MS (Multiple Sclerosis)

Multiple sclerosis is a chronic immune-mediated demyelinating disease of the central nervous system producing relapsing-remitting or progressive neurological deficits, including spasticity in roughly 80% of patients. The THC:CBD oromucosal spray nabiximols (Sativex) received European Medicines Agency (EMA)-country approvals beginning in 2010 as an add-on treatment for moderate-to-severe MS spasticity unresponsive to first-line antispastics. NASEM (2017) concluded there is substantial evidence that oral cannabinoids improve patient-reported MS spasticity symptoms, though evidence for clinician-measured spasticity (e.g., Ashworth scale) is less robust ⚠️. The Torres-Moreno et al. meta-analysis (2018) and the Koppel et al. American Academy of Neurology guideline (Neurology 2014) both supported oral cannabis extract and nabiximols for spasticity and MS-related central pain, while rating evidence weaker for tremor and bladder symptoms. → See also: Sativex, Nabiximols, THC, CBD, Spasticity.