IACM-Bulletin of December 19, 2010

Science — Dramatic improvement of neuromyotonia (Isaacs' syndrome) with THC in a case report

According to a case report from a hospital in Nantes, France, oral THC (dronabinol) improved the symptoms of a patient with Isaacs' syndrome, which did not respond to other treatments. A 56-year-old man presented with episodes of profuse sweating associated with muscular twitching that began one year before the first assessment in the hospital. Bouts of drenching sweats occurred 2 or 3 times a day, lasted from 20 minutes to 2 hours and were associated with intense itching on body truck. Body weight had decreased from 70 to 55 kg during that period. He presented with prominent generalized myokymia, i.e. involuntary, spontaneous, localized quivering of a few muscles bundles within a muscle. Antibodies to transmembrane channels specific for potassium were highly increased. Several medications and treatments, including intravenous immunoglobulins, were tried to reduce symptoms, but were all ineffective. Finally, THC was titrated up progressively to 20 mg/day over a one month period and used as a monotherapy.

Three months after the initiation of the treatment, the patient started to improve. After one year, myokymia completely disappeared, there were no longer any sweating attacks and body weight increased to 65 kg. In addition, antibodies to potassium channels were normal. Authors noted that "the dramatic improvement lasted for the last 2 years and is still ongoing." Isaacs' syndrome, also called neuromyotomia or continuous muscle fibre activity, is a peripheral motor nerve hyperactivity disorder. It is usually regarded as an autoimmune disease caused by antibodies against neuromuscular junction, resulting in an increase in neurotransmitter release. Authors think that "the mechanism of action of dronabinol was rather immunomodulatory than symptomatic."

(Source: Meyniel C, Ollivier Y, Hamidou M, Péréon Y, Derkinderen P. Dramatic improvement of refractory Isaacs' syndrome after treatment with dronabinol. Clin Neurol Neurosurg. 2010 Dec 6. [in press])

News in brief

USA — New Jersey

On 13 December the state Senate passed a resolution to require Governor Chris Christie's administration to rewrite its proposed regulations for the medical use of cannabis. Both the Senate and the Assembly have now voted that the proposed very restrictive regulations don't meet the Legislature's intent to create a system by which patients with certain conditions can have legal access to a drug that's illegal for everyone else. Under the state constitution, the administration now has 30 days to rewrite its regulations governing medical cannabis growing and distribution. If it refuses, lawmakers could vote again to invalidate all or part of the proposed regulations. (Source: Associated Press of 13 December 2010)

Holland — Coffee shops

A Dutch town was right in refusing to let foreigners buy cannabis, Europe's highest court said in a ruling on 16 December that will help the national government's plans to curb sales of the drug to tourists. The European Court of Justice ruled that the mayor of Maastricht -- a southern town near the German and Belgian borders and not far from France -- was right to close down a coffee shop that had been selling cannabis to non-residents. "A prohibition on admitting non-residents to coffee shops ... constitutes a measure capable of substantially limiting drug tourism and, consequently, of reducing the problems it causes," the Luxembourg-based court said in its judgment. (Source: Reuters of 17 December 2010)

USA — Iowa

According to a new poll the majority of Iowans are in favour of the medical use of cannabis. The poll found 62 percent of Iowans are in favour of legalizing medical cannabis, which is in line with the results from other states. (Source: Daily Iowan of 8 December 2010)

Science — Dysfunction of the heart

According to research at the National Institutes of Health in Bethesda, USA, the natural cannabinoid CBD (cannabidiol) attenuates cardiac dysfunction, oxidative stress, fibrosis, inflammation and cell death in animal models of diabetic cardiomyopathy. Authors concluded that "these results coupled with the excellent safety and tolerability profile of CBD in humans, strongly suggest that it may have great therapeutic potential in the treatment of diabetic complications, and perhaps other cardiovascular disorders." (Source: Rajesh M, et al. J Am Coll Cardiol 2010;56(25):2115-25.)

Science — Stress

Researchers of the Complutense University in Madrid, Spain, investigated the effects of a synthetic CB1 receptor agonist on effects caused by stress in mice. Exposure to stress elicits damage and inflammation to nerve cells in the brain, contributing to cell death and damage in stress-related neurological and neuropsychiatric diseases. They found multifaceted neuroprotective effects of the cannabinoid which "suggest that CB1 activation could be a new therapeutic strategy against neurological/neuropsychiatric pathologies," which involve certain brain regions and a neuroinflammatory component in their aetiology. (Source: Zoppy S, et al. Neuropsychopharmacology. 2010 Dec 8. [in press])

Science — Posttraumatic stress

According to research at the National Center for posttraumatic stress disorder in Boston, USA, with 142 adults suffering from posttraumatic stress (PTS) "trauma-exposed marijuana users with greater PTS symptom severity may use marijuana to cope with negative mood states, at least partially because of a lower perceived capacity to withstand emotional distress." (Source: Potter CM, et al. J Anxiety Disord. 2010 Nov 17. [in press])

Science — Anxiety

According to research at the Virginia Commonwealth University in Richmond, USA, the inhibition of the enzymes that degrade anandamide and 2-AG (2-arachidonoylglycerol) reduced anxiety in a mouse model of anxiety disorders such as obsessive-compulsive disorder. Both the increase of anandamide and the increase of the 2-AG concentration in the animals caused these effects. In contrast, THC was not consistently effective in the test. (Source: Kinsey SG, et al. Pharmacol Biochem Behav. 2010 Dec 7. [in press])