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multiple sclerosis

Standard treatment for multiple sclerosis

Multiple sclerosis is a disease in which nerve tissue is damaged by inflammation of the central and optic nerves such as the brain and spinal cord. The cause is a runaway immune system, which is thought to be an autoimmune disease.

When the central nervous system is examined by pathological anatomy, hardened parts can be seen in various places, so it has come to be called multiple sclerosis.

Since nerves are damaged by inflammation, it causes various symptoms such as visual impairment, motor paralysis, sensory impairment, and urination / defecation impairment. It is painful for the patient because it causes insomnia due to the pain caused by the stiffness of the muscles. It is not a disease that cures completely, but a disease that repeats recurrence and remission, which is a state of calm without symptoms.

Standard treatments performed in Japan include acute treatment when symptoms suddenly worsen and recurrence prevention treatment when symptoms are calm.

Acute treatment is steroid pulse therapy, in which a large amount of steroid is infused for 3 to 5 days. Steroids have a strong suppressive effect on inflammation and also have an immunosuppressive effect, so they are caused by neuroinflammation and are also used for multiple sclerosis, which is also an autoimmune disease. Blood purification therapy may be used if steroidal pulse therapy does not improve. Blood purification therapy is a treatment method in which blood is taken out of the body, the causative substance of inflammation is removed, and the blood is returned to the body.

After the acute phase has passed and the symptoms have subsided, treatment to prevent recurrence is given.

Drugs used as preventive treatments for recurrence include injections and oral medications.

  • Interferon β
  • Fingolimod
  • Dimethyl fumarate
  • Grunchlamer acetate
  • Natalizumab

The first choices for recurrence prevention are the injectable interferon β and grantyramer acetate. These two drugs are effective in reducing recurrence by about 30%. Serious side effects are rare even after use for more than 20 years, and Grantyramer acetate is characterized by being safer for pregnant women than other therapeutic agents.

Both fingolimod and dimethyl fumarate are said to reduce the recurrence rate by as much as 50% when taken, but they have the side effect of reducing the number of lymphocytes, which play an important role in immune function, so they are regular. It is a drug that requires a blood test.

Natalizumab is highly effective in reducing recurrence by as much as 70%, but it is sufficient for use due to the presence of serious side effects such as PML (progressive multifocal leukoencephalopathy) and herpes encephalopathy after long-term use. It is a drug that requires careful consideration.

Relationship between multiple sclerosis and medical cannabis

Medical cannabis is illegal in Japan for both possession and use under the Cannabis Control Law, but more and more countries around the world are lifting the ban on medical cannabis.

Medical cannabis is said to be effective against chronic pain, nausea and vomiting caused by cancer chemotherapy, sleep disorders, epilepsy and Parkinson’s disease, but motor dysfunction due to multiple sclerosis (stretching of limbs). It is said to be effective against nausea and pain.

According to an overseas study published in the Journal of Neuroimmune Pharmacology, Δ9-tetrahydrocannabinol contained in cannabis compounds suppresses neurotransmission abnormalities due to multiple sclerosis and reduces symptoms such as limb tension due to muscle stiffness. It was announced that it would be done.

In addition, it has been reported that the quality of sleep is improved, so it is expected to be effective for various symptoms such as painful muscle stiffness and sleep disorders due to multiple sclerosis.

Medical cannabis is said to have a neuroprotective effect, but it is still under research. If neuroprotective, it will impact the spread of medical cannabis worldwide as a new option for diseases caused by central nervous system lesions such as epilepsy and Parkinson’s disease.

Cases of treating multiple sclerosis with medical cannabis

Muscle relaxants may be used for multiple sclerosis because 2/3 of patients have muscle stiffness and spasms, but overseas, medical cannabis is actually used for multiple sclerosis spasms. I am.

Nabiximols (trade name: Sativex) is a drug in medical cannabis developed by the British pharmaceutical company GW Pharmaceuticals. It is a drug containing Δ9-tetrahydrocannabinol as an ingredient and is used as an oral spray.

Nabiximols will be marketed in Canada in 2005 after obtaining an indication for the treatment of neurogenic pain associated with multiple sclerosis. In addition, Nabiximols was approved in Australia in 2012 for moderate to severe seizures of multiple sclerosis, which was not effective with existing treatments, and currently about 30 countries around the world are using nabiximols. I am using.

Surprisingly, Otsuka Pharmaceutical, a Japanese pharmaceutical company, has a license agreement for the development and sale of nabiximols in the United States, with a view to joint research with GW Pharmaceuticals and medical cannabis.

Therefore, there is a possibility that research on medical cannabis will proceed in Japan as well.

 

References

Multiple sclerosis (MS) / Neuromyelitis optica (NMO)-Hyogo Prefectural Intractable Diseases Counseling Center

Comparison table of drugs and their characteristics, effects, etc.-Hyogo Prefectural Intractable Diseases Counseling Center

What kind of illness is MS?-National Center of Neurology and Psychiatry

Treatment of multiple sclerosis-JSTAGE

Pathophysiology of multiple sclerosis and advances in treatment-JSTAGE

Multiple sclerosis-Junichi Kira, Graduate School of Medicine, Kyushu University Hospital Neurology

Neuroprotection in Experimental Autoimmune Encephalomyelitis and Progressive Multiple Sclerosis by Cannabis-Based Cannabinoids

Cannabis and multiple sclerosis

Cannabis Relieves Multiple Sclerosis Symptoms, US Study-AFP, BBNEWS

What is spasticity-Higashitotsuka Memorial Hospital

Nabiximols for multiple sclerosis

British pharmaceutical company confident in clinical trial results but uneasy about “President Trump”-Forbes JAPAN

GW Pharamaceuticals

Otsuka Pharmaceutical and GW Pharmaceuticals cannabinoid cancer pain treatment “Sativex ® ” signed license agreement in the United States February 14

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