Effectiveness and Safety Evaluation of Medical Cannabis in Parkinson’s disease in Chiang Mai Neurological Hospital
Keywords:
Medical cannabis, Parkinson patient, SafetyAbstract
Background : Parkinson’s disease (PD) is one of the chronic disorders due to degeneration of a nervous system. Recent medical treatments are unable to cure or prevent progression. To alleviate the symptoms, there are needs to find efficient medications.
Objective : This study aimed to evaluate efficacy and safety of medical cannabis extract as part of treatment for patients with PD.
Methods : This was an open label study comparing 12 individuals’ conditions before and after administration of medical cannabis. The follow-up visits were appointed at the end of 1st, 3rd and 6th months after the first administration. The collected information included records of any adverse effects, Unified Parkinson’s Rating Scale Disease (UPDRS), The Pittsburgh Sleep Quality Index (PSQI), Stress Test, Patient Health Questionnaire (PHQ9) and Self-Rating Anxiety Scale (SAS).
Result : 8 of 12 participants (66.7%) were male with overall average age of 60.3 years and average duration after onset was 7.5 years. Participants were in stage 2 (41.7%) or 3 (58.3%). The dose was between two and five drops daily. After six months, there were statistically significant differences (p<0.05) of symptoms and severity of PD, level of stress, and quality of sleep between baseline and six-month assessments. The reported adverse effects included dry throat (16.7%), depression (8.3%), and dizziness (8.3%).
Conclusion : The administration of cannabis in elderly participants described in this study was safe with minor adverse effects and tended to reduce symptoms and severity of PD, level of stress and improve quality of sleep.
References
Pitayasiri R, Phanthumajinda K, Boonnak S. Treatable parkinson’s disease. Bangkok: Chulalongkorn Center of Excellence for Parkinson’s Disease and Related Disorders, King Chulalongkorn Memorial Hospital, Thai Red Cross Society; 2007.
JankovicJ, Tolosa E. Parkinson’s disease & moment disorder (6th ed.). Philadelphia: Wolters Kluwer. 2015.
Hirsch L, Jette N, Frolkis A, Steeves T, Pringsheim T. The incidence of parkinson’s disease: a systematic review and meta-analysis.Neuroepidemiology 2016; 46:292-300.
Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of parkinson’s disease: a systematic review and meta-analysis.Mov Disord. 2014; 29:1583-90.
GBD 2016 Parkinson’s disease Collaborators. Global, regional, and national burden of parkinson’s disease,1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2018;17:939-53.
Muangpaisan W, Hori H, Brayne C. Systematic review of the prevalence and incidence of parkinson’s disease in Asia. J Epidemiol 2009; 19:281-93.
Bhidayasiri R, Wannachai N, Limpabandhu S, Choeytim S,Suchonwanich Y, Tananyakul S, et al. A national registry to determine the distribution and prevalence of parkinson’s disease in Thailand: implications of urbanization and pesticides as risk factors for parkinson’s disease. Neuroepidemiology 2011;37:222-30.
Svenningsson P, Westman E, Ballard C, Aarsland D. Cognitive impairment in patients with parkinson’s disease:diagnosis,biomarkers, and treatment. Lancet Neurol 2012; 11:697-707.
Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17:427-42.
Halliday GM, McCann H. The progression of pathology in parkinson’s disease. Ann N Y Acad Sci. 2010;1184:188-95.
Bumrungrad Hospital. Parkinson’s disease [Internet]. Bangkok [cited 2019 Nov 13]. Available from:https://www.bumrungrad.com/th/conditions/parkinson-disease.
Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, et al. Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 2014; 82:1556-63.
The Government Pharmaceutical Organization and Alliances.Report of academic conference conclusion: The study and development of marijuana and hemp extracts for national development. [Internet]. Bangkok: GPO; 2018 [cite 2019 Nov 14].Available from: https://www2.gpo.or.th/LinkClick.aspx?Fileticke= IfSuh2BT-FA%3d&tabid=388&mid=1186&language=th-TH
Lotan I, Treves TA, Roditi Y, Djaldetti R. Cannabis (medical marijuana) treatment for motor and non–motor symptoms of parkinson disease: an open-label observational study. Clin Neuropharmacol 2014; 37:41-4.
Shohet A, Khlebtovsky A, Roizen N, Roditi Y, Djaldetti R. Effect of medical cannabis on thermal quantitative measurements of pain in patients with parkinson’s disease. Eur J Pain 2017;21:486-93.
Balash Y, Schleider LB, Korczyn AD, Shabtai H, Knaani J, Rosenberg A, et al. Medical cannabis in parkinson disease: real-life patients’experience. Clin Neuropharmacol 2017; 40:268-72.
Kindred JH, Li K, Ketelhut NB, Proessl F, Fling BW, Honce JM, et al. Cannabis use in people with parkinson’s disease and multiple sclerosis: a web-based investigation. Complement Ther Med 2017; 33:99-104.
Fahn S, Elton RL. Unified parkinson’s disease rating scale. In:Fahn S, Marsden CD, Goldstein M, Calne DB, editors.Recent developments in parkinson’s disease, Vol. 2, Florham Park:Macmillan Health Care Information;1987.
Jirapramukpitak T, Tanchaiswad W. Sleep disturbances among nurses of Songklanagarind Hospital. J Psychiatr Assoc Thailand 1997; 42:123-32.
Silpakit O. Srithanya stress scale. Journal of Mental Health of Thailand. 2008; 16:177-85.
Department of Mental Health, Working-Committee of clinical practice guideline of major depressive disorder for general practitioner in primary and secondary care hospital. Clinical practice guideline of major depressive disorder for general practitioner: CPG-MDD-GP [Internet]. 2010 [cited 2020 Jan15].Available from:https://www.thaidepression.com/www/ news54/CPG-MDD-GP.pdf.
Zung WW. A rating instrument for anxiety disorders.Psychosomatics 1971; 12:371-9.
Bougea A, Koros C, Simitsi AM, Chrysovitsanou C, Leonardos A,Stefanis L. Medical cannabis as an alternative therapeutics for parkinsons’ disease: systematic review. Complement Ther Clin Pract 2020; 39:101154.
Sieradzan KA, Fox SH, Hill M, Dick JP, Crossman AR, Brotchie JM. Cannabinoids reduce levodopa-induced dyskinesia in parkinson’s disease: a pilot study. Neurology2001; 57: 2108-11.
Carroll CB, Bain PG, Teare L, Liu X, Joint C, Wroath C, et al.Cannabis for dyskinesia in parkinson disease: a randomized double-blind crossover study. Neurology 2004; 63:1245-50.
Mesnage V, Houeto JL, Bonnet AM, Clavier I, Arnulf I, Cattelin F, et al. Neurokinin B, neurotensin, and cannabinoid receptor antagonists and parkinson disease. Clin Neuropharmacol 2004;27:108-10.
Chagas MH, Zuardi AW, Tumas V, Pena-Pereira MA, Sobreira ET,Bergamaschi MM, et al. Effects of cannabidiol in the treatment of patients with parkinson’s disease: an exploratory double-blind trial. J Psychopharmacol 2014;28:1088-98.
de Faria SM, de Morais Fabrício D, Tumas V, Castro PC, Ponti MA,Hallak JE, et al. Effects of acute cannabidiol administration on anxiety and tremors induced by a Simulated Public Speaking Test in patients with Parkinson’s disease. J Psychopharmacol 2020; 34:189-96.
Sangsawang C. Stress and coping in older persons with parkinson’s disease [Dissertation]. Chiangmai:Chiangmai University; 2017.
Zuardi AW, Crippa JA, Hallak JE, Pinto JP, Chagas MH, Rodrigues GG, et al. Cannabidiol for the treatment of psychosis in parkinson’s disease. J Psychopharmacolo 2009; 23:979-83.
Finseth TA, Hedeman JL, Brown RP, Johnson KI, Binder MS, Kluger BM. Self-reported efficacy of cannabis and other complementary medicine modalities by Parkinson’s disease patients in Colorado.Evid Based Complement Alternat Med 2015; 2015: 874849.
Frankel JP, Hughes A, Lees AJ, Stern GM. Marijuana for parkinsonian tremor. J Neurol Neurosurg Psychiatry 1990; 53:436.
Tasanabunyong K. Result of Treatment and safety of the marijuana oil extract in parkinson patients in Sakonnakorn Hospital. Thai Journal of Neurology 2020; 36:22-33.
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