Multiple sclerosis (MS)

Multiple Sclerosis (MS) is a chronic neurodegenerative condition that affects the central nervous system, primarily the brain and spinal cord. Damage to the myelin sheath—the protective covering of nerve fibers—disrupts communication between the brain and the rest of the body.

This disruption can result in a wide range of symptoms, including muscle spasms, numbness, fatigue, chronic pain, mood changes, and even paralysis. An estimated 300,000 – 400,000 people in the US suffer from MS, and it is the most common progressive neurological disease amongst young adults worldwide.

Medical cannabis has shown promise in alleviating specific MS-related symptoms, such as spasticity, fatigue, bladder problems, and neuropathic pain. Cannabinoids may also have neuroprotective properties that could help manage MS and other neurological diseases. Sativex, a 1:1 THC:CBD product, has been approved for the treatment of symptoms associated with MS.

Multiple Sclerosis Causes

The exact cause of MS remains unknown, but research suggests a combination of genetic, environmental, and immunological factors. Over 200 genetic variations have been identified that may increase susceptibility to MS. Environmental influences, such as low vitamin D levels, smoking, and certain viral infections (e.g., Epstein-Barr virus, or EBV), are also associated with increased risk.

In many cases, MS involves an immune-mediated process where T-cells and B-cells mistakenly attack the myelin sheath. This leads to inflammation, scarring, and impaired nerve function. While traditionally categorized as an autoimmune disease, some researchers suggest it may be more accurate to describe MS as an “immune-mediated” condition. Variations in immune system behavior highlight the complexity of its classification.

Multiple Sclerosis Symptoms & Health Effects

MS symptoms can vary widely depending on the individual and the severity of the condition. Common symptoms include:

• Physical symptoms: Muscle spasms, weakness, numbness, coordination and mobility issues, and chronic pain
• Sensory symptoms: Vision problems (e.g., blurred or double vision), tingling, and loss of sensation
• Cognitive symptoms: Memory lapses, difficulty concentrating, and problems with planning
• Emotional symptoms: Depression, anxiety, and mood swings
• Other health effects: Bladder and bowel dysfunction, sexual dysfunction, and chronic fatigue

Symptoms may progress gradually or occur in isolated attacks, with periods of remission in between. Chronic inflammation and immune dysregulation are hallmark features of MS.

Depression, anxiety, high blood pressure (hypertension), and high cholesterol (hyperlipidemia) are common comorbidities with MS.

Multiple Sclerosis Diagnosis

Diagnosing MS typically involves a combination of clinical evaluation, magnetic resonance imaging (MRI) scans, and sometimes lumbar punctures to detect abnormalities in cerebrospinal fluid. Blood tests may be used to rule out other conditions.

Key diagnostic criteria include evidence of damage in multiple areas of the central nervous system and the occurrence of symptoms over time.

Multiple Sclerosis Prognosis

The progression of MS varies significantly among individuals. Life expectancy amongst MS patients is around 6-7 years lower compared to the general population. Some people experience mild symptoms for decades, while others may face rapid deterioration. Factors influencing prognosis include the type of MS (e.g., relapsing-remitting, secondary progressive, primary progressive), early intervention, and adherence to treatment plans.

While MS currently has no cure, advances in medical treatments can help manage symptoms and slow disease progression.

Multiple Sclerosis Treatments

A mixture of prescription drugs and lifestyle changes are recommended for slowing the progression of MS and managing its symptoms.

First-Line Treatments

• Disease-modifying therapies (DMTs): Medications like interferon beta, glatiramer acetate, and monoclonal antibodies aim to reduce the frequency and severity of relapses
• Steroids: Used to manage acute relapses by reducing inflammation

Other Treatments

• • Symptom management: Includes medications for spasticity (e.g., baclofen, gabapentin), pain, and bladder dysfunction
  • Rehabilitation: Physiotherapy, occupational therapy, and speech therapy help maintain mobility and function
  • Lifestyle changes: Regular exercise, balanced nutrition, and stress management can support overall well-being

• Chemotherapy: For particularly aggressive forms of MS, high-dose chemotherapy and stem cell rescue (SCR) may be recommended. Immunomodulation in this manner may help reduce white blood cell count and slow the progression of MS.

Adjunctive Therapy & Alternative Treatments

Complementary approaches like acupuncture, mindfulness, and yoga may help alleviate some symptoms, though evidence of their efficacy is limited.

Herbal remedies such as Ginkgo biloba, valerian, turmeric/curcumin, Asian ginseng, bilberry leaf, German chamomile, Nigella sativa, and echinacea may also be helpful for managing anxiety, pain, inflammation, and insomnia associated with MS. Some research also suggests that green tea, coconut oil, and pumpkin seed oil may help improve posture and balance, and ease muscle weakness and fatigue, due to their antioxidant effects and ability to control triglyceride levels.

Cannabis for Multiple Sclerosis

Medical cannabis, particularly formulations with balanced THC:CBD ratios, has been shown to help manage MS symptoms. Products like Sativex, a 1:1 THC:CBD oral spray, are approved in some countries for spasticity, neuropathic pain, and bladder dysfunction in MS patients. Some patients also state that Sativex helps manage their insomnia.

Cannabinoids in cannabis offer a range of therapeutic effects:

• Tetrahydrocannabinol (THC): Reduces muscle spasms and pain, particularly neuropathic (nerve) pain)
• Cannabidiol (CBD): Anti-inflammatory, pain-relieving, and neuroprotective properties. CBD may also improve mobility in those with MS.
• Cannabinol (CBN): Sedative effects may improve sleep quality
• Cannabigerol (CBG): May promote neuroprotection and reduce oxidative stress and neuroinflammation

Other compounds in cannabis that could be helpful include:

• Terpenes: Compounds like myrcene, linalool, and beta-caryophyllene may enhance the therapeutic effects of cannabinoids due to their anti-inflammatory and analgesic (painkilling) properties
• Flavonoids:Anti-inflammatory and antioxidant properties may contribute to symptom relief in those with MS

Administration routes include:

• Inhalation: Provides rapid symptom relief
• Ingestion: Offers longer-lasting effects but with delayed onset
• Sublingual: Tinctures and oromucosal sprays allow for precise dosing

Medical cannabis may also help manage common MS comorbidities, such as anxiety and depression.

Additional Information for Patients

Patients considering medical cannabis should consult with a healthcare provider experienced in cannabinoid therapy. Factors to discuss include:

• Appropriate THC:CBD ratios for symptom management
• Potential drug interactions with existing treatments
• Legal and regulatory considerations in their region

Educational resources, support groups, and rehabilitation services can further empower patients in managing their condition and maintaining quality of life (QoL). Some organizations and charities include:

• MS Focus/Multiple Sclerosis Foundation
• Multiple Sclerosis Association of America (MSAA)
• MS Run the US
• National Multiple Sclerosis Society

Multiple Sclerosis FAQs

What sort of diet should I follow if I have MS?

A diet rich in nutrients, vitamin D, omega-3, and flavonoids is ideal for those with MS. Oily fish like salmon and mackerel, raw cacao and low-sugar, high-cocoa chocolate, avocados, seeds like flax and pumpkin seeds, berries like blueberries and raspberries, bananas, figs, mushrooms, whole grains like oats and rice, and probiotic-rich foods like yogurt or kimchi are recommended. Water, green tea, and herbal teas are also recommended.

Cutting back on dairy and avoiding alcohol and processed foods can also help improve quality of life in those with MS.

What type of exercise can I do with MS?

Exercising can be difficult if you have MS, as fatigue and muscle weakness can make it difficult to stay motivated. However, keeping physically active is extremely important in order to support brain health, improve mobility and balance, aid good-quality sleep, and positively impact symptoms like fatigue, pain, and mood.

Low impact exercises like walking, yoga, Tai Chi, pilates, swimming, golf, water aerobics, and hand figures of eight can be very helpful for those with MS. Kettlebell exercises and circuit training can be more strenuous, but may help maintain strength, balance, and stamina.

What aggravates multiple sclerosis?

Stress, heat, humidity, an infection such as cold or flu, vitamin D deficiency, a lack of sleep (insomnia), and overexertion may exacerbate symptoms or cause an MS flare up.

Resources

• The Prevalence of MS in the United States: https://pmc.ncbi.nlm.nih.gov/articles/PMC6442006/
• Investigating the Prevalence of Comorbidity in Multiple Sclerosis Clinical Trial Populations: https://www.neurology.org/doi/10.1212/WNL.0000000000209135
• Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study: https://jnnp.bmj.com/content/88/8/621 
• High-dose chemotherapy and multiple sclerosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC4696039/
• Therapeutic Yoga: Symptom Management for Multiple Sclerosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC4642819/
• Effects of green tea epigallocatechin-3-gallate on the proteolipid protein and oligodendrocyte transcription factor 1 messenger RNA gene expression in a mouse model of multiple sclerosis: https://pubmed.ncbi.nlm.nih.gov/28984112/
• Beneficial Effects of Plant Oils Supplementation on Multiple Sclerosis: A Comprehensive Review of Clinical and Experimental Studies: https://pmc.ncbi.nlm.nih.gov/articles/PMC10674509/
• Improvements in gait and balance in patients with multiple sclerosis after treatment with coconut oil and epigallocatechin gallate. A pilot study: https://pubs.rsc.org/en/content/articlelanding/2023/FO/D2FO02207A
• The Efficacy of Cannabis on Multiple Sclerosis-Related Symptoms: https://pmc.ncbi.nlm.nih.gov/articles/PMC9148011/
• Sativex (nabiximols): https://www.mssociety.org.uk/living-with-ms/treatments-and-therapies/cannabis/sativex
• Cannabinoids in the management of spasticity associated with multiple sclerosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC2626929/
• Cannabidiol to Improve Mobility in People with Multiple Sclerosis: https://pmc.ncbi.nlm.nih.gov/articles/PMC5874292/
• A double-blind, randomized, placebo-controlled study of the safety and effects of CBN without CBD on sleep quality: https://pubmed.ncbi.nlm.nih.gov/37796540/
• A cannabigerol quinone alleviates neuroinflammation in a chronic model of multiple sclerosis: https://pubmed.ncbi.nlm.nih.gov/22971837/
• Terpenes from Cannabis sativa induce antinociception in a mouse model of chronic neuropathic pain via activation of adenosine A 2A receptors: https://pubmed.ncbi.nlm.nih.gov/38709489/
• Flavonoids, the compounds with anti-inflammatory and immunomodulatory properties, as promising tools in multiple sclerosis (MS) therapy: A systematic review of preclinical evidence: https://pubmed.ncbi.nlm.nih.gov/33770729/

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