Cannabinoide bei Multipler Sklerose - therapeutisch sinnvoll?

Zusammenfassung

Seit Jahrhunderten werden Extrakte aus der Pflanze Cannabis sativa als Rausch- und Heilmittel gebraucht. Berichte von Patienten mit Multipler Sklerose (MS), die Marihuana rauchten und über eine positive Wirkung auf MS-assoziierte Symptome wie Spastik und Schmerz berichteten, haben Cannabis-Präparate wiederholt in die Diskussion als mögliche Therapie bei der MS gebracht. Allerdings sind nach vielen kleineren z. T. sehr heterogenen Studien erst kürzlich die Ergebnisse einer großen, multizentrischen, doppelblinden, plazebokontrollierten Studie zum Einsatz von Cannabinoiden in der Behandlung der Spastik und anderer Symptome bei der MS veröffentlicht worden. Basierend auf diesen Studien sowie auf Erkenntnissen aus der Grundlagenforschung und aus Experimenten in Tiermodellen ergeben sich Hinweise, dass Cannabinoide in der symptomatischen Therapie der MS sinnvoll sein könnten. Allerdings kann derzeit der breite Einsatz außerhalb von klinischen Studien nicht empfohlen werden. Darüber hinaus gibt es Hinweise auf immunmodulatorische und neuroprotektive Wirkmechanismen der Cannabinoide. Dieser Übersichtsartikel fasst den derzeitigen Stand der experimentellen und klinischen Forschung zum Einsatz von Cannabinoiden bei der Therapie der MS zusammen.

Abstract

For centuries extracts from the Cannabis sativa plant have been used for recreational use and as remedies. Anecdotal reports from patients with multiple sclerosis (MS) experiencing relief of their spasticity and pain after smoking marihuana have prompted discussions about a potential therapeutic application of cannabis preparations in MS. Only recently the first large, multicenter, double-blind, placebo controlled study was conducted evaluating the use of cannabinoids for treatment of spasticity and other symptoms related to MS. Based on this trial and previous uncontrolled observations together with insights from basic research and animal experiments there is reasonable evidence for the therapeutical employment of cannabinoids in the treatment of MS related symptoms. Furthermore, data are arising that cannabinoids have immunomodulatory and neuroprotective properties. However, results from clinical trials do not allow the recommendation for the general use of cannabinoids in MS. This article summarizes the present knowledge of clinical and experimental research regarding the therapeutic potential of cannabinoids for the treatment of MS.

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