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8/10/2019 Efficacy of Medical Marijuana
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Systematic review: Efficacy and
safety of medical marijuana in
selected neurologic disorder
Penyaji : Felicia ReynataPembimbing : dr. Parlin Soesanto, sp.S
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Abstract
Objective : To determine the efficacy of
medical marijuana in several neurological
conditions.
Methods : Systematic review of medical
marijuana (1948-2013) to treatment of
symptoms of multiple sclerosis (MS), epilepsy,
and movement disorder
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-9-Tetrahydrocannabinol
(THC)
Cannabidiol (CBD)
Non-psychoactive
Isolated pharmacologically active
components of Marijuana
The ratio determines therapeutic vspsychoactive effects.
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Endocannabinoids (anandamide and 2-arachidonyglycerol)
Widely distributed in the brain and spinal cord
CB-1 receptors concentrated in: Hippocampus
association cortices
basal ganglia
cerebellum
spinal cord (especially dorsal root ganglia)
peripheral nerves
including presynaptic sympathetic nerve terminals and absentfrom thalamus and brainstem
CB-2 receptors found in the periphery, including lymphtissue and in low concentration in some brain regions,including periaqueductal gray
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Activation through G-coupled membrane
proteins causes physiologic responses
expected from these regions
Well-being, psychosis
Impaired memory and cognitive processing
Slowed locomotor function
Antinociceptive
Antiemetic
Antispasticity
Sleep promoting effect
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Do cannabinoids relieve
spasticity in patients with MS?Nabiximols
Probably effective to reducepatient-reported symptoms
at 6 weeks. Probably ineffective for
reducing objective measures
at 6 weeks.
Oral cannabis extract
and THC
OCE effective to reduce
patient-reported scores.Probably ineffective to
reduce obejctive measures at
12-15 weeks
THC probably effective toreduce patien-reported
scores
Ineffective to reducce
objective measure in 15
weeks, possibly effective at 1
year.
Smoked marijuana
Uncertain efficacy due to lackof evidence
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Clinical Context
Standard medical therapy was continued inthese studies, no comment can be made as tocomparative effectiveness
Patient Global Impression of Change Scale,determine 30% of change in spasticity
Most improvements are seen in subjective
measure, probably due to the well beingfeeling provided by marijuana, or by painrelief which improved mobility
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What is the efficacy of using cannabinoids
to treat central pain or painful spasm in
MS?
Nabiximols
Probably
effective for
treating MS
related pain or
painful spasms
OCE and THC
OCE is effection
for reduction of
central pain
Smoked
marijuana
Unclear
efficacy for
reducing pain
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Do cannabinoids help treat
bladder dysfunction in MS?
Nabiximols:
Class I study showed no
difference in mean dailyepisodes of incontinence.
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Cannabinoids should be studied as other drugs
are, to determine their efficacy, and when
evidence is available, should be prescribed as
other drugs are.
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