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Abstract & Commentary
Source: Zajicek J, et al. Cannabinoids for treatment of spasticity and other symptoms related to multiple sclerosis (CAMS study): Multicenter randomized placebo-controlled trial. Lancet. 2003;362:1517-1526.
In this randomized, placebo-controlled trial of 15 weeks’ duration, 667 patients (mean age, 50; mainly EDSS 6-9) with stable advanced multiple sclerosis (MS) were assigned to 1 of 3 groups: oral cannabis, oral tetrahydrocannabinol (THC), or placebo. Tablets were dosed according to body weight, approximately 0.25mg/kg, on average 6-8 of the 2.5 mg THC (Marinol) tablets on a b.i.d. divided-dose schedule. There was no treatment effect on the primary outcome (P = .40) of spasticity scores using the Ashworth scale. The estimated difference in mean reduction in the Ashworth spasticity score for patients taking cannabis extract vs placebo was 0.32 (95% CI, -1.04 to 1.67) and for those taking THC vs placebo was 0.94 (95% CI, 0.44 to 2.31). There was, however, evidence of a treatment effect on patient-reported spasticity and pain (P = .003). The improvement in self-reported spasticity occurred in 61% of patients on cannabis extract, 60% on THC, and 46% on placebo. There was also a suggestion of benefit in the 10-m timed ambulation.
Spasticity is a complex symptom with components of increased tone or stiffness, often complicated by pain limitations in mobility. Although no objective improvement in spasticity scores could be documented in this trial, the subjective self-reported benefits of cannabinoids could be meaningful in patients dealing with painful symptomatology of advanced disease. — Brian R. Apatoff, Associate Professor of Neurology, New York Presbyterian Hospital-Cornell Campus; Assistant Editor, Neurology Alert.