Medical Marijuana for Blepharospasm

(AND A BIT ON TRANSCRANIAL STIMULATION AS WELL)

BRIAN D. BERMAN, MD, MS • REPORTED BY BRYAN RENEHAN

This presentation: • Discussed the history and use of medical marijuana, • Reviewed the potential of cannabinoids to treat blepharospasm, and • Provided update on magnetic and electrical stimulation approaches for blepharospasm.

The Cannabis plant was cultivated from prehistoric times in China, India, Egypt and was planted in Virginia in 1611, and in Plymouth Colony in 1632. The plant has many chemical compounds, but our concern is with Tetrahydrocannabinol (THC) which it has in high concentrations and has a major psychoactive component and Cannabidiol (CBD) which is up to 40% of plant’s extract and does not cause a high.

The medical literature shows that as early as 1842 the plant was used as an analgesic and anticonvulsant. Over the years, it was used to treat insomnia, neuralgia, dysmenorrhea, and migraines.

Its use began to be outlawed with the Marijuana Tax Act, 1937 which removed 28 cannabis-containing medicines from the U.S., and it eventually became illegal to possess with the listing of the plant in the Controlled Substances Act, 1970 – Schedule I.

In recent years, most states have lessened restrictions on the use and possession of Cannabis. There are currently prescribed medications on the market including Dronabinol (MarinolTM) a Synthetic THC for Nausea, appetite stimulation, MS pain; Cannabidiol (EpidiolexTM) a CBD extract for Epilepsy (Dravet, LG) and Nabiximols (SativexTM) a 1:1 THC:CBD for Pain in MS and cancer.

Current uses of CBD are as a painkiller, antiinflammatory, antioxidant, anxiety reducer, antipsychotic and suppression of muscle spasms. Current uses of THC are as a painkiller, anti-inflammatory, antioxidant, euphoriant, and suppression of nausea and vomiting.

As for safety, it is believed that the use of CBD and THC is less addictive than many other drugs including alcohol and more on par with caffeine.

When using these compounds, the reported side effects include redness of the eyes, increased appetite and thirst, decreased salivation, increased heart rate and blood pressure, slow heart rate and low standing blood pressure (high doses), urinary frequency, decreased intraocular pressure, euphoria, relaxation, dysphoria, anxiety, panic, subjective time slowing, depersonalization, altered sense of body proportion, auditory/visual illusions and hallucinations, impaired balance and coordination, and impaired memory and problem solving. Cannabinoid studies in dystonia have been limited. They have been limited in scope and in some reported cases only dealt with one patient. The conclusion from the studies is that Cannabinoids seem to be effective, but further studies are required to determine their role as complementary treatment in dystonia.

There is currently an ongoing study funded by BEBRF -2019 BEBRF Research Grant Effect of Nonpsychoactive Cannabidiol as an Adjunct to Botulinum

Brian D. Berman, MD, MS

. . . it is believed that the use of CBD and THC is less addictive than many other drugs including alcohol and more on par with caffeine.

CONTINUED ON NEXT PAGE