The Utility of Delta-9-Tetrahydrocannibinol Therapy in a Mul
A 40-year-old woman who has had relapsing-remitting MS his clinical and radiological data show low disease activity and the patient is treated with glatiramer acetate (40 mg thrice a week, subcutaneous). The patient presented after experiencing some sudden movements of the left arm and loss of conscience for a few seconds.

MRI revealed a very large right fronto-parietal brain lesion that originated inside the right frontal lobe and reached the homolateral corpus callosum and centrum semi vale with enhancement after gadolinium administration. The electroencephalogram showed homolateral focal epileptic waves. Sometimes, large MS lesions cause epileptic seizures that can regress after perilesional edema is reduced with steroid therapy (such symptoms were originally considered due to MS relapse). The patient started specific therapy with methylprednisolone 1 g intravenous (5 days) and lamotrigine 200 mg twice a day as symptomatic therapy. A second MRI showed unchanged results after steroid administration. After 3 weeks without seizures, the patient’s clinical symptoms worsened with left arm dysaesthesia and impairment of sensitivity to touch and pain. She started symptomatic therapy with pregabalin 75 mg twice a day. After 8 weeks, she presented a new epileptic seizure, so lacosamide 100 mg twice a day was also added.

There was a possibility that the large right frontal-parietal brain lesion was caused by a primitive brain tumor. So, after neurosurgical advice, the lesion was excised with a histological diagnosis of oligodendroglioma. After the operation, the author observed paresis of the left arm with spasticity and pain on mobilization, impairment of left-arm sensitivity to touch, frequent daily motor seizures of the left arm, and side effects due to the anti-epileptic drugs, such as cognitive impairment, weakness, and drowsiness. Steroids were necessary for 1 week (dexamethasone 4 mg, twice a day) and osmotic diuretics (Mannitol 18% 100 ml, 6 times a day).

Nabiximols as a symptomatic therapy to decrease the spasticity of the left arm, to lower the required dose of symptomatic drugs (pregabalin 75 mg twice a day to pregabalin 75 mg once a day), and finally to reduce side effects was introduced. After about 4 weeks of treatment with seven sprays a day, spasticity had improved, the pain had decreased and the patient was able to start a rehabilitation program. She also observed a reduction in the number of daily focal motor seizures after administering nabiximols in the morning, so it was possible to reduce anti-epilepsy treatment (lamotrigine 200 mg twice a day and lacosamide 100 mg twice a day to lamotrigine 100 mg twice a day and lacosamide 100 mg once a day). In conclusion, the positive effects of combined therapy should always be investigated to improve patient welfare. Sometimes a drug combination can have an unexpected but useful interaction.

M●●t L●●●●●●●●a and 1 others like this