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Parkinson’s – Research with cannabinoids

Parkinson’s disease is a progressive disease of the nervous system that affects almost 4 million people worldwide and around 200,000 in Brazil alone. Studies have shown that cannabis can slow the progression of the disease and help patients control associated symptoms.

Parkinson’s Disease Overview

Parkinson’s is a chronic neurodegenerative disease that causes the malfunction and eventual death of neurons in the brain. The condition usually begins with small tremors and gradually develops, eventually causing muscle stiffness and decreased speed of movement. Some neurons produce dopamine, a chemical compound that sends messages to the part of the brain that controls movement. Thus, as neurons die, the amount of dopamine decreases, affecting motor control.

Although the cause of Parkinson’s remains unknown, genetics and environmental factors likely play a role in the development of the disease. Specific genetic mutations have been identified in patients and having a close relative with Parkinson’s increases the chances of developing the disease. Exposure to toxins like pesticides and herbicides can also increase your risk.

Symptoms associated with Parkinson’s disease include tremors, bradykinesia (slowness of movement), muscle rigidity and postural instability. Tremors can occur in the hands, arms, legs, jaw and face. It is common for Parkinson’s to be accompanied by depression, cognitive problems, swallowing problems, sleep problems, fatigue and pain. It is also possible to occur parallel cases of psychosis, a serious impairment of mental and emotional faculties that causes a loss of contact with reality.

There is no cure for the disease. However, treatments can help alleviate symptoms. Medications can be used to help with movement, locomotion and tremors by increasing dopamine levels. In some cases, surgery may be necessary to regulate certain regions of the brain.

Effects of cannabis on Parkinson’s

Evidence suggests that cannabis has the potential to slow disease progression by offering neuroprotective effects. The cannabinoids found in cannabis are capable of suppressing excitotoxicity, glial activation and oxidative damage that causes the degeneration of dopamine-releasing neurons. Additionally, they improve the cell’s mitochondrial function and activate the removal of cellular debris, encouraging neuronal health 6, 7, 9, 16. Researchers have discovered evidence that a specific cannabinoid found in cannabis, THC (tetrahydrocannabinol), helps in the treatment of Parkinson’s disease by helping to prevent damage caused by free radicals and activating a receptor that stimulates the formation of new mitochondria 16.

Another important cannabinoid found in cannabis, CBD (cannabidiol), has also been shown to support mitochondria in neurons, leading researchers to conclude that CBD should be considered a possible therapeutic option for neurodegenerative diseases such as Parkinson’s due to its neuroprotective properties 3, 4.

Studies have also shown that cannabinoids interact with the CB1 and CB2 receptors of the endocannabinoid system to modulate the release of dopamine 12. Research also shows that cannabis can help Parkinson’s patients manage their symptoms. One study noted that after smoking cannabis, patients with Parkinson’s disease saw significant improvements in motor control, tremors, rigidity, bradykinesia, sleep, and pain 8.

Other studies have confirmed that cannabis has the ability to reduce bradykinesia and tremors 6, 7. More recently, a clinical study found that cannabis significantly reduced pain and motor symptoms in Parkinson’s patients 30 minutes after administration 11.

Significant improvements were observed in the well-being and quality of life of Parkinson’s patients who received daily doses of CBD for a week 1. One case study found that patients treated with CBD – although they did not notice significant improvements in motor control or other symptoms – showed a substantial and immediate reduction in events related to REM sleep behavior disorders 1.


In a survey, although only 4.3% of patients responded that they used cannabis to treat their symptoms, the use of the plant appeared as a more effective treatment option than vitamins, massage, art therapy, music therapy and relaxation 5. An anonymous questionnaire sent to patients with Parkinson’s disease found that 25% of the 339 respondents had consumed cannabis, with 45.9% of them reporting some type of benefit 14.

Additionally, CBD may help Parkinson’s disease patients who experience psychosis. Four weeks of cannabidiol use caused them to experience a significant decrease in psychotic symptoms, as assessed by the Brief Psychiatric Rating Scale (BPRS) and the Assessment of Psychotic Symptoms of Patients with Parkinson’s 17.

Recent studies on cannabis in Parkinson’s disease

References:

  1. Chagas, M.H., Eckeli, A.L., Zuardi, A.W., Pena-Pereira, M.A., Sobreira-Neto, M.A., Sobreira, E.T., Camilo, M.R., Bergamaschi, M.M., Schenck, C.H., Hallack, J.E., Tumas, V., and Crippa, J.A. (2014, October). Cannabidiol can improve complex sleep-related behaviours associated with rapid eye movement sleep behaviour disorder in Parkinson’s disease patients: a case serious. Journal of Clinical Pharmacy and Therapeutics, 39(5), 564-6. Retrieved from
    http://onlinelibrary.wiley.com/wol1/doi/10.1111/jcpt.12179/full.
  2. Chagas, M.H., Zuardi, A.W., Tumas, V., Pena-Pereira, M.A., Sobreira, E.T., Bergamaschi, M.M., dos Santos, A.C., Teixeira, A.L., Hallak, J.E., and Crippa, J.A. (2014, November). Effects of cannabidiol in the treatment of patients with Parkinson’s disease: an exploratory double-blind trial. Journal of Psychopharmacology, 29(11), 1088-98. Retrieved from
    http://journals.sagepub.com/doi/pdf/10.1177/0269881114550355.
  3. da Silva, V.K., de Freitas, B.S., da Silva Dornelles, A., Nery, L.R., Falavigna, L., Ferreira, R.D., Bogo, M.R., Hallak, J.E., Zuardi, A.W., Crippa, J.A., and Schroder, N. (2014, February). Cannabidiol normalizes caspase 3, synaptophysin, and mitochondrial fission protein DNM1L expression levels in rats with brain iron overload: implications for neuroprotection. Molecular Neurobiology, 49(1), 222-33. Retrieved from
    http://link.springer.com/article/10.1007%2Fs12035-013-8514-7.
  4. Fagan, S.G., and Campbell, V. A. (2014). The influence of cannabinoids on generic traits of neurodegeneration. British Journal of Pharmacology, 171(6), 1347–1360. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3954477/.
  5. Finseth, T.A., Hedeman, J.L., Brown, R.P. 2nd, Johnson, K.I., Binder, M.S., and Kluger, B.M. (2015). Self-reported efficacy of cannabis and other complementary medicine modalities by Parkinson’s disease patients in Colorado. Evidence-Based Complementary and Alternative Medicine, 2015, 874849. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363882/.
  6. Garcia-Arencibia, M., Garcia, C., and Fernandez-Ruiz, J. (2009, December). Cannabinoids and Parkinson’s disease. CNS & Neurological Disorders Drug Targets, 8(6), 432-9. Retrieved from
    http://www.eurekaselect.com/93569/article.
  7. Lastres-Becker, I., and Fernandez-Ruiz, J. (2006). An overview of Parkinson’s disease and the cannabinoid system and possible benefits of cannabinoid-based treatments. Current Medicinal Chemistry, 13(30), 3705-18. Retrieved from
    http://www.eurekaselect.com/58342/article.
  8. Lotan, I., Treves, T.A., Roditi, Y., and Djaldetti, R. (2014, March-April). Cannabis (medical marijuana) treatment for motor and non-motor symptoms of Parkinson disease: an open-label observational study. Clinical Neuropharmacology, 37(2), 41-4. Retrieved from
    http://journals.lww.com/clinicalneuropharm/pages/articleviewer.aspx?year=2014&issue=03000&article=00001&type=abstract.
  9. More, S.V., and Choi, D.K. (2015, April). Promising cannabinoid-based therapies for Parkinson’s disease: motor symptoms to neuroprotection. Molecular Neurodegeneration, 10, 17. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404240/.
  10. Parkinson’s disease. (2015, July 7). Mayo Clinic. Retrieved from
    http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/definition/con-20028488.
  11. Shohet, A., Khlebtovsky, A., Roizen, N., Roditi, Y., and Djaldetti, R. (2016, October 10). Effect of medical cannabis on thermal quantitative measurements of pain in patients with Parkinson’s disease. European Journal of Pain, doi: 10.1002/ejp.942 [Epub ahead of print]. Retrieved from
    http://onlinelibrary.wiley.com/doi/10.1002/ejp.942/full.
  12. Song, L., Yang, X., Ma, Y., Wu, N., and Liu, Z. (2014). The CB1 cannabinoid receptor agonist reduces L-DOPA-induced motor fluctuation and ERK1/2 phosphorylation in 6-OHDA-lesioned rats. Drug Design, Development and Therapy, 8, 2173–2180. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4226453/.
  13. Stampanoni Bassi, M., Sancesario, A., Morace, R., Centonze, D., and Iezzi, E. (2017, February). Cannabinoids in Parkinson’s Disease. Cannabis and Cannabinoid Research, 2(1), 21-29. Retrieved from
    http://online.liebertpub.com/doi/full/10.1089/can.2017.0002.
  14. Venderová, K., Růzicka, E., Vorísek, V., Visnovský, P. (2004, September). Survey on cannabis use in Parkinson’s disease: subjective improvement of motor symptoms. Movement Disorders, 19(9), 11-2-6. Retrieved from
    http://onlinelibrary.wiley.com/wol1/doi/10.1002/mds.20111/full.
  15. What is Parkinson’s Disease? (2015). Parkinson’s Disease Foundation. Retrieved from
    http://www.pdf.org/about_pd.
  16. Zeissler, M.L., Eastwood, J., McCorry, K., Hanemann, C.O., Zajicek, J.P., and Carrol, C.B. (2016, July 19). Delta-9-tetrahydrocannabinol protects against MPP+ toxicity in SH-SY5Y cells by restoring proteins involved in mitochondrial biogenesis. Oncotarget, 7(29), 46603-46614. Retrieved from
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216821/.
  17. Zuardi, A.W., Crippa, J.A., Hallak, J.E., Pinto, J.P., Chagas, M.H., Rodrigues, G.g., Dursun, S.M., and Tumas, V. (2009, November). Cannabidiol for the treatment of psychosis in Parkinson’s disease. Journal of Psychopharmacology, 23(8), 979-83. Retrieved from
    http://journals.sagepub.com/doi/pdf/10.1177/0269881108096519.
  18. Zuardi, A.W., (2008, September). Cannabidiol: from an inactive cannabinoid to a drug with wide spectrum of action. Revista Brasileira De Psiquiatria, 30(3), 271-80. Retrieved from
    http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462008000300015&lng=en&nrm=iso&tlng=en.

 

 

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