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Smoking Cannabis Eases Tremors in Parkinson’s Disease

SYDNEY — Smoking cannabis appeared to reduce tremor and pain and improve sleep among Parkinson’s disease patients, researchers from Israel reported here.

Overall, patients’ scores on the standard Unified Parkinson’s Disease Rating Scale (UPDRS) averaged 33 before they smoked cannabis in the laboratory and averaged 24 after 30 minutes (P<0.01), Ruth Djaldetti, MD, of Tel Aviv University Israel, reported at her poster presentation at the International Congress on Parkinson’s Disease and Movement Disorders.

smoking marijuana cannabis tremors parkinsons disease“We not only saw improvement in tremor in these patients, but also in rigidity and in bradykinesia,” Djaldetti told MedPage Today. “I would recommend use of marijuana to my patients as a last resort if nothing else was working for them or if they had pain.”

Medical marijuana is legal in Israel for the treatment of Parkinson’s disease, Djaldetti explained. “All of these 20 patients were cannabis users before we studied them. They were tested before they smoked cannabis in the clinic and then they were tested 30 minutes after smoking.” The patients were about 66 years of age and had been diagnosed with Parkinson’s disease for a mean of 7.5 years.

Prior to smoking, the 20 patients had an average score of 7.5 in the tremor domain of the UPDRS, but after 30 minutes following smoking the average tremor score declined to 3.5 (P<0.001), she said. The rigidity score declined from 7.4 to 6.4 (P=0.007). The bradykinesia score declined from an average of 13.2 to an average of 8.6 (P<0.001).

“There had been reported marked reductions in the Israeli media about the ability of marijuana to reduce tremor,” Djaldetti said. “We saw a reduction in tremor but it was less dramatic in our clinic than on television. The patients told us that the beneficial effect of cannabis smoking lasts for about 2 to 3 hours.”

Since 1996, when Californians approved medical marijuana, 17 other states and the District of Columbia have also approved its use. It is still illegal under federal law, although the Obama Administration has signaled that enforcement of the federal ban in states that have legalized it is not a government priority. It is legal for medical use in Canada and in many other countries.

Karin Gmitterova, MD, assistant professor of neurology at the University of Bratislava in Slovakia, told MedPage Today, “There is a community of patients that shares their experiences in using alternative forms of medication … They are more experienced with cannabis smoking in the Czech Republic and patients report that is can be helpful.”

“It won’t replace levodopa, of course,” continued Gmitterova, who did not participate in the study. However, “The reduction in the UPDRS score that we see here is not only statistically significant but this is clinically important as well.”

“When doctors can’t help patients, they will find other methods of treatment through word of mouth or the Internet or from family members or friends,” he added.

Djaldetti said that the researchers “were more taken with the improvements in rigidity and bradykinesia. On cannabis they were able to improve their fine motor skills. We did not see an improvement in gait and posture. I doubt that increasing the size of this study would result in a significant finding for gait or posture.”

In addition, all of the patients in the study were already on medications for pain relief but those therapies were not providing the relief required, she noted. “We saw a dramatic reduction in pain in our patients and in their ability to sleep. When their pain was reduced, they slept better.”

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary source: Movement Disorder Society
Source reference: Lotan I, et al “Medical marijuana (cannabis) treatment for motor and non-motor symptoms in Parkinson’s disease. An open-label observational study” MDS 2013.

By Ed Susman