ALS

Amyotrophic lateral sclerosis (ALS) is a progressive nervous system disease which causes loss of muscle control due to nerve cells in the brain and spinal cord being affected

  • What is ALS?
  • ALS & Cannabinoids
  • Text references, literature discussion
    & clinical trials

What is ALS?

Definition
Amyotrophic lateral sclerosis (ALS) is a progressive nervous system disease that causes loss of muscle control due to nerve cells in the brain and spinal cord being affected. ALS is a fatal disease as it affects the control of muscles necessary to move, speak, eat, and breathe. Currently, there is no cure to treat ALS and people rarely experience pain in the early or later stages of ALS.1

Symptoms
The signs and symptoms depend on which motor neurons. are affected and therefore differ greatly from person to person. However, people with ALS may often experience slurred speech, muscle twitching, and weakness in the hands, feet, or limbs before spreading to the rest of the body.
Other common symptoms are:1

  • Difficulty performing normal daily activities
  • Lack of balance e.g. ripping and/or falling
  • Muscle cramps and spasticity
  • Difficulty swallowing
  • Change in behavior and cognitive processes

Cause
Research proposes that ALS can be possibly caused by a complex interaction between genetic and environmental factors, whereas heredity accounts for 5%-10% of the cases. Furthermore, the risk of developing ALS is increased with age. Environmental factors like smoking, exposure to toxins, and military service may lead to the development of ALS.1

  • Cannabinoids
  • Cannabinoid receptors
  • Endocannabinoids

  • THC
  • CBG
  • CBD

  • CB2
  • PPARγ

  • 2AG
  • Terpenes
  • Strains
  • Enzymes
  • Metabolites

Terpenes

Strains

  • MAGL

Metabolites

The connection between ALS
& cannabinoids

Als disease spinal cord brain

Clinical evidence proposes the involvement of the endocannabinoids system in the treatment of ALS, as cannabinoids may prevent both neuronal excitotoxicity and degeneration, and hence may help reduce disease progression and improve the quality of life in such patients.2

Furthermore, preclinical data suggest that cannabis exhibits antioxidative, anti-inflammatory, and neuroprotective effects.3

Other findings show that cannabinoids may also be used in the treatment of spasticity in patients with ALS.4

Note: If you have any further information relevant to the connection between ALS and cannabinoids, or find any of the information inaccurate, outdated or incomplete please contact us here.

Text references, literature discussion
& clinical trials

  • Text references
  • Literature discussion
  • Clinical trials
Review

Patients with ALS and reactive gliosis were shown to have an elevated level of CB2 in the spinal cord- and cortical motor neurons, as well as astrocytes but no changes, were observed in CB1, MAGL, or FAAH (Espejo-Porras et al., 2018a).

In the TDP-43 (A315T) mouse model of ALS, reactive gliosis can be reduced by THC-like substances. Also, motor performance can be ameliorated by THC-like substances via CB2 (Espejo-Porras et al., 2018b).

In the hSOD (G93A) mouse model of ALS, THC can help in preventing neuronal excitotoxicity, ameliorating motor performance, and increasing survival by 5% (Raman et al., 2004; Urbi et al., 2018).

In the hSOD(G93A) mouse model of ALS, it was shown that elevation of 2AG by MAGL inhibition can play a role in shielding against inflammation and neurodegeneration (Pasquarelli et al., 2017).

In the hSOD(G93A) mouse model of ALS, a synthetic cannabigerol derivative exhibited protective effects against reactive gliosis, preserved motor neurons, and attenuated weight loss via pparγ (Rodríguez-Cueto et al., 2018).

References
Clinical Trials

In a case report, it was found that the progression of some but not all symptoms of ALS may be slowed down upon treatment with CBD (Nahler, 2017).

 A multicenter, double-blind, randomized, placebo-controlled, phase 2 trial included 59 subjects with ALS to assess whether THC/CBD oromucosal spray (1/1 mix) may help reduce spasticity. Each dose contained 2.7 mg THC and 2.5 mg CBD and subjects were directed to use a maximum of 12 doses per 24h. Participants who were treated with THC/CBD oromucosal spray were shown to improve on the Modified Ashworth Scale by 0.11, whereas health deterioration was observed in the placebo group by 0.16 (effect size 0.32, p=0.01) (Riva et al., 2018).

In a cannabis user survey, 13 participants with ALS reported that the symptoms of appetite loss, depression, pain, spasticity, and drooling may be reduced when using cannabis, giving moderate effectiveness (Amtmann et al., 2004).

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