{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:50:57Z","timestamp":1787028657527,"version":"build-2736575974"},"reference-count":34,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T00:00:00Z","timestamp":1742428800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Multiple Sclerosis (MS) is associated with a wide range of debilitating symptoms, and conventional therapies often fail to adequately address the disease\u2019s multifaceted challenges. Cannabidiol (CBD) 13.0% + Delta9-tetrahydrocannabinol (THC) 9.0% (CBD13\/THC9), a vaporized cannabis-based medicinal product, presents a novel therapeutic option for managing MS symptoms. Methods: This single-center longitudinal study followed 69 MS patients over a six-month period. Participants were assessed at treatment initiation and at three- and six-month intervals. Key measures included muscle spasticity, urine bladder dysfunction, and the evaluation of disability progression rate. The evaluation included the Modified Ashworth Scale (MAS), the Post Void Residual (PVR) volume, and the Expanded Disability Status Scale (EDSS). Results: Significant improvement was observed across all outcome assessments. The EDSS score was decreased over time (p = 0.009), indicating a slight reduction in disability progression rate, while MAS scores showed substantial improvement in muscle spasticity (p &lt; 0.001). Urine bladder function improved significantly, with PVR volume showing notable improvement between baseline and the six-month assessment (p &lt; 0.001). Correlation analyses revealed that a gradual increase in vaporized CBD13\/THC9 dose was correlated with slightly lower EDSS scores, while the adverse effects were negatively associated with the frequency of cannabinoid use. Finally, patients who were smokers used CBD13\/THC9 more frequently. Conclusions: The vaporized CBD13\/THC9 formulation demonstrated notable efficacy in slightly improving disability progression rate via reduction in muscle spasticity and urine bladder dysfunction in MS patients. This highlights its addon therapeutic value during rehabilitation in MS patients with debilitating disability symptoms.<\/jats:p>","DOI":"10.3390\/jcm14062121","type":"journal-article","created":{"date-parts":[[2025,3,20]],"date-time":"2025-03-20T09:17:39Z","timestamp":1742462259000},"page":"2121","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Evaluating Vaporized Cannabinoid Therapy in Multiple Sclerosis: Findings from a Prospective Single-Center Clinical Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-4618","authenticated-orcid":false,"given":"Konstantina","family":"Stavrogianni","sequence":"first","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"},{"name":"Department of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 451 10 Ioannina, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0722-9329","authenticated-orcid":false,"given":"Dimitrios K.","family":"Kitsos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6210-2086","authenticated-orcid":false,"given":"Vasileios","family":"Giannopapas","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"},{"name":"Department of Physical Therapy, University of West Attica, 122 43 Attica, Greece"},{"name":"Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), University of West Attica, 122 43 Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2192-9297","authenticated-orcid":false,"given":"Vassiliki","family":"Smyrni","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7496-1195","authenticated-orcid":false,"given":"Athanasios K.","family":"Chasiotis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"},{"name":"Department of Physical Therapy, University of West Attica, 122 43 Attica, Greece"},{"name":"Laboratory of Neuromuscular and Cardiovascular Study of Motion (LANECASM), University of West Attica, 122 43 Attica, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1347-8543","authenticated-orcid":false,"given":"Alexandra","family":"Akrivaki","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7069-4927","authenticated-orcid":false,"given":"Evangelia-Makrina","family":"Dimitriadou","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina","family":"Zompola","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John S.","family":"Tzartos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0640-3797","authenticated-orcid":false,"given":"Georgios","family":"Tsivgoulis","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7443-5179","authenticated-orcid":false,"given":"Sotirios","family":"Giannopoulos","sequence":"additional","affiliation":[{"name":"Second Department of Neurology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 157 72 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1056\/NEJMra1401483","article-title":"Multiple Sclerosis","volume":"378","author":"Reich","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Haki, M., AL-Biati, H.A., Al-Tameemi, Z.S., Ali, I.S., and Al-hussaniy, H.A. (2024). Review of multiple sclerosis: Epidemiology, etiology, pathophysiology, and treatment. Medicine, 103.","DOI":"10.1097\/MD.0000000000037297"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1080\/00207454.2018.1481066","article-title":"Sativex\u00ae as add-on therapy vs. further optimized first-line ANTispastics (SAVANT) in resistant multiple sclerosis spasticity: A double-blind, placebo-controlled randomised clinical trial","volume":"129","author":"Essner","year":"2019","journal-title":"Int. J. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jns.2016.09.054","article-title":"Cortical and spinal excitability in patients with multiple sclerosis and spasticity after oromucosal cannabinoid spray","volume":"370","author":"Squintani","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"ref_5","first-page":"1145","article-title":"Evaluating Sativex\u00ae in Neuropathic Pain Management: A Clinical and Neurophysiological Assessment in Multiple Sclerosis","volume":"17","author":"Russo","year":"2016","journal-title":"Pain Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Nouh, R.A., Kamal, A., and Abdelnaser, A. (2023). Cannabinoids and Multiple Sclerosis: A Critical Analysis of Therapeutic Potentials and Safety Concerns. Pharmaceutics, 15.","DOI":"10.3390\/pharmaceutics15041151"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"277","DOI":"10.9740\/mhc.2016.11.277","article-title":"Delta-9-tetrahydrocannabinol and cannabidiol: Separating the chemicals from the \u201cweed\u201d, a pharmacodynamic discussion","volume":"6","author":"Boggs","year":"2016","journal-title":"Ment. Health Clin."},{"key":"ref_8","first-page":"607","article-title":"Review of the Endocannabinoid System","volume":"6","author":"Lu","year":"2021","journal-title":"Biol. Psychiatry Cogn. Neurosci. Neuroimaging"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Haddad, F., Dokmak, G., and Karaman, R. (2022). The Efficacy of Cannabis on Multiple Sclerosis-Related Symptoms. Life, 12.","DOI":"10.3390\/life12050682"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nouh, R.A., Kamal, A., Oyewole, O., Abbas, W.A., Abib, B., Omar, A., Mansour, S.T., and Abdelnaser, A. (2024). Unveiling the Potential of Cannabinoids in Multiple Sclerosis and the Dawn of Nano-Cannabinoid Medicine. Pharmaceutics, 16.","DOI":"10.3390\/pharmaceutics16020241"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1097\/j.pain.0000000000001386","article-title":"Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain","volume":"160","author":"McLaughlin","year":"2019","journal-title":"Pain"},{"key":"ref_12","unstructured":"Patel, V.B., Preedy, V.R., and Martin, C.R. (2023). Neurobiology and Physiology of the Endocannabinoid System, Elsevier."},{"key":"ref_13","unstructured":"Lavipharm (2025, January 10). Product Features of Maroxim. Available online: https:\/\/lavipharm.com\/product-features-maroxim\/."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Vu\u010dkovi\u0107, S., Srebro, D., Vujovi\u0107, K.S., Vu\u010deti\u0107, \u010c., and Prostran, M. (2018). Cannabinoids and Pain: New Insights From Old Molecules. Front. Pharmacol., 9.","DOI":"10.3389\/fphar.2018.01259"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1770","DOI":"10.1002\/cbdv.200790152","article-title":"Human Cannabinoid Pharmacokinetics","volume":"4","author":"Huestis","year":"2007","journal-title":"Chem. Biodivers."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1212\/WNL.0000000000000363","article-title":"Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders: Report of the Guideline Development Subcommittee of the American Academy of Neurology","volume":"82","author":"Koppel","year":"2014","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s11910-018-0814-x","article-title":"The Use of Cannabis and Cannabinoids in Treating Symptoms of Multiple Sclerosis: A Systematic Review of Reviews","volume":"18","author":"Nielsen","year":"2018","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_18","first-page":"CD013444","article-title":"Cannabis and cannabinoids for symptomatic treatment for people with multiple sclerosis","volume":"2022","author":"Filippini","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/S1474-4422(17)30470-2","article-title":"Diagnosis of multiple sclerosis: 2017 revisions of the McDonald criteria","volume":"17","author":"Thompson","year":"2018","journal-title":"Lancet Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ciccarelli, O., Barkhof, F., Calabrese, M., De Stefano, N., Eshaghi, A., Filippi, M., Gasperini, C., Granziera, C., Kappos, L., and Rocca, M.A. (2024). Using the Progression Independent of Relapse Activity Framework to Unveil the Pathobiological Foundations of Multiple Sclerosis. Neurology, 103.","DOI":"10.1212\/WNL.0000000000209444"},{"key":"ref_21","unstructured":"(2025, January 05). WMA Declaration of Helsinki. Available online: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/MRR.0000000000000057","article-title":"Validity and reliability of the Greek version of the Modified Fatigue Impact Scale in multiple sclerosis patients","volume":"37","author":"Bakalidou","year":"2014","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1093\/ageing\/29.3.223","article-title":"Reliability of measurement of muscle tone and muscle power in stroke patients","volume":"29","author":"Gregson","year":"2000","journal-title":"Age Ageing"},{"key":"ref_24","first-page":"576","article-title":"Inter- and intra-rater reliability of the Modified Ashworth Scale: A systematic review and meta-analysis","volume":"54","year":"2018","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102378","DOI":"10.1016\/j.msard.2020.102378","article-title":"Lower urinary tract dysfunction in patients with multiple sclerosis: A post-void residual analysis of 501 cases","volume":"45","author":"Motta","year":"2020","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_26","unstructured":"Field, A. (2017). Discovering Statistics Using IBM SPSS Statistics, Sage Publications. North American Edition."},{"key":"ref_27","unstructured":"IBM Corp (IBM SPSS Statistics for Windows, 2021). IBM SPSS Statistics for Windows, Version 28.0."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Torres-Moreno, M.C., Papaseit, E., Torrens, M., and Farr\u00e9, M. (2018). Assessment of Efficacy and Tolerability of Medicinal Cannabinoids in Patients With Multiple Sclerosis: A Systematic Review and Meta-analysis. JAMA Netw. Open., 1.","DOI":"10.1001\/jamanetworkopen.2018.3485"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"47","DOI":"10.2217\/nmt-2021-0058","article-title":"Updates and advances in multiple sclerosis neurotherapeutics","volume":"13","author":"Amin","year":"2023","journal-title":"Neurodegener. Dis. Manag."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.msard.2015.10.007","article-title":"Spasticity in multiple sclerosis: Associations with impairments and overall quality of life","volume":"5","author":"Milinis","year":"2016","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1007\/s41669-024-00501-x","article-title":"Cost and Quality of Life of Disability Progression in Multiple Sclerosis Beyond EDSS: Impact of Cognition, Fatigue, and Limb Impairment","volume":"8","author":"Wasem","year":"2024","journal-title":"PharmacoEconomics Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"105661","DOI":"10.1016\/j.msard.2024.105661","article-title":"The impact of bladder problems on well-being in multiple sclerosis\u2014A cross-sectional study","volume":"87","author":"Islamoska","year":"2024","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3147","DOI":"10.1093\/brain\/awac016","article-title":"How patients with multiple sclerosis acquire disability","volume":"145","author":"Lublin","year":"2022","journal-title":"Brain"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2234","DOI":"10.1097\/PRS.0b013e3181f44abc","article-title":"Observational studies: Cohort and case-control studies","volume":"126","author":"Song","year":"2010","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/2121\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:57:16Z","timestamp":1760029036000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/6\/2121"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,20]]},"references-count":34,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["jcm14062121"],"URL":"https:\/\/doi.org\/10.3390\/jcm14062121","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,20]]}}}