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What is Parkinson’s Disease?

Parkinson’s disease (PD) is a chronic disease characterized by neurodegeneration. It affects mainly the elderly population, with an approximate prevalence rate of 1 to 2% among individuals 65 years of age or older. Parkinson’s disease presents with a wide variety of symptoms, which can be broadly categorized into motor symptoms and non-motor symptoms.

Motor symptoms include:

  1. Bradykinesia (mask-like face, infrequent blinking, and degrading fine motor skills)
  2. Vocal affection
  3. Rigidity and postural instability
  4. Tremors, which commonly occur during rest
  5. Gait or walking difficulties
  6. Dystonia, which is known as repetitive muscle movements that make different body parts twist

Parkinson’s disease also has several non-motor symptoms that are quite troublesome to patients with the disease, with the final end result of poor quality of life. These symptoms include the following:

  1. Constipation
  2. Urinary incontinence
  3. Sexual affection
  4. Orthostatic hypotension
  5. Sleep-related issues
  6. Cognitive problems
  7. Psychosis
  8. Depression
  9. Pain
  10. Anxiety

Parkinson’s disease occurs as a result of the loss of neurons that primarily contain dopamine in the basal ganglia. The basal ganglia is the part of our brain that is involved with executing motor functions, behaviors, and emotions. When this part is affected, the patient starts to develop the various motor and non-motor symptoms of Parkinson’s disease.

There are multiple factors that contribute to the neurodegeneration of this region of the brain, such as:

  1. Dysfunction of the mitochondria
  2. Oxidative stress
  3. Limited protein degradation
  4. Accumulation of Lewy bodies in the remaining neurons (which is the hallmark of Parkinson’s disease)

What are the Treatment Options for Parkinson’s Disease?

Since the major problem behind Parkinson’s disease is the loss of dopamine-containing neurons, the treatment of this disease aims to increase the levels of dopamine in the brain. This can be achieved by the following drugs:

  1. Dopamine precursors, such as levodopa (L-Dopa).
  2. Dopamine-degradation inhibitors, such as dopadecarboxylase inhibitors, monoamine oxidase inhibitors (MAOI), and catechol-O-methyl transferase (COMT) inhibitors.

Levodopa is the main line of management of the motor symptoms associated with Parkinson’s disease. Unfortunately, some patients fail to respond to it. Furthermore, when levodopa is used for prolonged periods of time, it results in the unfortunate side effect of dyskinesia. Therefore, its therapeutic effects become limited over time.

In addition, patients with Parkinson’s disease use other drugs to manage their non-motor symptoms, including antidepressants, anxiolytics, antipsychotics, and many others. However, all of these drugs have well-known side effects, particularly in the long-term, and their effectiveness is very limited. Also, such non-motor symptoms do not resolve with the use of the main dopaminergic medications.

Therefore, physicians and researchers are constantly investigating new alternative options to manage both the motor and non-motor symptoms of Parkinson’s disease, with higher efficacy and better safety profile. Some of the options that have shown great benefit in this condition include the use of cannabinoids, such as cannabidiol.

Parkinson’s Disease and the Endocannabinoid System

As there are multiple cannabinoids inside marijuana, cannabinoids exist naturally in our bodies. They are referred to as endocannabinoids. The endocannabinoid system consists of the following parts:

  • Endocannabinoids, such as N-arachidonoyl ethanolamine or anandamide
  • Cannabinoid receptors: type 1 (CB1) and type 2 (CB2)
  • Enzymes that participate in the production of endocannabinoids, such as fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL)

The endocannabinoid compounds are naturally found in a great amount in different brain areas that are involved with body movements, such as the basal ganglia, which is involved in the development of Parkinson’s disease.

A large number of preclinical and animal studies confirm that cannabinoids play a critical role in the pathogenesis of this disease. It was observed that the endocannabinoid system undergoes several neurochemical changes according to the course of Parkinson’s disease. These changes include the reduction in the number of CB1 receptors in the brain during the early stages of the condition. Meanwhile, CB1 receptors, CB2 receptors, and the endocannabinoid tone were noted to increase during the intermediate and late stages of Parkinson’s disease.

The Effects of Various Cannabinoids on Parkinson’s Disease

Multiple cannabinoid compounds have been investigated in patients with Parkinson’s disease, including tetrahydrocannabinol (THC) and cannabidiol (CBD).

Four randomized controlled clinical trials were previously conducted to determine the effectiveness of several cannabinoids in treating the motor symptoms of Parkinson’s disease. Two randomized trials investigated the effectiveness of nabilone (THC) in 7 and 15 patients with Parkinson’s disease. Patients were also treated with levodopa. The use of nabilone was well-tolerated in all patients. One trial found that nabilone significantly reduced the occurrence of levodopa-induced dyskinesia, while the other trial found no significant difference in dystonia (one of the motor symptoms of Parkinson’s disease).

Another trial reported no significant change in dystonia in 19 patients with Parkinson’s disease following the use of cannabis capsules (2.5 mg THC/ 1.25 mg CBD oil in sub-lingual formulation) twice daily for 4 weeks. The final trial also found no significant change in dystonia in 8 patients with Parkinson’s disease who were treated with rimonabant (an inverse agonist of CB1 receptors).

Clinical Evidence of the Therapeutic Role of CBD in Parkinson’s Disease

The clinical and therapeutic properties of CBD in treating various motor and non-motor symptoms of Parkinson’s disease have been studied in a limited number of non-placebo-controlled clinical trials. An open-label clinical trial included 6 patients with Parkinson’s disease and psychotic symptoms. Patients were given CBD at a dose of 150 to 400 mg/day for 4 weeks. CBD resulted in a significant remarkable improvement in both psychotic and global symptoms. In another randomized clinical trial, 21 patients with Parkinson’s disease were treated with CBD capsules (75 or 300 mg/day) for 6 weeks. Patients on CBD witnessed significant improvement in their quality of life, activities of daily living, and well-being. In another case series, 4 patients with Parkinson’s disease were treated with 75 or 300 mg CBD capsules for 6 weeks. CBD resulted in remarkable significant improvement in their sleeping symptoms.

In all of these studies, CBD was well-tolerated with no remarkable side effects.

A Take-Home Note

Although multiple clinical trials have demonstrated the effectiveness of CBD in treating some motor and non-motor symptoms of Parkinson’s disease, the therapeutic potential of CBD has not been clearly studied in some Parkinson’s disease symptoms. Also, there is a great need for randomized placebo-controlled trials to further confirm the therapeutic benefits of CBD in this disease.

Therefore, if you have Parkinson’s disease that is unresponsive to common medications, consult with your doctor regarding the addition of CBD to your treatment regimen.


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