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Dystonia is a movement disorder that is characterized by involuntary muscle spasms. Studies have shown cannabis reduces the contractions associated with dystonia.
Overview of Dystonia
Dystonia is a disorder that is associated with involuntary muscle contractions that cause slow, repetitive or twisting movements. Depending on the form of dystonia, one muscle, a group of muscles or muscles throughout the body can be affected. The spasms, which can be mild or severe, can interfere with performing day-to-day tasks and can cause abnormal postures. Sometimes the involuntary movements are painful.
The spasms associated with dystonia can begin with a foot cramp or a tendency for one foot to drag, or handwriting worsening. In some cases, the contractions can cause the neck to turn involuntarily. Eyes may blink rapidly or be forced closed. The tremors can also cause speaking difficulties. Symptoms can worsen with fatigue or stress.
The cause of some forms of dystonia is genetic, but the cause of most cases is unknown. According to the National Institute of Neurological Disorders and Stroke, researchers believe that damage or an abnormality in the brain’s basal ganglia or other regions that control movement are responsible for dystonia. Dystonia can also be a symptom of another disease or condition, such as Parkinson’s disease, Huntington’s disease, Wilson’s disease, traumatic brain injury, stroke, brain tumors, and infections. It can also develop in response to certain medications.
There is no cure for dystonia. Medications can help manage symptoms. In some cases, surgery can disable or regulate nerves or regions in the brain.
Findings: Effects of Cannabis on Dystonia
Research has found that cannabis improves dystonia. Two of the major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), activate the CB1 and CB2 receptors of the endocannabinoid system, which in turn regulate the excitatory and inhibitory neurotransmitters necessary to curtail spasticity and muscle tremors (Pertwee, 2002) (Syed, McKeage & Scott, 2014) (Smith, 2002). Studies support that medical cannabis offers significant improvements in muscle spasticity, both in mice trials and in human subjects (Borgelt, Franson, Nussbaum & Wang, 2013) (Baker, et al., 2000).
One study found that five patients undergoing daily treatments of CBD experienced a 20 to 50% improvement in dystonia (Consroe, Sandyk & Snider, 1986). The same researchers had previously reported that CBD treatments caused significant dystonia improvements in both a 65-year-old woman and a 31-year-old man (Sandyk, Snider, Consroe & Elias, 1986).
Numerous case studies have supported cannabis’ dystonia-curtailing benefits. In one, a 52-year old woman with multiple sclerosis experienced a decreased frequency of dystonia in response to cannabis-based medications. She also reported improvements in sleep quality and anxiety (Deutsch, et al., 2008). In another, a 42-year-old chronic pain patient reported an improvement in dystonia following cannabis inhalation (Chatterjee, Almahrezi, Ware & Fitzcharles, 2002). Smoking cannabis also caused a marked improvement in dystonia in a patient with Wilson’s disease (Uribe Roca, Michelli & Viotti, 2005). A 38-year-old pianist saw an improvement in motor control following THC intake, causing the researchers to conclude that THC significantly improves focal dystonia (Jabusch, Schneider & Altenmuller, 2004).
Along with pain, muscle spasm is the most common reason that medical cannabis is recommended and prescribed by medical professionals (Borgelt, Franson, Nussbaum & Wang, 2013).
States That Have Approved Medical Marijuana for Dystonia
Currently, only the states of Illinois and New Mexico (cervical dystonia) have approved medical marijuana for the treatment of dystonia. However, in Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment. In addition, various other states will consider allowing medical marijuana to be used for the treatment of dystonia with the recommendation from a physician. These states include: California (any debilitating illness where the medical use of marijuana has been recommended by a physician), Connecticut (other medical conditions may be approved by the Department of Consumer Protection), Massachusetts (other conditions as determined in writing by a qualifying patient’s physician), Nevada (other conditions subject to approval), Oregon (other conditions subject to approval), Rhode Island (other conditions subject to approval), and Washington (any “terminal or debilitating condition”).
Sixteen states have approved medical marijuana for the treatment of spasms. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington.
Several states have approved medical marijuana specifically to treat “chronic pain,” which can develop in some cases of dystonia. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island and Vermont. The states of Nevada, New Hampshire, North Dakota, Montana, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have approved cannabis for the treatment of “intractable pain.”
Recent Studies on Cannabis’ Effect on Dystonia
Baker, D., Pryce, G., Croxford, J.L., Brown, P., Pertwee, R.G., Huffman, J.W., and Layward, L. (2000, March 2). Cannabinoids control spasticity and tremor in a multiple sclerosis model. Nature, 404(6773), 84-7.
Borgelt, L.M., Franson, K.L., Nussbaum, A.M., and Wang, G.S. (2013, February). The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy, 33(2), 195-209.
Chatterjee, A., Almahrezi, A., Ware, M., and Fitzcharles, M.A. (2002, July). A dramatic response to inhaled cannabis in a woman with central thalamic pain and dystonia. Journal of Pain and Symptom Management, 24(1), 4-6.
Consroe, P., Sandyk, R., and Snider, S.R. (1986, November). Open label evaluation of cannabidiol in dystonic movement disorders. The International Journal of Neuroscience, 30(4), 277-82.
Deutsch, S.I., Rosse, R.B., Connor, J.M., Burket, J.A., Murphy, M.E., and Fox, F.J. (2008, May). Current status of cannabis treatment of multiple sclerosis with an illustrative case presentation of a patient with MS, complex vocal tics, paroxysmal dystonia, and marijuana dependence treated with dronabinol. CNS Spectrums, 13(5), 393-403.
Dystonia. (2015, November 25). Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/dystonia/home/ovc-20163692.
Dystonias Fact Sheet. (2015, July 6). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/dystonias/detail_dystonias.htm.
Jabusch, H.C., Schneider, U., and Altenmuller, E. (2004, August). Delta9-tetrahydrocannabinol improves motor control in a patient with musician’s dystonia. Movement Disorders, 19(8), 990-1.
Pertwee, R.G. (2002, August). Cannabinoids and multiple sclerosis. Pharmacology & Therapeutics, 95(2), 165-74.
Sandyk, R., Snider, S.R., Consroe, P., and Elias, S.M. (1986, July). Cannabidiol in dystonic movement disorders. Psychiatry Research, 18(3), 291.
Smith, P.F., (2002, June). Cannabinoids in the treatment of pain and spasticity in multiple sclerosis. Current Opinion in Investigational Drugs, 3(6), 859-64.
Syed, Y.Y., McKeage, K., and Scott, L.J. (2014, April). Delta-9-tetrahydrocannabinol-cannabidiol (Sativex): a review of its use in patients with moderate to severe spasticity due to multiple sclerosis. Drugs, 74(5), 563-78.
Uribe Roca, M.C., Micheli, F., and Viotti, R. (2005, January). Cannabis sativa and dystonia secondary to Wilson’s disease. Movement Disorders, 20(1), 113-5.
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