Spinocerebellar ataxia is a group of inherited genetic disorders that cause the degeneration of the brain’s cerebellum. Studies have shown cannabis offers neuroprotective effects, therefore potentially limiting the progression of the disorder, and can help patients manage pain and spasms.
Overview of Spinocerebellar Ataxia
Spinocerebellar ataxia (SCA) is a group of progressive and degenerative genetic diseases that cause movement problems. There are many different types of spinocerebellar ataxia, each of which causes the cerebellum to degenerate that in turn causes a loss in muscle coordination. Most cases of spinocerebellar ataxia are hereditary.
Spinocerebellar ataxia can develop in people of all ages. Symptoms usually begin with coordination and balance problems. As the disease progresses, speech and swallowing difficulties, muscle spasms and stiffness, eye muscle weakness and involuntary movement and cognitive impairment often occur. Those with SCA will also often experience numbness, tingling or pain in their limbs, uncontrolled muscle tensing, muscle wasting and muscle twitching. People with SCA live about 10 to 20 years after symptoms first appear.
There is no cure for spinocerebellar ataxia and the disorder is often fatal. Treatment efforts typically focus on managing symptoms associated with the disorder and physical therapy to strengthen and reduce atrophy in muscles.
Findings: Effects of Cannabis on Spinocerebellar Ataxia
While research on cannabis’ direct effect on spinocerebellar ataxia is limited, studies have shown that cannabis has neuroprotective effects, suggesting that it could potentially limit the progression of the disease. Cannabinoids suppress excitotoxicity, glial activation and oxidative injury that cause the degeneration of the neurons. They improve the function of cell’s mitochondria and activation of cellular debris clearance, further encouraging neuron health (More & Choi, 2015) (Garcia-Arencibia, Garcia & Fernandez-Ruiz, 2009) (Lastres-Becker & Fernandez-Ruiz, 2006) (Zeissler, et al., 2013). A major cannabinoid found in cannabis, tetrahydrocannabinol (THC), has been shown to help in the treatment of Parkinson’s disease by preventing free radical damage and encouraging the formation of new mitochondria (Zeissler, et al., 2013). Cannabidiol (CBD), another major cannabinoid found in cannabis, has also demonstrated its ability to support the health of neural cells mitochondria, causing the researchers concluded that CBD should be considered as a potential therapeutic option in neurodegenerative disorders (da Silva, et al., 2014) (Zuardi, 2008). Cannabinoids have also shown to protect the brain in patients with Alzheimer’s disease by reducing the deleterious effects of amyloid-beta, reduce inflammation, and support the brain’s repair process by enhancing neurogenesis, or the birth of new cells (Campbell & Gowran, 2007).
Cannabis can also help spinocerebellar ataxia patients manage the muscle spasms and pain associated with their disease. Medical cannabis has been shown to significantly improve muscle spasticity, both in mice and clinical trials (Borgelt, Franson, Nussbaum & Wang, 2013) (Baker, et al., 2000). THC and CBD, through their activation of the CB1 and CB2 cannabinoid receptors, help regulate the excitatory and inhibitory neurotransmitters necessary to curtail spasms (Syed, McKeage & Scott, 2014) (Smith, 2002). Their activation of the CB1 and CB2 receptors also helps in the management of pain. These receptors regulate the release of neurotransmitter and central nervous system immune cells to manage pain levels (Woodhams, Sagar, Burston & Chapman, 2015). Studies reveal that THC and CBD effectively reduce pain associated with some cancer, neuropathy, spasticity, headache, migraines, and other acute pain and chronic pain conditions (Jensen, Chen, Furnish & Wallace, 2015) (Baron, 2015). They are effective against both neuropathic and nociceptive pain, and have shown to help manage pain that had previously proven refractory to other treatments (Boychuck, Goddard, Mauro & Orellana, 2015) (Wallace, et al., 2015) (Lynch & Campbell, 2011). One study found that 94% of HIV-positive patients reported an improvement in muscle pain and 90% reported an improvement in nerve pain after cannabis use (Woolridge, et al., 2005).
States That Have Approved Medical Marijuana for Spinocerebellar Ataxia
Currently, only the state of Illinois has approved medical marijuana for the treatment of spinocerebellar ataxia. 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 spinocerebellar ataxia 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”).
Seventeen states have approved medical marijuana for the treatment of spasms, which are commonly associated with spinocerebellar ataxia. These states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New Hampshire, Oregon, Rhode Island and Washington.
Several states have approved medical marijuana specifically to treat “chronic pain,” a symptom associated with spinocerebellar ataxia. 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 Spinocerebellar Ataxia
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. Retrieved from http://www.nature.com/nature/journal/v404/n6773/full/404084a0.html.
Baron, E.P. (2015, June). Comprehensive Review of Medicinal Marijuana, Cannabinoids, and Therapeutic Implications in Medicine and Headache: What a Long Strange Trip It’s Been… Headache, 55(6), 885-916. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1111/head.12570/full.
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. Retrieved from http://onlinelibrary.wiley.com/wol1/doi/10.1002/phar.1187/full.
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.
Campbell, V. A., & Gowran, A. (2007). Alzheimer’s disease; taking the edge off with cannabinoids? British Journal of Pharmacology, 152(5), 655–662. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2190031/.
Cao, C., Li, Y., Liu, H., Bai, G., Mayl, J., Lin, X., Sutherland, K., Nabar, N., and Cai, J. (2014). The potential therapeutic effects of THC on Alzheimer’s disease. Journal of Alzheimer’s Disease, 42(3), 973-84. Retrieved from http://content.iospress.com/articles/journal-of-alzheimers-disease/jad140093.
da Silva, V.K., de Freitas, B.S., da Silva Dornelles, A., Nery, L.R., Falavigna, L., Ferreira, R.D., Bogo, M.R., Hallak, J.E., Zuardi, A.W., Crippa, J.A., and Schroder, N. (2014, February). Cannabidiol normalizes caspase 3, synaptophysin, and mitochondrial fission protein DNM1L expression levels in rats with brain iron overload: implications for neuroprotection. Molecular Neurobiology, 49(1), 222-33. Retrieved from http://link.springer.com/article/10.1007%2Fs12035-013-8514-7.
Eubanks, L.M., Rogers, C.J., Beuscher, A.E. 4th, Koob, G.F., Olson, A.J., Dickerson, T.J., and Janda, K.D. (2006, November-December). A molecular link between the active component of marijuana and Alzheimer’s disease pathology. Molecular Pharmaceuticals, 3(6), 773-7. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562334/.
Garcia-Arencibia, M., Garcia, C., and Fernandez-Ruiz, J. (2009, December). Cannabinoids and Parkinson’s disease. CNS & Neurological Disorders Drug Targets, 8(6), 432-9. Retrieved from http://www.eurekaselect.com/93569/article.
Jensen, B., Chen, J., Furnish, T., and Wallace, M. (2015, October). Medical Marijuana and Chronic Pain: a Review of Basic Science and Clinical Evidence. Current Pain and Headache Reports, 19(10), 524. Retrieved from http://link.springer.com/article/10.1007%2Fs11916-015-0524-x.
Lastres-Becker, I., and Fernandez-Ruiz, J. (2006). An overview of Parkinson’s disease and the cannabinoid system and possible benefits of cannabinoid-based treatments. Current Medicinal Chemistry, 13(30) 3705-18. Retrieved from http://www.eurekaselect.com/58342/article.
Lotan, I., Treves, T.A., Roditi, Y., and Djaldetti, R. (2014, March-April). Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study. Clinical Neuropharmacology, 37(2), 41-4. Retrieved from http://journals.lww.com/clinicalneuropharm/pages/articleviewer.aspx?year=2014&issue=03000&article=00001&type=abstract.
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/.
More, S.V., and Choi, D.K. (2015, April). Promising cannabinoid-based therapies for Parkinson’s disease: motor symptoms to neuroprotection. Molecular Neurodegeneration, 10, 17. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404240/.
NINDA Ataxias and Cerebellar or Spinocerebellar Degeneration Information Page. (2015, July 17). National Institute of Neurological Disorders and Stroke. Retrieved from http://www.ninds.nih.gov/disorders/ataxia/ataxia.htm.
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.
Spinocerebellar ataxia. (n.d.). Genes and Disease. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK22234/.
Spinocerebellar ataxia type 1. (2015, November 18). Genetics Home Reference. Retrieved from http://ghr.nlm.nih.gov/condition/spinocerebellar-ataxia-type-1.
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.
Wallace, M.S., Marcotte, T.D., Umlauf, A., Gouaux, B., and Atkinson, J.H. (2015, July). Efficacy of Inhaled Cannabis on Painful Diabetic Neuropathy. Journal of Pain, 16(7), 616-27. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5152762/.
Woodhams, S.G., Sagar, D.R., Burston, J.J., and Chapman, V. (2015). The role of the endocannabinoid system in pain. Handbook of Experimental Pharmacology, 227, 119-43. Retrieved from http://link.springer.com/chapter/10.1007%2F978-3-662-46450-2_7.
Woolridge, E., Barton, S., Samuel, J., Osario, J., Dougherty, A., and Holdcroft, A. (2005, April). Cannabis use in HIV for pain and other medical symptoms. Journal of Pain and Symptom Management, 29(4), 358-67. Retrieved from http://www.jpsmjournal.com/article/S0885-3924(05)00063-1/fulltext.
Zeissler, M.L., Eastwood, J., Hanemann, C.O., Zajicek,J., and Carroll, C., (2013). 9-Tetrahydrocannabinol is protective through PPARy dependent mitochondrial biogenesis in a cell culture model of Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry, 84. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216821/.
Zuardi, A.W., (2008, September). Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. Revista Brasileira De Psiquiatria, 30(3), 271-80. Retrieved from http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462008000300015&lng=en&nrm=iso&tlng=en.