CHAPTER 11: Cannabinoids as a Therapeutic Approach in Multiple Sclerosis

There are numerous historical reports that people with multiple sclerosis (MS) have for many years been self-medicating with illegally obtained street cannabis or, more recently, medicinal cannabis in the countries where this is available to alleviate the symptoms associated with MS. These anecdotal reports have been confirmed by data from animal models of MS and more recently clinical trials on the ability of cannabinoids to alleviate limb spasticity, which is a common feature of progressive MS, pain, bladder dysfunction and neurodegeneration. Experimental studies into the biology of the endocannabinoid system have revealed that cannabinoids have efficacy, not only in symptom relief but also as neuroprotective agents, which may slow disease progression and thus delay the onset of symptoms such as limb spasticity. This chapter discusses what we now know about the endocannabinoid system as it relates to MS and also the therapeutic potential of cannabinoid therapeutics as disease-modifying or symptom control agents, as well as future therapeutic strategies including the potential for slowing disease progression due to neurodegeneration in MS.