בתחום הנוירולוגיה :
מחלת הפרקינסון הינה מחלה כרונית ניוונית של מערכת העצבים, המאופיינת בהפרעות מוטוריות טיפוסיות, עקב פגיעה ביצור הדופמין המשמש להעברת אותות במערכת העצבים המרכזית.
בישראל ניתן להגיש בקשה לקבלת רישיון לטיפול בקנאביס רפואי במקרים הבאים:
► למטופלים המאובחנים בפרקינסון, המטופלים במשך שנה לפחות בטיפול אנטיפרנקסוני, הסובלים מכאב (כאב כרוני או כאב הנגרם מהריגידיות) אשר לא הגיבו לטיפול מקובל בכאב.
► קונטראינדקציה לטיפול - פסיכוזה פעילה.
ההמלצה לטיפול ע"י קנביס רפואי תוגש על ידי הנוירולוג המטפל המתחייב לביצוע מעקב רפואי מדי שלושה חודשים לפחות.
בשנת הטיפול הראשונה הרישיון יוגבל לתקופות של שלושה חודשים בכל פעם וחידוש הרשיון יותנה בבחינה והמלצה משותפת של הנוירולוג והפסיכיאטר המטפלים בכל פעם. החל משנת הטיפול השניה –הרישיון יוגבל לתקופות של עד שנה בכל פעם ומותנה בהמלצה של הנוירולוג המטפל והמלצה פסיכיאטרית.
► קנאביס רפואי ופרקינסון (מתוך "גראס באישור רופא") :
?Cannabidiol: a promising drug for neurodegenerative disorders
Department of Experimental Pharmacology, Faculty of Pharmacy, University of Naples Federico II, Via D. Montesano 49, Naples, Italy. firstname.lastname@example.org
Neurodegenerative diseases represent, nowadays, one of the main causes of death in the industrialized country. They are characterized by a loss of neurons in particular regions of the nervous system. It is believed that this nerve cell loss underlies the subsequent decline in cognitive and motor function that patients experience in these diseases. A range of mutant genes and environmental toxins have been implicated in the cause of neurodegenerative disorders but the mechanism remains largely unknown. At present, inflammation, a common denominator among the diverse list of neurodegenerative diseases, has been implicated as a critical mechanism that is responsible for the progressive nature of neurodegeneration. Since, at present, there are few therapies for the wide range of neurodegenerative diseases, scientists are still in search of new therapeutic approaches to the problem. An early contribution of neuroprotective and antiinflammatory strategies for these disorders seems particularly desirable because isolated treatments cannot be effective. In this contest, marijuana derivatives have attracted special interest, although these compounds have always raised several practical and ethical problems for their potential abuse. Nevertheless, among Cannabis compounds, cannabidiol (CBD), which lacks any unwanted psychotropic effect, may represent a very promising agent with the highest prospect for therapeutic use
Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action
Department of Neurology, Psychiatry and Medical Psychology, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil. email@example.com
The aim of this review is to describe the historical development of research on cannabidiol
This review was carried out on reports drawn from Medline, Web of Science and SciELO
DISCUSSION:After the elucidation of the chemical structure of cannabidiol in 1963, the initial studies showed that cannabidiol was unable to mimic the effects of Cannabis. In the 1970's the number of publications on cannabidiol reached a first peak, having the research focused mainly on the interaction with delta9-THC and its antiepileptic and sedative effects. The following two decades showed lower degree of interest, and the potential therapeutic properties of cannabidiol investigated were mainly the anxiolytic, antipsychotic and on motor diseases effects. The last five years have shown a remarkable increase in publications on cannabidiol mainly stimulated by the discovery of its anti-inflammatory, anti-oxidative and neuroprotective effects. These studies have suggested a wide range of possible therapeutic effects of cannabidiol on several conditions, including Parkinson's disease, Alzheimer's disease, cerebral ischemia, diabetes, rheumatoid arthritis, other inflammatory diseases, nausea and cancer.
In the last 45 years it has been possible to demonstrate that CBD has a wide range of pharmacological effects, many of which being of great therapeutic interest, but still waiting to be confirmed by clinical trials
Cannabidiol for the treatment of psychosis in Parkinson's disease.
Zuardi AW, Crippa JA, Hallak JE, Pinto JP, Chagas MH, Rodrigues GG, Dursun SM, Tumas V
J Psychopharmacol. 2009 Nov;23(8):979-83. doi: 10.1177/0269881108096519. Epub 2008 Sep 18
Department of Neuropsychiatry and Medical Psychology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil. firstname.lastname@example.org
The management of psychosis in Parkinson's disease (PD) has been considered a great challenge for clinicians and there is a need for new pharmacological intervention. Previously an antipsychotic and neuroprotective effect of Cannabidiol (CBD) has been suggested. Therefore, the aim of the present study was to directly evaluate for the first time, the efficacy, tolerability and safety of CBD on PD patients with psychotic symptoms. This was an open-label pilot study. Six consecutive outpatients (four men and two women) with the diagnosis of PD and who had psychosis for at least 3 months were selected for the study. All patients received CBD in flexible dose (started with an oral dose of 150 mg/day) for 4 weeks, in addition to their usual therapy. The psychotic symptoms evaluated by the Brief Psychiatric Rating Scale and the Parkinson Psychosis Questionnaire showed a significant decrease under CBD treatment. CBD did not worsen the motor function and decreased the total scores of the Unified Parkinson's Disease Rating Scale. No adverse effect was observed during the treatment. These preliminary data suggest that CBD may be effective, safe and well tolerated for the treatment of the psychosis in PD.
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Beneficial and adverse effects of cannabidiol in a Parkinson patient with sinemet-induced dystonic dyskinesia.
Snider SR, Consroe P
Improvement of dyskinesia
In idiopathic dystonia, the terapeutic effect of marijuana smoking is reported to be comparable to diazepam (C.D. Marsden, in Disorders of Movement, 1981,81). The non-psychoactive cannabis derivative, cannabidiol (CBD), also improves dystonia (Consroe and Snider, in Cannbinoids as Therapeutic Agents, in press). We report the effect of CBD on dystonia secondary to Sinemet in parkinsonism, a disorder thought to be a relative contraindication for cannabinoids (D.Moss et al, Pharmacol Biochem Behav 1981, 1984). The patient, a 42-year- old man with an 8-year history of parkinsonism, developed peak-dose dyskinesia about 4 years ago and action dystonia affecting all limbs more recently. Trihexyphenidyl and bromocriptine each produced only slight improvement. To stable optimal dosages of the three drugs, CBD was added, starting with 100 mg/d and increasing by 100 mg weekly. At 100 to 200 mg/d, there was a decrease in clinical fluctuations and in dyskinesia scores (by 30%) without a significant worsening of the parkinsonism. At 300 to 400 mg/d, there was no further improvement in the dyskinesia, and adverse effects (dizziness, drowsiness, increased Parkinson symptoms) appeared. CBD withdrawal resulted in 3 days of severe generalized dystonia and several weeks of increased sensitivity to Sinemet, suggestive of a “drug holiday” effect.
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Recent developments in the therapeutic potential of cannabinoids.
Corey S. Department of Pharmacology and Toxicology, Institute of Neurobiology, Medical Sciences Campus University of Puerto Rico, San Juan, Puerto Rico 00901. email@example.com
OBJECTIVE : To examine the recent evidence that marijuana and other cannabinoids have therapeutic potential
METHODS : Literature published since 1997 was searched using the following terms: cannabinoid, marijuana, THC, analgesia, cachexia, glaucoma, movement, multiple sclerosis, neurological, pain, Parkinson, trial, vomiting. Qualifying clinical studies were randomized, double-blind, and placebo-controlled. Selected open-label studies and surveys are also discussed.
RESULTS : A total of 15 independent, qualifying clinical trials were identified, of which only three had more than 100 patients each. Two large trials found that cannabinoids were significantly better than placebo in managing spasticity in multiple sclerosis. Patients self-reported greater sense of motor improvement in multiple sclerosis than could be confirmed objectively. In smaller qualifying trials, cannabinoids produced significant objective improvement of tics in Tourette's disease, and neuropathic pain. A new, non-psychotropic cannabinoid also has analgesic activity in neuropathic pain. No significant improvement was found in levodopa-induced dyskinesia in Parkinson's Disease or post-operative pain. No difference from active placebo was found for management of cachexia in a large trial. Some immune system parameters changed in HIV-1 and multiple sclerosis patients treated with cannabinoids, but the clinical significance is unknown
CONCLUSION : Cannabinoids may be useful for conditions that currently lack effective treatment, such as spasticity, tics and neuropathic pain. New delivery systems for cannabinoids and cannabis-based medicinal extracts, as well as new cannabinoid derivatives expand the options for cannabinoid therapy. More well-controlled, large clinical tests are needed, especially with active placebo.