Efeitos do canabidiol no tratamento da espasticidade de pacientes adultos com disfunção neurológica : revisão sistemática

Abstract

Spasticity is a common motor disorder in adults with neurological dysfunction, characterized by an increased muscle tone resulting from upper motor neuron lesions. This condition affects between 38% and 80% of patients with neurological diseases, including Multiple Sclerosis, Stroke, and Spinal Cord Injury, and is associated with significant functional impairment, reduced quality of life, and increased healthcare costs. Conventional pharmacological treatments, such as baclofen and tizanidine, present relevant limitations related to adverse effects and tolerability, highlighting the need for safer and more effective therapeutic alternatives. Cannabidiol (CBD), a phytocannabinoid derived from Cannabis sativa, has emerged as one of these alternatives due to its modulatory effects on the endocannabinoid system and its potentially favorable safety profile. However, the available evidence still lacks a systematic synthesis capable of guiding clinical practice. Therefore, the present study aimed to analyze, through a systematic review, the effects of cannabidiol on the treatment of spasticity in adult patients with neurological dysfunction. The review was conducted in accordance with the Cochrane Handbook (version 6.0) and PRISMA guidelines, with the protocol registered in PROSPERO (CRD42024620605). Searches were performed in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and the Virtual Health Library (VHL) in January 2025 and updated in August 2025. Randomized controlled trials evaluating CBD in adults with neurological dysfunction using validated instruments to assess spasticity were included. Study selection and data extraction were carried out by two independent reviewers, with disagreements resolved by a third reviewer. A total of 11 randomized, double-blind, placebo-controlled trials published between 2004 and 2024 were included, predominantly involving patients with Multiple Sclerosis. Most studies used nabiximols (THC 2.7 mg + CBD 2.5 mg per spray), administered via the oromucosal route, with individualized titration and treatment duration ranging from 21 days to 14 weeks. Six studies demonstrated statistically significant superiority of nabiximols over placebo in reducing spasticity, primarily assessed using the Modified Ashworth Scale and the Numerical Rating Scale, while five studies found no significant differences between groups. The most frequently reported adverse effects included dizziness, nausea, fatigue, somnolence, and dry mouth, which were predominantly mild to moderate and transient, with serious adverse events reported in only one study.The available evidence suggests that CBD, particularly in the form of nabiximols, has therapeutic potential for the management of spasticity in adults with neurological dysfunction, with an acceptable safety profile compared to conventional treatments. However, methodological heterogeneity among studies and the predominance of research involving patients with Multiple Sclerosis limit the generalizability of the findings. Therefore, future studies evaluating isolated CBD, more diverse populations, and longer follow-up periods are needed.