Problem: Norah, a 26-year-old female living in Tasmania, first noticed her symptoms in the summer of 2019. She experienced blurring of vision in one eye which then turned into vision loss. This was accompanied by excessive fatigue and some clumsiness. All symptoms dissipated after 4 days. Her GP sent her for some tests including an MRI. The MRI scan findings revealed a plaque in her corpus callosum; the physician classified her event as a "clinically isolated syndrome" of multiple sclerosis (MS).
Approximately 10 months later, Norah's symptoms resurfaced: she experienced the same fatigue, vision disturbances and numbness in her arms and legs. A second MRI revealed three more plaques; prompting a diagnosis of relapsing-remitting MS (RRMS). Over the next year Norah has been prescribed interferon 1a, glatiramer and fingolimod.
One of Norah's friends suggested she try hash brownies (chocolate brownie cakes with marijuana cooked inside) to help calm her symptoms. Norah was unsure how this would work and worried that this would be addictive.
Q1. Compare the three drugs that Norah is taking in terms of their mechanism of action and how this is related to the pathology we see in MS.
Q2. Discuss the use of marijuana recreationally, and as a potential treatment in MS. You should address Norah's concerns about addiction.