Spasticity is a common neurologic condition in patients with multiple sclerosis, stroke, cerebral palsy or an injured spinal cord. Animal studies suggest that THC has an inhibitory effect on polysynaptic reflexes. Some spastic patients claim improvement after inhaling cannabis. We tested muscle tone, reflexes, strength and performed EMGs before and after double‐blinded oral administration of either 10 or 5 mg THC or placebo. The blinded examiner correctly identified the trials in which the patients received THC in seven of nine cases. For the group, 10 mg THC significantly reduced spasticity by clinical measurement (P < 0.01). Quadriceps EMG interference pattern was reduced in those four patients with primarily extensor spasticity. THC was administered to eight other patients with spasticity and other CNS lesions. Responses varied, but benefit was seen in three of three patients with “tonic spasms.” No benefit was noted in patients with cerebellar disease.

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The visually evoked potential was abnormal in 17 of 18 patients with Huntington disease. Both early and late wave components were affected, and the averaged amplitude for the patients was reduced in comparison with 50 normal control subjects. Despite striking attenuation and disorganization of the complex, latency of initial wave components was normal. The abnormality was not present in patients with a variety of other nonfocal cerebral disorders nor in 13 children of patients with Huntington disease.

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SUMMARY.Women's health has received greater attention with the recognition of significant differences in disease expression and drug action in men and women. Multiple sclerosis is a neurological disorder with important gender differences. MS patients have employed cannabis to treat a number of symptoms associated with the disease including spasticity, pain, tremor, fatigue, and autonomic dysfunction. The scientific literature includes supportive case reports, single-patient (N-of-1) trials and randomized clinical trials. Large-scale clinical trials are underway to answer questions concerning the efficacy and safety of cannabis in patients with MS. While these studies will answer important questions concerning the actions of cannabinoids on the nervous system, additional studies in female MS patients will be needed to address issues such as gender-specific actions on symptoms such as pain and autonomic dysfunction along with studies in menopausal and post-menopausal women. Since the drug-drug interactions have been reported with cannabinoids, the effects of cannabis on the actions of other centrally-acting drugs should be explored.

Head trauma has been reported to cause significant but temporary focal neurologic signs in children and adolescents.' The findings described include transient hemiparesis, somnolence, irritability, vomiting, blindness, and brainstem signs. These episodes of reversible neurologic dysfunction may resemble classical migraine, and may have a similar underlying mechanism. Matthews2 reported &dquo;classical migraine&dquo; attacks after &dquo;heading&dquo; the ball among British football players. The authors have observed a similar phenomenon in a college wrestler. Treatment with the 8-adrenergic blocker, propranolol, provided control of symptoms and permitted him to participate in intercollegiate wrestling. CASE REPORTIn December 1976, a 19-year-old college wrestler noticed numbness on the right side of his body, including the arm, leg, face, and trunk, following a blow to the side of the head, which persisted for several hr. He then developed nausea, vomiting, and a temporal throbbing headache that persisted for 12 hr. He reported at least five other episodes, precipitated by temporal head injury, with resultant unilateral paresthesias, confusion, nausea, vomiting, and throbbing headache. He gave a history of similar symptoms in the past, not related to trauma, but sometimes provoked by drinking alcoholic beverages. A history of migraine headaches was reported for the patient's mother.During physical examination several days after the episode, the patient was normotensive and no bruits were audible in the head or neck. The neurologic examination was entirely normal, including detailed sensory testing.In summary, the patient experienced recurrent neurologic symptoms and vascular headache associated with head trauma while wrestling. The episodes persisted for up* to 12 hr and were provoked specifically by blows to the side of the head. Given a positive family history, and past history of vascular headache after alcohol ingestion, it was felt that symptoms reflected traumainduced cerebral vasospasm similar to migraine. In an attempt at prophylaxis, propranolol (40 mg daily) was started.In a follow-up examination 2 months after starting medication, the patient described two subsequent brief episodes of short duration and less severity than previous attacks. During that period of time, he had won 10 wrestling matches and was ranked fourth in the nation in his weight division. He reported no adverse side effects and was willing to continue with the medication.

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