Multiple Sclerosis (MS) is an inflammatory demyelinating and neurodegenerative disorder of the central nervous system (CNS) affecting 2.5 million people globally. This disease is the main cause of non-traumatic neurologic disability in young adults and commonly characterised as problems with mobility; from numbness in the extremities to full body paralysis. Patients with MS are also known to experience the following symptoms: issues with vision, pain, muscle spasms and spasticity (muscle tightness and stiffness), fatigue, and cognitive impairment. The severity of symptoms varies between individuals and can change significantly over time. Many individuals with MS describe their symptoms as appearing through periods of relapse and remission.

The underlying cause of MS is yet to be fully determined, however, studies using rat models with induced autoimmune encephalomyelitis - the experimental animal form of human MS- found antigen-specific T cells to pass across the blood-brain barrier causing inflammation of the nervous tissue. As a result, myelinated neuron cells were degraded which led to paralysis.

What is Cannabidiol (CBD) Oil?

Cannabidiol (CBD) is the second most abundant component of the ​Cannabis Sativa plant. This component of the plant is non-psychoactive and is known to possess anti-inflammatory and neuroprotective effects against autoimmune diseases, such as rheumatoid arthritis and inflammatory bowel disease (IBS). Given the limited evidence on the pathophysiology of MS, medicinal cannabis and CBD have been proposed as a potentially effective treatment for the symptoms of MS.

In 2019, a drug known as Sativex - an oil spray which delivers 2.5mg of CBD and 2.7mg of tetrahydrocannabinol (THC) per dose- became available to many MS sufferers in England who suffer from ‘moderate’ to ‘severe’ spasticity that is not alleviated with the use of conventional pharmaceuticals. At present, Sativex is not available on the NHS in Scotland and Northern Ireland, however, this is something the ​MS Society UK​ is aiming to achieve.

A ​clinical study​ carried out in 2012, evaluated the effectiveness of Sativex in MS-related spasticity in a placebo-control trial. The findings of the study showed those who received Sativex achieved a better quality of life and lower spasticity than they did before starting the CBD: THC treatment. However, how CBD interacts with the biochemical systems underlying MS was not determined.

Effectiveness of CBD in Treating MS

A ​recent study​ published in 2018, administered CBD oil to experimental autoimmune encephalomyelitis mice models to investigate and understand the biochemical mechanisms in which CBD blocks MS-related symptoms.

Once female mice began to display symptoms of the disease, they were treated with either CBD or a placebo control agent. This experiment involved recording the development of the disease using clinical scores correlated with different symptom expressions. The clinical scores were recorded as 0 (no symptoms) to 6 (death), covering a broad spectrum of observable symptoms. The average clinical scores for each cohort were recorded daily and the scores for CBD treated animal models and the placebo control models were analysed and compared to determine the effectiveness of CBD therapy.

According to the study, the cohort of mice receiving the placebo drug developed the animal form of MS at a steady rate, with a maximum average clinical score of 4.1 throughout the duration of the experiment. In this particular experiment, a clinical score of 4.0 refers to a state of tetraparalysis - weakness of all four limbs. In comparison, the cohort of mice receiving CBD treatment displayed a slower onset of symptoms, with a maximum clinical score of 2,1, meaning these animal models experienced paralysis of the back limbs only.

Following on from these results, numerous i​n vivo​ and ​ex vivo​ tests were performed in an attempt to identify the exact biochemical systems responsible for the effectiveness of the CBD treatment. The study successfully identified two previously unknown systems by which CBD acts to alleviate the clinical effects of MS and MS-related symptoms. The first system is thought to positively impact the levels of anti-inflammatory cytokines and negatively impact the levels of pro-inflammatory cytokines. The second proposed system is thought to indirectly influence anti-inflammatory myeloid-derived suppressor cells (MDSCs) which blocks the production of T cells that normally occur in autoimmune conditions. This research has facilitated further cannabis and CBD related studies and provided a deeper understanding of the role of CBD within the human body. This is crucial if more effective drugs targeting autoimmune diseases are to be developed.

The researchers involved in the study concluded their work with the recommendation that ‘CBD may pose as a strong candidate for the treatment of MS and other various autoimmune disorders’ as a new non-psychoactive therapeutic. Future research of MDSC inhibition using CBD-based drugs could facilitate the design of new autoimmune disease treatments.

Human Trials using CBD Oil to Treat MS

Many scientists believe CBD could offer positive pharmacological effects due to its proven anti-inflammatory, anti-oxidative, anti-microbial, antipsychotic and neuroprotective properties. According to a review published in ​Frontiers in Neurology,​ 2018, CBD is safe with no risk of abuse or misuse. Furthermore, there is no evidence of CBD negatively altering heart rate, blood pressure or body temperature.

At present, regarding MS, only cannabis products containing both CBD and THC have been administered during human clinical trials. In addition, only trials in which the ratio of CBD: THC was 1:1 (or greater) have reported significant reductions in spasticity and pain in patients. Thus, there is no conclusive evidence of whether oils containing only CBD are effective in managing MS-related symptoms as, currently, all human trials have involved varying levels of THC and CBD, or only THC.

Although practical evidence is limited, there is an increasing number of individuals with MS turning to CBD oil which is readily available throughout the world. At present, it can be said that CBD oil appears to work for certain sufferers whereas others feel little or no benefit.

What is the recommended CBD Dose?

CBD is available in a variety of forms such as patches, capsules, sprays, oils, topical creams, and edibles. There is no standard dose that delivers the desired effect for all people, however, most companies that produce CBD products recommend starting with a low dose and gradually increasing. CBD oil is available in many countries with CBD oil being the most renowned and used form. The majority of CBD products have the recommended daily dose printed on the packaging which should not be exceeded.

Possible Side Effects of CBD

The majority of people will tolerate CBD, however, it is important to be aware of possible side effects caused by CBD. Side effects can include; tiredness, diarrhoea, changes in appetite, dry mouth, loss of appetite or gain in appetite. Interestingly, the full effects of long-term CBD use on hormones are yet to be fully elucidated.

Before using CBD for the first time, it is recommended to first consult your GP or a medical professional. Especially if you are taking any other medications as CBD can make these drugs more or less effective. Consulting a doctor first will facilitate monitoring and adjustments to be made accordingly.

CBD Oil Treatment Advice

• If you are interested in trying CBD oil to manage your MS symptoms or any other health issue, always consult a medical professional or doctor first.

• Always research the company where you plan to purchase CBD products to ensure they are of high quality.

• There are several conflicting articles regarding CBD oil and its effects. Remember research is still ongoing and the full effects of CBD are yet to be determined. The best way to form your opinion is to try it yourself and monitor any effects on their symptoms in a diary.

• Start a diary one or two weeks before using CBD products as this will provide a baseline.

• Decide on a realistic trial period - 2 or 3 weeks depending on the severity of symptoms.

• It may also be beneficial to record any dietary or lifestyle changes.

• Review your recordings after the trial period to determine if there has been an improvement in your MS symptoms.