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Medical marijuana vs cbd oil for parkinson’s disease

Marijuana for Parkinson’s Disease?

Dr. Mohanty is Research Scholar and Dr. Lippmann is Emeritus Professor at the University of Louisville School of Medicine in Louisville, Kentucky.

Abstract

Marijuana is popular in the United States and is being widely legalized for recreational and medicinal purposes. It remains a Schedule 1 substance without fully proven risks and benefits; yet, it is increasingly available in many US states and territories. Cannabis might have medicinal efficacy in Parkinson’s disease as a form of medical marijuana. Endocannabinoid receptors exist throughout the nervous system and are documented to influence receptors affecting a wide variety of areas. Neuroprotective aspects might be induced by cannabis exposure that might yield benefit against the nigrostriatal degeneration of patients with Parkinson’s disease. Animal investigations support suggestions of improvement in bradykinesia and/or tremors, but this is unsubstantiated in human studies. However, some patient surveys and anecdotal or case reports indicate that marijuana attenuates some motor manifestations of parkinsonism and also of non-motor, mood and/or cognitive symptoms. Medical marijuana might benefit motor and nonmotor aspects of Parkinson’s disease patients. Currently, these assertions are not substantiated in human investigations and cannabis can also induce side effects. Until studies clarify the safety and efficacy of pharmacotherapy with cannabis products, medical marijuana remains largely without scientific endorsement. Research has yet to document the full benefits, risks, and clinical applications of marijuana as a treatment for patients with Parkinson’s disease.

Keywords: cannabis, marijuana, medical marijuana, neurology, Parkinson’s disease, parkinsonism, motor symptoms, stiffness, rigidity, bradykinesia, tremor

Cannabis is becoming increasingly popular in the United States. 1 Many states have approved recreational marijuana, and several others allow medical and/or additional usages. 1 Medical marijuana is prescribed for a variety of indications; now, it even has possible application for people with Parkinson’s disease (PD). Cannabis might provide relief at diminishing bradykinesia, stiffness, rigidity, and tremors.

LEGALITY

Marijuana is a Schedule 1 substance, and without definitive proof of efficacy and/or safety, it is not nationally approved for medical indications. However, pharmaceutical marijuana is legal in 29 states, Puerto Rico, Guam, and the District of Columbia. 1 Variations exist within the laws of these states/territories, with some states imposing restrictions on tetrahydrocannabinol (THC) content, while permitting higher concentration cannabidiol (CBD) products. Seventeen states have low-THC, high-CBD laws in effect. 1

MARIJUANA

There are two species of cannabis—sativa and indica—and many types of cannabinoids have been identified. Sativa strains have high quantities of THC, which can produce euphoria, while indica contains more CBD. 2 Both cross the blood brain barrier and can exert neurotropic effects. THC is more psychoactive and is the recreational component of marijuana. Cannabidiol, being less psychoactive, is commonly employed as an analgesic, sedative, anti-emetic, and/or as an appetite stimulant. 2 , 3

NEUROBIOLOGY

Endocannabinoid receptors exist in the brain, particularly at the cortex, cerebellum, basal ganglia, hippocampus, spinal cord, and peripheral nerves. 4 These receptors control muscular movements and appear to confer anti-epileptic, sedative, anxiolytic, anti-psychotic, anti-oxidant, and neuroprotective properties. These receptors might also exhibit anti-emetic, antineoplastic, antidiabetic, anti-inflammatory, and anti-ischemic effects. 5 Cannabidiol binds to cannabinoid-1 (CB1) receptors in the central nervous system (CNS), while CB2 receptors have more influence on the immune system. 6

MECHANISM

Animal research substantiates evidence of anti-oxidant action by THC and CBD, which might provide neuroprotection against progressive degeneration of nigrostriatal dopaminergic neurons in patients with PD. 7 CB receptors upregulate in response to noxious stimuli to mitigate inflammatory damage. In animals, CB1 antagonists lowered bradykinesia, while CB1 agonists reduced tremor; however, these benefits have not been demonstrated in patients who exhibit PD signs and symptoms. 8 However, patient surveys report alleviation of non-motor symptoms, specifically depressed mood, fatigue, and memory impairments. 9 Additionally, there are anecdotal accounts of neurological efficacy at decreasing parkinsonian motor manifestations.

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PHARMACOTHERAPY

Optimum dosing that achieves efficacy while minimizing adverse effects remains to be established. Current information might not be generalizable to the individual need of each patient. Single case reports support cannabis as a therapeutic agent. 10 Topical and oral cannabinoids are optimally provided in solvents due to their lipophilic nature. Starting at low dosages in cannabis-naïve individuals and utilizing slow increases in dosage help minimize adverse consequences. Clinical efficacy in patients with PD is directed toward bradykinesia, stiffness, rigidity, and tremors, which is mediated by nigrostriatal neurons. 10

ADVERSITIES

Side effects vary in accordance to THC and CBD formulations, and they include fatigue, dizziness, nausea, xerostomia, anxiety, headache, visual changes, impaired cognition, cough, and/or palpitations. 10 Driving and operating potentially dangerous equipment is not recommended for 8 to 12 hours after ingestion. Cannabis products are contraindicated during pregnancy or lactation and for people with cardiac decompensation. 10 Marijuana is ill-advised for children or young adults until the brain is fully developed. 11 Smoking cannabis has its own inherent risks. Beyond neurodevelopmental concerns, cannabis also has unclear risk for cardiac dysfunction and psychiatric concerns, such as for the emergence of depression and/or psychosis.

CONCLUSION

Marijuana has been shown to attenuate motor and nonmotor signs and symptoms of PD. However, there are limitations to the available research, including small sample sizes and lack of standardized clinical outcome measures. Neurologic manifestations of PD might be alleviated with cannabis products, but such assertions are yet be established in reference to patient-specific factors, such as disease stage, target symptoms, and prior levodopa exposure, and dosages of cannabis product have yet to be established. Further research will reveal the efficacy and safety of medical marijuana for patients with motor manifestations of parkinsonism. Until then, pharmacotherapy with cannabis should be considered and applied with caution.

REFERENCES

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7. García-Arencibia M, González S, de Lago E, et al. Evaluation of the neuroprotective effect of cannabinoids in a rat model of Parkinson’s disease: importance of antioxidant and cannabinoid receptor-independent properties. Brain Res. 2007; 1134 :162–170. [PubMed] [Google Scholar]

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10. MacCallum C, Russo E. Practical considerations in medical cannabis administration and dosing. Eur J Int Med. 2018; 49 :12–19. [PubMed] [Google Scholar]

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Articles from Innovations in Clinical Neuroscience are provided here courtesy of Matrix Medical Communications

Using CBD to Treat Parkinson’s Disease Symptoms

The benefits and research around CBD are still emerging

Colleen Travers writes about health, fitness, travel, parenting, and women’s lifestyle for various publications and brands.

Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. These medical reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more.

Diana Apetauerova, MD, is board-certified in neurology with a subspecialty in movement disorders. She is an associate clinical professor of neurology at Tufts School of Medicine.

With the legalization of medical marijuana, many states are approving the use of it in a non-traditional way to treat the symptoms of certain conditions, including Parkinson’s disease. Marijuana has two major components to it—tetrahydrocannabinol (THC) and cannabidiol (CBD). Both may help with nausea and muscle pain or spasms, but unlike THC, CBD doesn’t give you the “high” feeling marijuana is most commonly known for. This makes it an enticing, natural way for many to help treat their Parkinson’s disease symptoms. What’s more, is that because CBD is a natural compound from the Cannabis sativa plant, using it may also leave you side effect-free, unlike many prescription medications.

Research

The body of research on using CBD for Parkinson’s disease symptoms is rapidly growing, as Parkinson’s disease affects 1% of the population over 60 years old.   Parkinson’s disease is a neurological condition, affecting the nervous system. Parts of the brain that produce dopamine, which is responsible for sending messages to the body in order to direct movement, become damaged or die. This results in tremors, muscle stiffness, the inability to use facial expressions, and trouble balancing.

In connection with Parkinson’s disease as well as other movement-related disorders, CBD may help improve motor skills. In one study published in Frontiers in Pharmacology CBD was shown to have a more preventative role in delaying abnormal movement symptoms in animal models of Parkinson’s.  

Since Parkinson’s disease can take some time to properly diagnose when the symptoms are already prevalent, using CBD once diagnosed may not offer much benefit. With early detection combined with the use of CBD together the possibility of reducing movement-related symptoms increases.

Those dealing with Parkinson’s disease may also have trouble sleeping due to REM sleep behavior disorder (RBD), a condition in which patients ‘act out’ their dreams while asleep. A study published in the Journal of Clinical Pharmacy and Therapeutics found that four patients with Parkinson’s disease who also suffered from RBD had a decrease of RBD symptoms during sleep with the use of CBD.

In some cases, people suffering from Parkinson’s disease may also have symptoms of psychosis, ranging in hallucinations to vivid dreams and illusions. Research has found that CBD may be able to help. In research out of University of São Paulo in Brazil, patients were given a dose of CBD starting out at 150 milligrams (mg) per day in addition to their current treatment plan of therapy for four weeks. The use of CBD showed no adverse effects, no impact on worsening motor function, and a decrease in their reported psychosis symptoms, meaning that not only can it help with the physical setbacks of Parkinson’s disease, it can also play a part in the cognitive challenges as well. This was however an older study and current clinical trial evidence to support the use of CBD is minimal.

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More research out of Brazil suggests CBD can improve the overall quality of life of those with Parkinson’s disease. In a sample of 21 patients, those who were treated with 75 mg to 300 mg of CBD per day reported a significant increase in quality of life, though no significant differences were noted in motor and general symptoms or neuroprotective effects. This goes to show how much results can vary when it comes to the effects of CBD, requiring larger studies to be done in order to get more definitive answers to this treatment option.

Uses and Safety

Parkinson’s disease can impact cognitive function and memory, particularly in those whose symptoms progress to Parkinson’s disease dementia. Because of this, medical marijuana with both THC and CBD may not be recommended, as it can impair thinking and brain function even more so. CBD by itself may be a safer route.

CBD has been discovered as an effective way to help treat Parkinson’s disease symptoms because it interacts with two cannabinoid receptors in the body found on certain cells called CB1 and CB2. By interacting with one or both of these receptors, CBD may delay tremor development as well as have protective neurological benefits. But as seen with the above studies, there is no uniform approach or conclusion on this treatment method. This means that patients may react differently to using CBD, some having tremendous success while others seeing little difference. But regardless of whether or not CBD is an effective treatment option for you, you always need to consult your treating physician to make sure this treatment will not cause side effects.

What can cause side effects is if a patient decides to mix medical marijuana with their treatment plan that consists of certain prescription medications. If you plan to use medical marijuana as opposed to CBD by itself, it’s smart to consult a healthcare provider or your pharmacist before you start mixing it in with other medications to make sure it’s safe for you.

Should You Use It?

While the research on CBD to treat Parkinson’s disease symptoms is largely inconclusive, its mild effect on patients as a whole makes it enticing to try in addition to an existing traditional treatment plan. Parkinson’s disease has no cure. But with prescription medication, therapy, and now perhaps the use of nontraditional options like CBD, patients may be able to experience less frequency and severity of symptoms that affect their motor skills.

If you’re interested in trying CBD for Parkinson’s disease, talk to your healthcare provider about it. They will be able to point you to the latest research and provide recommendations on how much you should take. They will also be able to monitor your progress with the rest of your care team in order to come to a conclusion if this is the right treatment plan for you.