ALS

ALS is a progressive neurodegenerative disease of upper and lower motor neurons producing muscle weakness, spasticity, fasciculations, bulbar dysfunction, and respiratory failure, with median survival of 3–5 years from onset. Endocannabinoid signaling modulates excitotoxicity and neuroinflammation in preclinical ALS models, prompting clinical interest. NASEM (2017) rated evidence as insufficient to support or refute cannabinoids for ALS symptom management. The CANALS trial (Riva et al., Lancet Neurol 2019) randomized 59 ALS patients to nabiximols (Sativex) or placebo for 6 weeks and reported a modest but statistically significant improvement in the Modified Ashworth Scale for spasticity, with good tolerability; the trial was small and short-duration, and did not demonstrate disease modification ⚠️. Small open-label studies of dronabinol have reported symptomatic improvement in cramps and spasticity without effect on progression. → See also: Nabiximols, Sativex, Dronabinol, Spasticity.