NORML: 多發性硬化症 MS

多發性硬化症（MS）是一種慢性退行性中樞神經系統疾病，會引起炎症、肌肉無力以及運動協調能力喪失。隨著時間的推移，MS患者通常會變得永久性殘疾，在某些情況下，該疾病可能是致命的。根據美國國家多發性硬化症協會的資料，每週約有200人被診斷為此病，通常發病年齡為20至40歲。

調查數據顯示，MS患者經常求助於大麻來緩解症狀，[1-3] 一些研究估計，近一半的MS患者會報告目前使用該物質。[4-5] 許多患者表示，他們使用大麻後，症狀有所改善，並能減少處方藥的使用。[6]

許多研究，包括隨機對照安慰劑試驗，都證實了大麻或全植物大麻萃取物在MS患者中的安全性和有效性。[7-20] 例如，在聖地牙哥大學贊助的一項臨床試驗中，"吸煙大麻在症狀和疼痛減輕方面優於安慰劑，對於那些對治療抵抗的痙攣患者而言，效果更為明顯。" [21] 近年來，包括加拿大、丹麥、德國、新西蘭、西班牙和英國等國家的衛生監管機構已批准在MS患者中處方使用植物來源的大麻萃取物。長期使用這些萃取物已被證明是安全且有效的。[22] 相對低劑量的植物來源萃取物在人體試驗中也顯示出良好的療效和耐受性。[23]

前臨床模型表明，大麻素除了提供症狀管理外，還可能抑制多發性硬化症（MS）的進展。2003年，倫敦大學神經學研究所的研究人員在《Brain》期刊發表文章，報告指出，合成大麻素激動劑WIN 55,212-2在多發性硬化症動物模型中提供了“顯著的神經保護”。研究人員總結道：“這項研究的結果很重要，因為它們表明，除了症狀管理之外，大麻可能還能減緩最終導致慢性殘疾的神經退行性過程，這可能對多發性硬化症及其他疾病有所影響。”[24] 其他研究人員也報告了類似的發現，記錄了“使用大麻素激動劑WIN 55,512-2處理EAE小鼠後，減少了它們的神經學殘疾和疾病進展。”[25] 植物來源的大麻素的使用也被證明能提升多發性硬化症患者的免疫功能，這表明大麻素對MS患者可能具有“改變疾病進程的潛力”。[26]

縱向試驗也表明，大麻療法可能會減緩多發性硬化症（MS）在人類中的臨床進展。[27] 一項對167名多發性硬化症患者進行的延長開放標籤研究的觀察數據結果顯示，使用全植物大麻素提取物能在長時間的治療過程中緩解疼痛、痙攣及膀胱失禁等症狀（研究參與者的平均治療期間為434天），且無需增加劑量。[28] 來自另一項為期兩年的開放標籤延長試驗的結果顯示，使用大麻提取物與選定多發性硬化症患者的神經病理性疼痛長期減少有關。平均而言，這項研究中的患者在服用大麻提取物的期間，需要的每日藥物劑量較少，且疼痛中位數得分隨著服用時間的延長而降低。[29] 研究人員指出，除非大麻素療法能夠停止MS的進展，否則這些結果在患有進行性疾病如MS的患者中不太可能出現。

儘管全球對使用大麻提取物治療MS的接受度逐漸提高，但並非所有患者對此類治療有反應。然而，在某些情況下，對提取物無反應的患者對草本大麻產品則表現出有利反應。[30] 這些結果強調，即使在已經可以處方醫療大麻提取物的法域內，大麻花仍應保持為合法的治療選項。

參考文獻

[1] Clark et al. 2004. Patterns of cannabis use among patients with multiple sclerosis. Neurology 62: 2098-2010.

[2] Rudroff and Honce. 2017. Cannabis and multiple sclerosis: The way forward. Frontiers in Neurology 8: 299.

[3] Banwell et al. 2016. Attitudes to cannabis and patterns of use among Canadians with multiple sclerosis. Multiple Sclerosis and Related Disorders 10: 123-126.

[4] Reuters News Wire. August 19, 2002. “Marijuana helps MS patients alleviate pain, spasms.”

[5] Braley et al. 2020. Cannabisnoid use among Americans with MS: Current trends and gaps in knowledge. Multiple Sclerosis Journal – Experimental, Translational and Clinical 6 [open access journal].

[6] McCormack et al. 2019. Multiple Sclerosis and use of medical cannabis: A retrospective review evaluating symptom outcomes. Neurology 92 (Supplement).

[7] Kindred et al. 2017. Cannabis use in people with Parkinson’s disease and Multiple Sclerosis: A Web-based investigation. Complementary Therapies in Medicine 33: 99-104.

[8] Farzaei et al. 2017. Efficacy and tolerability of phytomedicines in multiple sclerosis patients: A review. CNS Drugs 31: 867-889.

[9] Chong et al. 2006. Cannabis use in patients with multiple sclerosis. Multiple Sclerosis 12: 646-651.

[10] Rog et al. 2005. Randomized, controlled trial of cannabis-based medicine in central pain in multiple sclerosis. Neurology 65: 812-819.

[11] Wade et al. 2004. Do cannabis-based medicinal extracts have general or specific effects on symptoms in multiple sclerosis? A double-blind, randomized, placebo-controlled study on 160 patients. Multiple Sclerosis 10: 434-441.

[12] Brady et al. 2004. An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. Multiple Sclerosis 10: 425-433.

[13] Vaney et al. 2004. Efficacy, safety and tolerability of an orally administered cannabis extract in the treatment of spasticity in patients with multiple sclerosis: a randomized, double-blind, placebo-controlled, crossover study. Multiple Sclerosis 10: 417-424.

[14] Zajicek et al. 2003. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis: multicentre randomized placebo-controlled trial. The Lancet 362: 1517-1526.

[15] Page et al. 2003. Cannabis use as described by people with multiple sclerosis [PDF]. Canadian Journal of Neurological Sciences 30: 201-205.

[16] Wade et al. 2003. A preliminary controlled study to determine whether whole-plant cannabis extracts can improve intractable neurogenic symptoms. Clinical Rehabilitation 17: 21-29.

[17] Consroe et al. 1997. The perceived effects of smoked cannabis on patients with multiple sclerosis. European Journal of Neurology 38: 44-48.

[18] Meinck et al. 1989. Effects of cannabinoids on spasticity and ataxia in multiple sclerosis. Journal of Neurology 236: 120-122.

[19] Ungerleider et al. 1987. Delta-9-THC in the treatment of spasticity associated with multiple sclerosis. Advances in Alcohol and Substance Abuse 7: 39-50.

[20] Denis Petro. 1980. Marijuana as a therapeutic agent for muscle spasm or spasticity. Psychosomatics 21: 81-85.

[21] Corey-Bloom et al. 2012. Smoked cannabis for spasticity in multiple sclerosis: a randomized, placebo-controlled trial. CMAJ 10: 1143-1150.

[22] M. Trojano. 2016. THC:CBD observational study data: Evolution of resistant MS spasticity and associated symptoms. European Neurology 75: 4-8.

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[25] de Lago et al. 2012. Cannabinoids ameliorate disease progression in a model of multiple sclerosis in mice, acting preferentially through CB(1) receptor-mediated anti-inflammatory effects. Neuropharmacology 62: 2299-2308.

[26] Killestein et al. 2003. Immunomodulatory effects of orally administered cannabinoids in multiple sclerosis. Journal of Neuroimmunology 137: 140-143.

[27] Pryce et al. 2015. Neuroprotection in experimental autoimmune encephalomyelitis and progressive multiple sclerosis by cannabis-based cannabinoids. Journal of Neuroimmune Pharmacology 10: 281-292.

[28] Wade et al. 2006. Long-term use of a cannabis-based medicine in the treatment of spasticity and other symptoms of multiple sclerosis. Multiple Sclerosis 12: 639-645.

[29] Rog et al. 2007. Oromucosal delta-9-tetrahydrocannabinol/cannabidiol for neuropathic pain associated with multiple sclerosis: an uncontrolled, open-label, 2-year extension trial. Clinical Therapeutics 29: 2068-2079.

[30] Secca et al. 2016. The use of medical-grade cannabis in patients non-responders to nabiximols. Journal of Neurological Sciences 15: 349-351.

原文標題：《Multiple Sclerosis》

原文作者：NORML

原始網站：https://norml.org

翻譯者：大麻101

翻譯日期：2025年4月

翻譯聲明：本文章由原文翻譯而來，原文發表於NORML。如需閱讀原文，請訪問 https://norml.org/marijuana/library/recent-medical-marijuana-research/multiple-sclerosis/