# _Cannabis sativa_ L. as a Natural Drug Meeting the Criteria of a Multitarget Approach to Treatment
## 4 Pharmacological Application
### Sclerosis Multiplex  
Multiple sclerosis is the most common inflammatory demyelinating disease of the central nervous system. It arises as a result of an autoimmune response directed against myelin, which, in consequence, leads to worsening neurodegeneration and disability [108]. Common symptoms of multiple sclerosis include vision problems, pain, muscle weakness, balance problems, and paralysis [109]. In addition, patients who suffer from spasticity, which is defined as the activation of muscles without the patient's will, are under increased risk of complications and are subject to pain and problems with falling asleep [110]. These symptoms are caused by progressive abnormal neuronal transmission. The disease is initially characterized by long asymptomatic periods abruptly interrupted by relapses, usually lasting several days or weeks [109]. The beginning of modern treatment of multiple sclerosis can be associated with the introduction of interferon beta and glatiramer acetate in the treatment of multiple sclerosis with relapsing remission [111]. Then, mono \begin{table}
\begin{tabular}{c c c} \hline \hline  & **Test Group** & **Control Group** \\ \hline Number of patients & 61 & 59 \\ \hline Applied treatment & 20 mg/kg body weight of cannabinoid daily & Placebo \\ \hline Number of seizures per month after four weeks & 12.4 & 14.9 \\ of standard treatment & 5.9 & 14.1 \\ \hline The proportion of patients in whom the number & 43\% & 27\% \\ of seizures decreased by at least 50\% & 5\% & 0\% \\ \hline Percentage of patients who were completely & 5\% & 0\% \\ seizure-free & & \\ \hline \hline \end{tabular}
\end{table} 
Table 4: Results of the efficacy of CBD in the treatment of epileptic seizures in Dravet’s syndrome in children [105]. clonal antibodies were introduced, such as natalizumab, and, later, also alemutzumab and ocelizumab. Oral medicines such as fingolimod, teriflunomide, dimethyl fumarate, and cladribine have also been developed. New therapeutic options are still being sought, especially for continuously progressive forms of the disease. Currently, the available therapies may delay disease progression and reduce the number of attacks but do not improve the patients' quality of life [56; 108]. Numerous clinical and preclinical studies give hope that cannabinoids derived from _Camabis sativa_ L. can be used to control chronic pain and spasticity. Preclinical studies have also demonstrated the potential use of endocannabinoids' neuroprotective properties and partial inhibition of disease progression [108]. Nabiximols, THC, and oral _Cannabis_ extract are believed to be helpful in the treatment of spasticity. Sativex(r) is currently the only pharmaceutical product approved for this indication. However, Sativex(r) is not a first-line treatment. It is indicated for the relief of moderate-to-severe spasticity symptoms in adult sclerosis multiplex (SM) patients who are unresponsive to other spasticity-relieving medicinal products and show a clinically significant improvement in spasticity symptoms in the initial stage of therapy. Medical marijuana reduces the pain and spasticity in SM but negatively affects balance and posture. Nabiximols may also be effective in disturbance of the normal bladder function, which is common in this condition [109]. The effects of individual cannabinoids on pain and muscle spasticity in SM patients are shown in Table 5.  
Studies of the use of medical marijuana in the treatment of SM suggest a reduction in spasticity after using phytocannabinoids, but it is not statistically significant. However, there was a clinically significant subjective reduction in spasticity reported by patients. Cannabinoids appear to be well-tolerated by patients using them as add-on therapy. It enables them to improve their score on the Ashworth Scale, which is a measure of spasticity by measuring the resistance that occurs when soft tissue is passively stretched. However, many studies give contradictory results, often without statistical significance.