efficacy of medical marijuana

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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efficacy of medical marijuana

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