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Cannabis Sativa L. Is a Herbaceous Plant in the Cannabis Genus, A

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Cannabis Sativa L. Is a Herbaceous Plant in the Cannabis Genus, A Modern Phytomorphology 8: 65–70, 2015 APPLICatION OF MEDICAL CANNABIS IN PatIENTS WITH CENTral NERVE SYSTEM DISORDERS Lidia Kotuła, Alicja Petniak, Ewa Kołodziej, Magdalena Amarowicz, Marcin Urbańczuk, Katarzyna Schab, Paulina Gil-Kulik, Jolanta Karwat, Jarosław Kotuła, Paulina Mulawka, Dominika Mulawka, Janusz Kocki Abstract. Cannabis sativa is an annual plant in the Cannabaceae family, species of the genus Cannabis. Cannabis contains active elements, including Δ9-tetrahydrocanabinol (THC) and cannabidiol (CBD). Neurological disorders are typically associated with neurodegeneration. It means that there is no causal treatment. Usually we can only modulate disease. It is very necessary to patients to reduce pain sensation or excessive muscle tension. The paper contains a description of therapeutic possibilities treatment of cannabis in neurological disorders such as Alzheimer’s disease, multiple sclerosis, Tourette syndrome and spasticity. Key words: Cannabis sativa, cannabis, Alzheimer’s disease, multiple sclerosis, Tourette’s syndrome, dystonia Department of Clinical Genetics, Medical University of Lublin (Zakład Genetyki Klinicznej UM w Lublinie), ul. Radziwiłłowska 11, 20-080 Lublin, Poland; [email protected] Cannabis sativa L. is a herbaceous plant the main ingredient, but other substances – in the Cannabis genus, a species of the such as CBD – can also have an active effect. Cannabaceae family. Other names for cannabis The composition determines both: the effects are marijuana or weed. Each part of the plant and the side effects of the cannabis. Three types is harvested differently, depending on the of medicinal cannabis are available through purpose of usage. Its seeds are used to make pharmacies: Sativex, Bedrocan, Bedrobinol and hempseed oil (for cooking, lamps or paints), Bediol. They have different composition and bird feed. The flowers (and the leaves, stems, strength varies. and seeds) contain psychoactive chemical compounds known as cannabinoids that can Types of cannabinoid receptors be use for medicinal, recreational, and spiritual purposes. Historically, C. sativa has been used The body’s own cannabinoid system has as hallucinogenic, hypnotic, sedative, analgesic, been identified El-Alfy( et al. 2010). The and anti-inflammatory agent. Nowadaysdiscovery of this system, which comprises cannabis is used as a recreational or medicinal endocannabinoids: anandamid (AEA), drug, and as part of religious rites. Modern 2-arachidonoiloglicerol (2-AG) and receptors, cannabis has been subject to legal restrictions, confirmed that cannabis has a positive currently illegal in most countries of the world. effect on certain illnesses and conditions Medical marijuana can be use in Europe (Great (Bisogno et al. 2005). Endocannabinoids Britain, the Netherlands, Spain and Belgium). (anandamid) and cannabinoids are also found Cannabis contains more than 85 active at the intersection of the body’s various systems, elements, including Δ9-tetrahydrocanabinol allowing communication and coordination (THC), cannabidiol (CBD), Cannabigerols between different cell types. (CBG), Cannabichromenes (CBC), In human body two types of cannabinoid Cannabinol (CBN) and Cannabinodiol receptors have been identified: CB1 and CB2 (CBDL) (El-Alfy et al. 2010). THC is usually receptors (Howlett et al. 2002). The first type © The Author(s), 2015 66 Modern Phytomorphology 8 (2015) CB1 is mostly found in the central nervous involves the parts of the brain that control system (CNS), connective tissues, gonads, thought, memory and language. People with glands, and organs. In CNS it takes a role in AD may have trouble remembering things modulating pain. It also has an anti-emetic effect, that happened recently or names of people and has influence on the memory and the motor they know- mild cognitive impairment (MCI). system (Pacher et al. 2006). The second type of Patients with Alzheimer’s are also likely to receptors CB2 is peripheral, and it is primarily experience depression, agitation and appetite found in immune system cells (in the spleen in loss, among other symptoms. There are no particular) (Pacher & Mechoulam 2001). approved treatments or medications which Probably it is responsible for the can be available to stop the progression of immunomodulatory effects of cannabinoids. AD. A review of the recent scientific literature Endocannabinoids and cannabinoids are indicates that cannabinoid therapy may provide also found at the intersection of the body’s symptomatic relief to patients afflicted with AD various systems, allowing communication and while also may moderate the progression of the coordination between different cell types. They disease (Pazos et al. 2004). Investigators from are synthesized on-demand from cell membrane The Scripps Research Institute in California in arachidonic acid derivatives, have a local effect 2006 reported that THC inhibits the enzyme and short half-life before being degraded by the responsible for the aggregation of amyloid enzymes fatty acid amide hydrolase (FAAH) plaque – the primary marker for Alzheimer’s and monoacylglycerol lipase (MAGL). disease (Eubanks et al. 2006). Preclinical Cannabinoids can be administered by studies have demonstrated that cannabinoids smoking, vaporizing, transdermal patch, oral/ can also prevent cell death by anti-oxidation sublingual or rectal ingestion, and injection. (Hampson et al. 1998). Cannabinoids’ Data currently available shows that medicinal neuroprotective properties could also play cannabis can help to relieve pain and muscle a role in moderating AD. Writing in the spasms/cramps associated with (MS) or spinal September 2007 issue of the British Journal of cord damage, long-term neurogenic pain Pharmacology, investigators at Ireland’s Trinity caused by, nerve damage, phantom limb pain, College Institute of Neuroscience concluded, facial neuralgia or chronic pain following an that cannabinoids offer a multi-faceted attack of shingles, tics associated with Tourette approach for the treatment of Alzheimer’s syndrome, nausea, reduced appetite, weight loss disease by providing neuroprotection and and debilitation associated with cancer or AIDS, reducing neuro-inflammation. Manipulation nausea and vomiting caused by medication or of the cannabinoid pathway offers a radiotherapy for cancer and AIDS. pharmacological approach for the treatment Patients generally tolerate medical cannabis of AD that may be efficacious than current well. Side effects of medicinal cannabis can treatment regimens (Campbell & Gowran be: mood-altering effects, insomnia or heart 2007). palpitations. Other effects are: relaxation, feeling hungry, heightened, sensitivity to the Dystonia perception of colors and music. Also the time reaction may be slower, especially during the Dystonia is a neurological movement first hours after use. disorder characterized by abnormal high muscle tension and involuntary, painful muscle Alzheimer’s disease contractions. It is the third most common movement disorder after Parkinson’s disease Alzheimer’s disease (AD) is a neurological and tremor. CB1 receptors are highly expressed disorder of unknown origin that is characterized in the basal ganglia (a substantia nigra), in the by a progressive loss of memory and learned cerebellum and in the brain regions involved behavior (dementia). It begins slowly. It first in motor control (Hohmann & Herkenham Kotuła L. et al. Application of medical cannabis with central nerve system disorders 67 2000; Moldrich & Wenger 2000). In year These include a pair of randomized, placebo- 2002 case study has been published in the controlled clinical trials demonstrating that July issue of The Journal of Pain and Symptom smoking cannabis reduces neuropathy in Management (Chatterjee et al. 2002). It patients with HIV by more than 30 percent reported reduction symptoms of dystonia after compared to placebo (Abrams et al. 2007). In smoking cannabis in a 42-year-old chronic 2008, double-blind, randomized clinical trial pain patient. Investigators reported that has been reported both high and low doses subject’s subjective pain score was extenuated of inhaled cannabis reduced neuropathic pain from 9 to 0 (on a 0 to 10 visual analog scale) of diverse causes in subjects unresponsive to following cannabis inhalation (48 hours standard pain therapies (Wilsey et al. 2008). observation). In time of experiment patient did In 2009, an international team of investigators not require any conventional analgesics drags. from the United Kingdom, Belgium and A second case study reporting “significant Romania affirmed these preclinical findings clinical improvement” following cannabis in a clinical study of intractable cancer pain inhalation in a single 25-year-old patient patients. They concluded: the THC/CBD with generalized dystonia due to Wilson’s extract showed a more promising efficacy disease. It was documented by an Argentinian profile than the THC extract alone (Johnson research team in the August 2004 issue of the et al. 2009). journal Movement Disorders (Uribe Roca Finally, in 2010, at McGill University et al. 2004). To contrast, in 2002 randomized, improved that, smoked cannabis significantly placebo-controlled study investigating the use reduced pain, improves sleep quality and of the synthetic oral cannabinoid naboline anxiety in participants with refractory pain (Cesamet) in 15 patients afflicted with when conventional therapies had failed (Ware generalized and segmental primary dystonia et al. 2010). A review in 2011 in British Journal did not show a significant
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