Cannabis and Restless Leg Syndrome
Restless leg syndrome (RLS) is a neurological movement
disorder characterized by unpleasant or painful sensations, often in the legs,
and an overwhelming and uncontrollable urge to move the leg to relieve the
discomfort these sensations cause. Unfortunately for sufferers, these
sensations are frequently activated by sitting or lying down, and this makes
work meetings, long trips, sleep, and relaxing difficult, at best. The syndrome
can result in a debilitating lack of sleep that can ripple through a person’s
life causing difficulties with their work and personal life and may,
understandably, cause depression.
Although there are no studies addressing the causes or
symptoms of restless leg syndrome, observational reports from both Parkinson’s
disease (PD) and RSL patients show similar improvement in aspects of motor
control when using CBD (cannabidiol: a phytocannabinoid produced by cannabis plants). CBD is a promiscuous molecule that exhibits its actions
widely throughout the nervous system and the periphery, so any number of receptor
sites may be underlying its mechanism of action in RLS. However, the
uncontrolled movements of both PD and RLS may share a dysregulation in dopaminergic
tone in specific areas of the brain related to movement.
Studies on Cannabis and Restless Leg Syndrome
Studies have found cannabinoid receptors in the direct and
indirect pathways of the basal ganglia and it is agreed that, as a part of the Endocannabinoid System (ECS), these CB1 receptors and the cannabinoids can
exert an impact on aspects of motor function. CBD interacts with these
receptors and may help to correct the dysregulation to dopamine production. CBD
is a known anxiolytic (a medication that relieves anxiety) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
CBD use
during the day may relieve some of the distress experienced by RLS sufferers
while reducing their levels of background stress. CBD has also exhibited
biphasic effects in treating anxiety, in that it has been shown to be
anxiolytic at low or moderate dose, but not at high dose. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4813392/
Adding low to moderate doses of THC, preferably in oral
form, may provide pain relief, a reduction or elimination of undesirable
movement when sitting or in repose, relief of insomnia symptoms, and result in
more restful sleep.
In animal studies, modulation of these facets of the ECS was
found to have positive impacts on PD, though less so in human studies. Induced
behavioral changes because of the artificial creation of parkinsonism in rodent
models were noticeably ameliorated when CB1 was negatively modulated (CBD is a
negative modulator at the receptor). https://www.ncbi.nlm.nih.gov/pubmed/15755685
Profound shifts occur in CB1 signaling in these pathways,
once the dopamine has been depleted (as can be seen in PD), and also occurs
after levodopa replacement therapies for both PD and RLS. Luckily, many of the
symptoms of changes resulting from levodopa therapies are reversible if a
patient discontinues use. Concurrent use of CBD and levodopa may allow for
reduction of the levodopa dose, and could possibly stall the side effects that
include the dyskinesia (distortion of motor movement) that is common with
chronic levodopa therapies. https://www.ncbi.nlm.nih.gov/pubmed/19414037
Although the exact mechanisms remain unknown, some researchers argue that CB1 receptors may have minimal direct involvement in neuroprotection.
"Our results support the view of a potential neuroprotective action of cannabinoids against the in vivo and in vitro toxicity of 6-hydroxydopamine, which might be relevant for PD. Our data indicated that these neuroprotective effects might be due, among others, to the antioxidant properties of certain plant-derived cannabinoids, or exerted through the capability of cannabinoid agonists to modulate glial function, or produced by a combination of both mechanisms" https://www.ncbi.nlm.nih.gov/pubmed/15837565
Although the exact mechanisms remain unknown, some researchers argue that CB1 receptors may have minimal direct involvement in neuroprotection.
"Our results support the view of a potential neuroprotective action of cannabinoids against the in vivo and in vitro toxicity of 6-hydroxydopamine, which might be relevant for PD. Our data indicated that these neuroprotective effects might be due, among others, to the antioxidant properties of certain plant-derived cannabinoids, or exerted through the capability of cannabinoid agonists to modulate glial function, or produced by a combination of both mechanisms" https://www.ncbi.nlm.nih.gov/pubmed/15837565
Dysregulation of mechanisms related to dopamine signaling
may be involved in the connection underlying sleep movement disorders in PD and
RLS. Depletion of this neurotransmitter or dysregulation within the basal
ganglia often results in involuntary movements. This type of dysregulation is a
known contributing factor in PD and may be involved in RLS. In fact, many
people suffering from Parkinson’s disease also have RLS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372848/
In the striatum region of the brain, PD patients have a significantly increased expression of CB1 receptors and given CBD’s ability indirectly to interact with them to restore endocannabinoid tone, it may help ameliorate this dysregulation.
In the striatum region of the brain, PD patients have a significantly increased expression of CB1 receptors and given CBD’s ability indirectly to interact with them to restore endocannabinoid tone, it may help ameliorate this dysregulation.
Dosage
Taking cannabinoids orally requires some patience or
planning to achieve even relief over time, as swallowed medicines typically
take 45 minutes to 1 hour to be felt. Inhaled forms are felt immediately and
sublingual (under the tongue) or sprays both take about 20 minutes to be felt.
Oral cannabis is quite effective for increasing the quality
of rest and sleep, for longer-lasting analgesia, and freedom from motor
stimulation. THC is effective for anxiety at 2.5 – 5 mg when taken sublingually
(or swallowed for more potent effect) and CBD is effective orally and
sublingually at 5 – 10 mg.
CBD can be used without psychoactive effect if taken in a
spray or sublingually in a CBD:THC ratio of 10:1 or higher, in doses of 5 mg
CBD in the morning and again mid-afternoon. It can also be used throughout the
day, but it is advised that the last dose of the day occur before 5 p.m., as
CBD can be wake-promoting.
THC taken orally is recommended for sleep: 5 mg THC,
swallowed one hour before bed to reduce underlying unpleasant sensations
leading to unwanted motor activity. Swallowing THC increases its soporific and
analgesic effects and extends the period of action.
For vaporized or inhaled dosing, 2.5 – 7.5 mg CBD is
recommended three to four times throughout the day for faster onset of relief
than with oral administration. THC in the evening before bed, at 2.5 – 5 mg.
Use the lowest effective dose of THC to avoid the development of a tolerance whenever
possible.
High-CBD cultivars with considerable myrcene or
caryophyllene terpenes, and THC cultivars with myrcene terpenes at bedtime are recommended. Find strains with myrcene terpenes and caryophyllene.
Information about RLS was taken from the amazing book Cannabis Pharmacy: The Practical Guide to Medical Marijuana by Michael Backes, Andrew Weil, M.D. and Jack McCue, M.D. Find it here.
