ABSTRACT

Medical cannabinoids and their use in neurological diseases

The medicinal properties of cannabis obtained from Cannabis sativa or Cannabis indica have been known for thousands of years, but its chemical structure was not determined until mid-20th century. However, the discovery of delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD) and other phytocannabinoids made it possible to take advantage of their full potential and to synthesize their analogues. Both phytocannabinoids, their synthetic analogues and endocannabinoids are referred to as cannabinoids (CBs). There is also evidence of an endocannabinoid system and its relevance to certain physiological processes as well as the pathogenesis of multiple diseases, which has paved the way for attempts to use CBs in pharmacotherapy. Due to media interest and the increasing availability of CBs, many neurological patients are seeking information on whether they can benefit from their use. Despite promising pre-clinical studies on CBs, the existing clinical evidence is limited and heterogeneous, and points to various side effects. If the standard therapy fails to provide satisfactory benefits, the current recommendations allow cannabinoids to be considered for use in the treatment of neuropathic pain, certain symptoms of multiple sclerosis as well as seizures associated with Lennox-Gastaut or Dravet syndrome. At present, there is no evidence that would support the prescribing of cannabinoids for migraines and headaches, back pain, Alzheimer’s disease or movement disorders, such as Huntington’s disease, Parkinson’s disease or Tourette syndrome. Additional randomized and placebo-controlled studies are required to investigate the potential benefits from the use of cannabinoids for these conditions.

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