Spastic quadriplegia is a rare but severe type of cerebral palsy that causes
spasticity in all four limbs. Studies have shown marijuana can help patients
manage the spasms, seizures and pain caused by the condition.
Overview of Spastic Quadriplegia
Spastic quadriplegia is the most severe form of cerebral palsy, a
neurological disorder that appears in infancy or early childhood. Spastic
quadriplegia is caused by brain damage or abnormalities that develop most
commonly before birth. The damage prevents the brain from effectively
controlling movement or maintaining posture and balance.
The specific types of brain damage that can cause spastic quadriplegia,
according to the National Institute of Neurological Disorders and Stroke, is
damage to the white matter of the brain, abnormal development of the brain,
bleeding in the brain, and severe lack of oxygen in the brain.
The spastic quadriplegia type of cerebral palsy affects all four limbs, the
trunk and the face, and often causes moderate-to-severe intellectual
disability. Spastic quadriplegia causes children to experience severe muscle
stiffness in their limbs and a loose, floppy neck. The condition commonly
prevents them from walking or speaking clearly. In addition, it can cause
frequent and uncontrollable seizures. Chronic pain develops due to severely
While spastic quadriplegia cannot be cured, treatment can help manage the
condition’s associated symptoms and help many children eventually have
near-normal lives as adults. Therapy efforts can include physical,
occupational, recreational, speech and language therapies, medications to
relax stiff muscles, surgery to lengthen muscles, and assistive devices to
help with communication and mobility.
Findings: Effects of Cannabis on Spastic Quadriplegia
The limited amount of research on cannabis’ effect on cerebral palsy
conditions suggests that marijuana does offer therapeutic benefits. Adults
with cerebral palsy participating in a survey on the effectiveness of
treatments responded that marijuana, though rarely used, provided the most
pain relief (Hirsh, Kratz, Engel & Jensen, 2011). In addition, a case study
of a 45-year-old man with a type of cerebral palsy that caused seizures
found that marijuana treatment caused a marked improvement (Mortati,
Dworetzky & Devinsky, 2007). One animal research study study found that
treating newborn mice or rats with white matter brain damage mimicking that
of cerebral palsy provided neuroprotective effects and protected the
developing brain (Shouman, et al., 2006).
There’s markedly more research demonstrating cannabis’ medical efficacy for
symptoms like spasms, seizures and pain associated with other conditions
that support its use as a treatment opportunity for spastic quadriplegia.
The two major cannabinoids found in cannabis, tetrahydrocannabinol (THC) and
cannabidiol (CBD) act upon the endocannabinoid system via the cannabinoid
receptors CB1 and CB2, which reduce muscle spasms, seizures and pain.
Studies have shown cannabis to be effective at significantly reducing muscle
spasms in patients with multiple sclerosis (Syed, McKeage & Scott, 2014)
(Smith, 2002) (Pertwee, 2002). Multiple scientific reviews have concluded
that CBD is a well-tolerated and promising therapeutic treatment that has
demonstrated the ability to reduce or even eliminate seizures (Blair,
Deshpande & DeLorenzo, 2015) (Rosenberg, Tsien, Whalley & Devinsky, 2015) (Szaflarski
& Bebin, 2014) (Devinsky, et al., 2014). One case report analyzing a young
epileptic girl found that medical marijuana brought the child’s seizure
frequency from nearly 50 convulsive seizures per day to 2-3 nocturnal
convulsions per month. In addition, the child was able to wean from the
additional antiepileptic drugs she had been taking (Maa & Figi, 2014). In
addition, cannabis has demonstrated the ability to significantly lower pain
levels in patients suffering from neuropathic and nociceptive pain, and has
even shown it can help manage pain that has proven refractory to other
treatments (Boychuck, Goddard, Mauro & Orellana, 2015) (Lynch & Campbell,
2011). Because of its effectiveness, cannabis is prevalent among the chronic
pain population to lower pain levels and improve sleep and mood (Ware, et
States That Have Approved Medical Marijuana for Spastic Quadriplegia
Currently, Louisiana is
the only state to have approved medical marijuana specifically for the
treatment of spastic quadriplegia.
A number of other states will consider allowing medical marijuana to be used
for the treatment of spastic quadriplegia with the recommendation from a
physician. These states include: California (any
debilitating illness where the medical use of marijuana has been recommended
by a physician), Connecticut (other
medical conditions may be approved by the Department of Consumer
Protection), Massachusetts (other
conditions as determined in writing by a qualifying patient’s physician), Nevada (other
conditions subject to approval), Oregon (other
conditions subject to approval), Rhode
conditions subject to approval), and Washington (any
“terminal or debilitating condition”).
D.C., any condition can be approved for medical marijuana as long as a
DC-licensed physician recommends the treatment.
In addition, fifteen states have approved medical marijuana for the
treatment of spasms, a symptom associated with spastic quadriplegia. These
states include: Arizona, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New
Hampshire, Oregon, Rhode
Island and Washington. Connecticut allows
marijuana to be used to treat intractable spasticity and New
it for spasticity disorders.
Eighteen states approve medical marijuana to treat seizures, which often
occur from spastic quadriplegia. These states include: Alaska, Arizona, Arkansas, California, Colorado, Delaware, Hawaii, Louisiana, Maryland, Michigan, Minnesota, Montana, Nevada, New
Dakota, Ohio, Oregon, Pennsylvania (intractable
Island, Tennessee (intractable
seizures), Vermont and Washington.
Several states have approved medical marijuana specifically to treat
“chronic pain,” which is a symptom that can arise in individuals with
spastic quadriplegia. These
states include: Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Maryland, Michigan, Montana, New
Mexico, Ohio, Oregon, Pennsylvania, Rhode
Island and Vermont.
The states of Nevada, New
Dakota, Ohio and Vermont allow
medical marijuana to treat “severe pain.” The states of Arkansas, Minnesota, Ohio, Pennsylvania and Washington have
approved cannabis for the treatment of “intractable pain.”
Recent Studies on Cannabis’ Effect on Spastic Quadriplegia
Marijuana found to cause marked improvement in adult man with cerebral
palsy and epilepsy.
Marijuana: an effective antiepileptic treatment in partial epilepsy? A
case report and review of the literature.
Cannabinoids provided neuroprotection in mice and rats with brain
lesions mimicking brain damage found in humans with cerebral palsy.
Endocannabinoids potentially protect the newborn brain against
AMPA-kainate receptor mediated excitotoxic damage.
Blair, R.E., Deshpande, L.S., and DeLorenzo, R.J. (2015, September).
Cannabinoids: is there a potential treatment role in epilepsy? Expert
Opinion on Pharmacology,
Boychuck, D.G., Goddard, G., Mauro, G., and Orellana, M.F. (2015 Winter).
The effectiveness of cannabinoids in the management of chronic nonmalignant
neuropathic pain: a systematic review. Journal
of Oral & Facial Pain and Headache,
Cerebral Palsy: Hope Through Research. (2015, July 2). National
Institute of Neurological Disorders and Stroke.
Retrieved from http://www.ninds.nih.gov/disorders/cerebral_palsy/detail_cerebral_palsy.htm#268993104.
Devinsky, O., Cilio, M.R., Cross, H., Fernandez-Ruiz, J., French, J., Hill,
C., Katz, R., Di Marzo, V., Jutras-Aswad, D., Notcutt, W.G.,
Martinez-Orgado, J., Robson, P.J., Rohrback, B.G., Thiele, E., Whalley, B.,
and Friedman, D. (2014, June). Cannabidiol: pharmacology and potential
therapeutic role in epilepsy and other neuropsychiatric disorders. Epilepsia,
Facts About Cerebral Palsy. (2015, July 13). Centers
for Disease Control and Prevention.
Retrieved from http://www.cdc.gov/ncbddd/cp/facts.html.
Hirsch, A.T., Kratz, A.L., Engel, J.M., and Jensen, M.P. (2011, March).
Survey results of pain treatments in adults with cerebral palsy. American
Journal of Physical Medicine & Rehabilitation,
Lynch, M.E., and Campbell, F. (2011, November). Cannabinoids for treatment
of chronic non-cancer pain; a systematic review of randomized trials. British
Journal of Clinical Pharmacology,
Maa, E. and Figi, P. (2014, June). The case for medical marijuana in
Mortati, K., Dworetzky, B., and Devinsky, O. (2007, Spring). Marijuana: an
effective antiepileptic treatment in partial epilepsy? A case report and
review of the literature. Reviews
in Neurological Diseases,
Pertwee, R.G. (2002, August). Cannabinoids and multiple sclerosis. Pharmacology
Rosenberg, E.C., Tsien, R.W., Whalley, B.J., and Devinsky, O. (2015, August
18). Cannabinoids and Epilepsy. Neurotherapeutics,
Epub ahead of print. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26282273.
Shouman, B., Fontaine, R.H., Baud, O., Schwendimann, L., Keller, M.,
Spedding, M., Lelievre, V., and Gressens, P. (2006, June). Endocannabinoids
potentially protect the newborn brain against AMPA-kainate receptor mediated
excitotoxic damage. British
Journal of Pharmacology,
Smith, P.F., (2002, June). Cannabinoids in the treatment of pain and
spasticity in multiple sclerosis. Current
Opinion in Investigational Drugs,
Syed, Y.Y., McKeage, K., and Scott, L.J. (2014, April).
Delta-9-tetrahydrocannabinol-cannabidiol (Sativex): a review of its use in
patients with moderate to severe spasticity due to multiple sclerosis. Drugs,
Szaflarski, J.P., and Bebin, E.M. (2014, December). Cannabis, cannabidiol,
and epilepsy–from receptors to clinical response. Epilepsy
Ware, M.A., Doyle, C.R., Woods, R., Lynch, M.E., and Clark, A.J. (2003,
March). Cannabis use for chronic non-cancer pain: results of a prospective
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