials are underway.
Cannabis as a Treatment Option for MS
Until approval of this medication, MS sufferers who live in a state with legal cannabis may become medical marijuana patients to have access to the cannabinoids needed to help manage their complaints. I see quite a few MS a patients in my private cannabis practice. When they ask if they can treat their disease with cannabis, I try to explain that I view cannabis as a complementary additive to their regimen.
It is intended to help manage symptoms related to their MS, but not to treat the MS per se. Cannabis acts as an anti-spasmodic drug, relaxing muscles to ease stiffness. It also relieves the pain associated with MS because cannabis is a natural anti-inflammatory substance.
Often patients will ask me which cannabis is best to help with MS. Given that Sativex is a 1:1 CBD:THC preparation, I suggest starting with that ratio and altering it based on results. I suggest a baseline, longer-acting product, such as a sublingual drop or oral concentration, as a daily dose after breakfast and dinner. Then I suggest using a rapid acting form factor such as a vape pen or flower to use for breakthrough symptoms. Some patients also use edibles for longer lasting impact. Topical cream, patches and gels, either 1:1 or higher THC, can also be used in conjunction with other products.
Choosing the Right Cannabis for Your MS
Strains such as Harlequin or Canna-Tsu, with higher amounts of CBD native to them, can work without the impairment noted with high-THC strains. Those with the terpene myrcene can be helpful to muscle relaxation, and those with caryophyllene can help with the underlying inflammation of MS. But remember, every human is unique, and each person’s Endocannabinoid System is also unique.
Therefore, it is important to use the guidance of a marijuana practitioner to choose what might be best, because there are many people, especially those who suffer from chronic ailments, who have idiosyncratic responses to any treatment. If a high-THC strain with limonene and pinene helps your MS, then that is the best strain for you.
Of those famous folks I mentioned with MS, Montel Williams is open about his use of cannabinoids to manage his disease. Hopefully, if cannabis is descheduled or even legalized, drugs such as Sativex will become available through mainstream medicine to help the hundred of thousands of patients who are unable to obtain it at this time.