RT Journal Article
SR Electronic
T1 Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders
JF Neurology
JO Neurology
FD Lippincott Williams & Wilkins
SP 1556
OP 1563
DO 10.1212/WNL.0000000000000363
VO 82
IS 17
A1 Barbara S. Koppel
A1 John C.M. Brust
A1 Terry Fife
A1 Jeff Bronstein
A1 Sarah Youssof
A1 Gary Gronseth
A1 David Gloss
YR 2014
UL http://n.neurology.org/content/82/17/1556.abstract
AB Objective: To determine the efficacy of medical marijuana in several neurologic conditions.Methods: We performed a systematic review of medical marijuana (1948–November 2013) to address treatment of symptoms of multiple sclerosis (MS), epilepsy, and movement disorders. We graded the studies according to the American Academy of Neurology classification scheme for therapeutic articles.Results: Thirty-four studies met inclusion criteria; 8 were rated as Class I.Conclusions: The following were studied in patients with MS: (1) Spasticity: oral cannabis extract (OCE) is effective, and nabiximols and tetrahydrocannabinol (THC) are probably effective, for reducing patient-centered measures; it is possible both OCE and THC are effective for reducing both patient-centered and objective measures at 1 year. (2) Central pain or painful spasms (including spasticity-related pain, excluding neuropathic pain): OCE is effective; THC and nabiximols are probably effective. (3) Urinary dysfunction: nabiximols is probably effective for reducing bladder voids/day; THC and OCE are probably ineffective for reducing bladder complaints. (4) Tremor: THC and OCE are probably ineffective; nabiximols is possibly ineffective. (5) Other neurologic conditions: OCE is probably ineffective for treating levodopa-induced dyskinesias in patients with Parkinson disease. Oral cannabinoids are of unknown efficacy in non–chorea-related symptoms of Huntington disease, Tourette syndrome, cervical dystonia, and epilepsy. The risks and benefits of medical marijuana should be weighed carefully. Risk of serious adverse psychopathologic effects was nearly 1%. Comparative effectiveness of medical marijuana vs other therapies is unknown for these indications.AAN=American Academy of Neurology; AE=adverse effect; CBD=cannabidiol; CI=confidence interval; CRS=category rating scale; HD=Huntington disease; ITT=intention-to-treat; MS=multiple sclerosis; NRS=numeric rating score; OCE=oral cannabis extract; THC=Δ-9-tetrahydrocannabinol; UHDRS=Unified Huntington's Disease Rating Scale; UPDRS=Unified Parkinson's Disease Rating Scale; VAS=visual analog scale