Cannabinoide bei multipler Sklerose?

Zusammenfassung

Cannabinoide werden von vielen Patienten mit MS als alternative Therapie von Spastik und Schmerzen angewendet. Pathophysiologische Überlegungen, experimentelle Ergebnisse, Fallberichte sowie kleine Fallserien deuten in der Tat günstige Effekte von Cannabinoiden auf diese Symptome an. Allerdings fanden neuere kontrollierte Studien keinen positiven Effekt auf die Spastik. Viele Patienten erleben subjektiv eine Symptombesserung unter Cannabinoiden, auch wenn die objektiven Parameter unverändert bleiben. Gravierende Nebenwirkungen von Cannabinoiden sind selten. Darüber hinaus könnten sich Cannabinoide aufgrund immunmodulatorischer Effekte günstig auf den Krankheitsverlauf der MS auswirken; klinische Daten hierzu liegen noch nicht vor. Zur Behandlung der MS gibt es derzeit kein zugelassenes Fertigarzneimittel, das Cannabinoide enthält. Solange nicht valide Daten aus prospektiven Studien vorliegen, kann der Einsatz von Cannabinoiden bei MS nicht empfohlen werden. Im Einzelfall und bei Symptomen, die auf übliche Maßnahmen nicht ansprechen, kann ein experimenteller Therapieversuch nach Protokoll mit Cannabinoiden gerechtfertigt sein.

Abstract

Many patients with MS consider cannabinoids as an alternative treatment for spasticity, pain, and other MS symptoms. Pathophysiological considerations, animal experiments, single case reports and a few small case series indicate indeed that cannabinoids may improve these symptoms. However, recent controlled clinical trials do not support this view. Many patients report subjective improvement after cannabinoids, even if the objective parameters remain unchanged. Serious side effects of cannabinoids are uncommon. Because of immunomodulatory properties; cannabinoids might positively influence the course of the disease. However, there are no clinical studies on the long-term effects of cannabinoids in MS. Cannabinoids cannot be recommended for general use in MS patients until reliable data from clinical trials is available. In selected patients with symptoms refractory to conventional treatment, an experimental therapy with cannabinoids may be justified.

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