Multiple sclerosis (MS) is an disease that affects the brain and spinal cord. In patients with multiple sclerosis, the immune system attacks the myelin, which is the protective substance that covers and insulates the nerve fibers. The deterioration of the myelin leads to nerve damage, affecting the axons, which causes communication problems between the brain and other parts of the body. While it is known that the multiple sclerosis is caused by the abnormal response of the immune system, the disease is labeled as immune-mediated disease instead of an autoimmune disease because the exact antigen or target is still unknown.
According to statistics, there are over 400,000 cases of multiple sclerosis in the United States with about 200 new cases reported each week.
The exact cause of multiple sclerosis is still undetermined. However, there are several theories that suggests the reason why patients develop multiple sclerosis. Causes range from vitamin D deficiency to viral infections. Another theory suggest that consuming too much salt might also contribute to the development of the disease.
Depending on the location of the affected nerve fibers, the symptoms of the disease might vary from person to person. Symptoms of multiple sclerosis include numbness or weakness in one or more limbs, partial or complete loss of vision, prolonged double vision, tingling or pain in parts of the body, electric shock sensations that occur with certain neck movements (Lhermitte sign), tremor, lack of coordination, slurred speech, fatigue, dizziness, bowel problems, and problems with bladder function.
There are four types of multiple sclerosis:
Relapsing-Remitting Multiple Sclerosis (RRMS)
RRMS is the most common ofthe disease. Patienst with this type of MS respond to treatment and then resolve. When new symptoms of appear, patients exerience temporary periods called relapses, flare-ups or exacerbations.
Secondary-Progressive Multiple Sclerosis (SPMS)
For patients diagnosed with SPMS, symptoms worsen gradually over time with or without the occurence of relapses and remissions. A patient is diagnosed with this type of MS when the problems caused by an exacerbation don’t fully resolve during remission.
Primary-Progressive Multiple Sclerosis (PPMS)
Occuring in about 10% of MS patients, PPMS is characterized by the gradual worsening of symptoms without episodes of remission or improvement of symptoms.
Progressive-Relapsing Multiple Sclerosis (PRMS)
A rare form of MS, patients with PRMS experience escalating symptoms over time and intermittent episodes of remission.
The available treatment options for multiple sclerosis aims to decrease the frequency of relapses and to delay the progression of the disease. Pharmaceutical drugs are administered via injection, intravenously, or orally.
While the exact mechanism is still unknown, inteferon therapies achieve anti-inflammatory and immunomodulatory effects for MS patients. However, patients might experience side effects with its usage such as flu-like symptoms, menstrual disorders, and increased spasticity. In some cases, patients develop severe depression.
Glatiramer acetate is an immunomodulatory treatment for MS patients. Doctors usually prescribe a daily injection of the drug for the treatment of RRMS. But with the usage of the drug, patients might experience side effects such as reactions at the injection site (eg. pain, redness, soreness, itching, swelling), nausea, vomiting, chills, joint aches, body aches, neck pain, back pain, double vision, headache, increased urge to urinate, weakness, runny nose, swelling in the hands or feet, vaginal itching or discharge, fever, chills, flu-like symptoms, sore throat, or sores on the mouth or lips.
Dimethyl furate is an immunomodulatory treatment for relapsing forms of MS. Usage may cause side effects such as flushing, redness, itching, burning feeling of the skin, stomach or abdominal pain, diarrhea, nausea, and vomiting.
Fingolimod is an oral drug used to treat relapsing forms of MS by reducing the frequency of clinical exacerbations and delay the accumulation of physical disability. However, usage might cause side effects such as headache, abnormal liver tests, diarrhea, cough, flu, sinusitis, back pain, abdominal pain, and pain in the arms or legs.
The exact mechanism of teriflunomide is not completely understood but it is used to treat patients with relapsing forms of MS. Usage might cause side effects such as liver problems, influenza, hair loss, nausea, diarrhea, burning or prickly feeling in the skin, and numbness or tingling in the hands or feet which is different from the patient’s MS symptoms.
Mitoxantrone is administered to patients with RRMS, PRMS or SPMS in order to treat worsening symptoms. Aside from that, this is also used to reduce neurologic disability andthe frequency of clinical exacerbations. Usage, however, might cause side effects such as nausea, diarrhea, constipation, heartburn, stomach pain, hair loss, menstrual disorders, runny nose, tiredness, depression, blue-green colored urine, or bluish color of the whites of the eyes after administration of the drug.
Natalizumab acts by preventing the inflammatory events that lead to the development of multiple sclerosis lesions. This is given to patients with rapidly progressing MS or high disease activity despite using an alternate MS therapy. Usage may cause side effects such as headaches, tiredness, joint or muscle pain, stomach pain, diarrhea, skin rashes, depression, painful menstrual cramps, and cold symptoms (eg. stuffy nose, sneezing, sore throat).
Alemtuzumab is used to decrease the relapse rate of patients with RRMS. But because of the risk of developing serious side effects (more than 1 in 100 patients), it is often limited to MS patients who have not responded to other treatment options. These serious side effects include overactive or underactive thyroid, infusion associated reactions (eg. headaches, rashes, fever, nausea), respiratory infections, urinary infections, decrease in white blood cless, changes in blood pressure, changes in heart reate, rashes, and musculoskeletal pain.
Multiple Sclerosis and Medical Marijuana
Various studies and anecdotes have shown that medical marijuana can be used to treat and help with the symptoms of various diseases and disorders. Because of the naturally occuring cannabinoid receptors of the body, cannabinoids (the substances found in medical marijuana) trigger these receptors and help alleviate symptoms.
In the case of multiple sclerosis, the use of medical marijuana will help in managing the symptoms associated with the disease because of its beneficial properties which includes anti-inflammation, pain relief, anti-spasmodic, anti-depressant, abdominal issues, and sleep disturbances. But because of issues of legality, further research is still very limited on the mechanism of these cannabinoids in helping manage the symptoms of the disease.