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Spastic Quadriplegia – Medical Marijuana Research Overview

Spastic quadriplegia is a rare but severe type of cerebral palsy that causes spasticity in all four limbs. Studies have shown marijuana can help patients manage the spasms, seizures and pain caused by the condition.

Overview of Spastic Quadriplegia

Spastic quadriplegia is the most severe form of cerebral palsy, a neurological disorder that appears in infancy or early childhood. Spastic quadriplegia is caused by brain damage or abnormalities that develop most commonly before birth. The damage prevents the brain from effectively controlling movement or maintaining posture and balance.

The specific types of brain damage that can cause spastic quadriplegia, according to the National Institute of Neurological Disorders and Stroke, is damage to the white matter of the brain, abnormal development of the brain, bleeding in the brain, and severe lack of oxygen in the brain.

The spastic quadriplegia type of cerebral palsy affects all four limbs, the trunk and the face, and often causes moderate-to-severe intellectual disability. Spastic quadriplegia causes children to experience severe muscle stiffness in their limbs and a loose, floppy neck. The condition commonly prevents them from walking or speaking clearly. In addition, it can cause frequent and uncontrollable seizures. Chronic pain develops due to severely tight muscles.

While spastic quadriplegia cannot be cured, treatment can help manage the condition’s associated symptoms and help many children eventually have near-normal lives as adults. Therapy efforts can include physical, occupational, recreational, speech and language therapies, medications to relax stiff muscles, surgery to lengthen muscles, and assistive devices to help with communication and mobility.

Findings: Effects of Cannabis on Spastic Quadriplegia

The limited amount of research on cannabis’ effect on cerebral palsy conditions suggests that marijuana does offer therapeutic benefits. Adults with cerebral palsy participating in a survey on the effectiveness of treatments responded that marijuana, though rarely used, provided the most pain relief (Hirsh, Kratz, Engel & Jensen, 2011). In addition, a case study of a 45-year-old man with a type of cerebral palsy that caused seizures found that marijuana treatment caused a marked improvement (Mortati, Dworetzky & Devinsky, 2007). One animal research study study found that treating newborn mice or rats with white matter brain damage mimicking that of cerebral palsy provided neuroprotective effects and protected the developing brain (Shouman, et al., 2006).

There’s markedly more research demonstrating cannabis’ medical efficacy for symptoms like spasms, seizures and pain associated with other conditions that support its use as a treatment opportunity for spastic quadriplegia. The two major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD) act upon the endocannabinoid system via the cannabinoid receptors CB1 and CB2, which reduce muscle spasms, seizures and pain.

Studies have shown cannabis to be effective at significantly reducing muscle spasms in patients with multiple sclerosis (Syed, McKeage & Scott, 2014) (Pertwee, 2002). Multiple scientific reviews have concluded that CBD is a well-tolerated and promising therapeutic treatment that has demonstrated the ability to reduce or even eliminate seizures (Blair, Deshpande & DeLorenzo, 2015) (Rosenberg, Tsien, Whalley & Devinsky, 2015) (Szaflarski & Bebin, 2014) (Devinsky, et al., 2014). One case report analyzing a young epileptic girl found that medical marijuana brought the child’s seizure frequency from nearly 50 convulsive seizures per day to 2-3 nocturnal convulsions per month. In addition, the child was able to wean from the additional antiepileptic drugs she had been taking (Maa & Figi, 2014). In addition, cannabis has demonstrated the ability to significantly lower pain levels in patients suffering from neuropathic and nociceptive pain, and has even shown it can help manage pain that has proven refractory to other treatments (Boychuck, Goddard, Mauro & Orellana, 2015) (Lynch & Campbell, 2011). Because of its effectiveness, cannabis is prevalent among the chronic pain population to lower pain levels and improve sleep and mood (Ware, et al., 2003).

States That Have Approved Medical Marijuana for Spastic Quadriplegia

Currently, Louisiana is the only state to have approved medical marijuana specifically for the treatment of spastic quadriplegia.

A number of other states will consider allowing medical marijuana to be used for the treatment of spastic quadriplegia 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”).

In Washington D.C., any condition can be approved for medical marijuana as long as a DC-licensed physician recommends the treatment.

In addition, fifteen states have approved medical marijuana for the treatment of spasms, a symptom associated with spastic quadriplegia. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington. Connecticut allows marijuana to be used to treat intractable spasticity and New Jersey allows it for spasticity disorders.

Several states approve medical marijuana to treat seizures, which often occur from spastic quadriplegia. These states include: Alaska, Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, North Dakota, Ohio, Oregon, Pennsylvania (intractable seizures), Rhode Island, Tennessee (intractable seizures), Vermont, Washington and West Virginia (intractable seizures).

Several states have approved medical marijuana specifically to treat “chronic pain,” which is a symptom that can arise in individuals with spastic quadriplegia. These states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New Mexico, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont and West Virginia.  The states of Nevada, New Hampshire, North Dakota, Ohio and Vermont allow medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania, Washington and West Virginia have approved cannabis for the treatment of “intractable pain.”

Recent Studies on Cannabis’ Effect on Spastic Quadriplegia

  • Marijuana found to cause marked improvement in adult man with cerebral palsy and epilepsy.
    Marijuana: an effective antiepileptic treatment in partial epilepsy? A case report and review of the literature.
    (https://goo.gl/0nWcyV)
  • Cannabinoids provided neuroprotection in mice and rats with brain lesions mimicking brain damage found in humans with cerebral palsy.
    Endocannabinoids potentially protect the newborn brain against AMPA-kainate receptor mediated excitotoxic damage.
    (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751782/)

References:

Blair, R.E., Deshpande, L.S., and  DeLorenzo, R.J. (2015, September). Cannabinoids: is there a potential treatment role in epilepsy? Expert Opinion on Pharmacology, 16(13), 1911-4. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4845642/.

Boychuck, D.G., Goddard, G., Mauro, G., and Orellana, M.F. (2015 Winter). The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. Journal of Oral & Facial Pain and Headache, 29(1), 7-14. Retrieved from https://goo.gl/R28LWD.

Cerebral Palsy: Hope Through Research. (2015, July 2). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#268993104.

Devinsky, O., Cilio, M.R., Cross, H., Fernandez-Ruiz, J., French, J., Hill, C., Katz, R., Di Marzo, V., Jutras-Aswad, D., Notcutt, W.G., Martinez-Orgado, J., Robson, P.J., Rohrback, B.G., Thiele, E., Whalley, B., and Friedman, D. (2014, June). Cannabidiol: pharmacology and potential therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia, 55(6), 791-802. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707667/.

Facts About Cerebral Palsy. (2015, July 13). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/ncbddd/cp/facts.html.

Hirsch, A.T., Kratz, A.L., Engel, J.M., and Jensen, M.P. (2011, March). Survey results of pain treatments in adults with cerebral palsy. American Journal of Physical Medicine & Rehabilitation, 90(3), 207-216. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036542/.

Lynch, M.E., and Campbell, F. (2011, November). Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomized trials. British Journal of Clinical Pharmacology, 72(5), 735-744. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243008/.

Maa, E. and Figi, P. (2014, June). The case for medical marijuana in epilepsy. Epilepsia, 55(6), 783-6. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/epi.12610/full.

Mortati, K., Dworetzky, B., and Devinsky, O. (2007, Spring). Marijuana: an effective antiepileptic treatment in partial epilepsy? A case report and review of the literature. Reviews in Neurological Diseases, 4(2), 103-6. Retrieved from https://goo.gl/0nWcyV.

Pertwee, R.G. (2002, August). Cannabinoids and multiple sclerosis. Pharmacology & Therapeutics, 95(2), 165-74. Retrieved from http://www.sciencedirect.com/science/article/pii/S0163725802002553.

Rosenberg, E.C., Tsien, R.W., Whalley, B.J., and Devinsky, O. (2015, August 18). Cannabinoids and Epilepsy. Neurotherapeutics, Epub ahead of print. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604191/.

Shouman, B., Fontaine, R.H., Baud, O., Schwendimann, L., Keller, M., Spedding, M., Lelievre, V., and Gressens, P. (2006, June). Endocannabinoids potentially protect the newborn brain against AMPA-kainate receptor mediated excitotoxic damage. British Journal of Pharmacology, 149(4), 442-51. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1751782/.

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. Retrieved from http://link.springer.com/article/10.1007%2Fs40265-014-0197-5.

Szaflarski, J.P., and Bebin, E.M. (2014, December). Cannabis, cannabidiol, and epilepsy–from receptors to clinical response. Epilepsy & Behavior, 41, 277-82. Retrieved from http://www.epilepsybehavior.com/article/S1525-5050(14)00413-2/fulltext.

Ware, M.A., Doyle, C.R., Woods, R., Lynch, M.E., and Clark, A.J. (2003, March). Cannabis use for chronic non-cancer pain: results of a prospective survey. Pain, 102(1-2). Retrieved from http://journals.lww.com/pain/Abstract/2003/03000/Cannabis_use_for_chronic_non_cancer_pain__results.23.aspx.

  • October 6, 2015