# Enhancing the endocannabinoid system to treat residual disease in relapse-free multiple sclerosis

## TL;DR

This paper proposes a new treatment approach for residual symptoms in relapse-free multiple sclerosis by enhancing the endocannabinoid system.

## Contribution

A new algorithm combining cannabinoid agents and lifestyle changes to treat residual MS disease.

## Key findings

- High-Efficacy Therapies reduce relapses but leave residual symptoms in MS patients.
- The endocannabinoid system may help manage spasticity and related symptoms in MS.
- A new treatment algorithm was proposed based on clinical experiences and published evidence.

## Abstract

The recent introduction of High-Efficacy Therapies (HETs) in clinical practice has drastically reduced the frequency of acute inflammatory episodes and relapses, in patients with Multiple Sclerosis (MS), gradually shifting the interest of clinicians toward preventing disease progression and treating symptoms associated with the residual disease. This article summarizes the output of a recent meeting (June 2025, in Rome) among an Italian group of neurologists, who discussed about published evidence supporting the involvement of the endocannabinoid system (ECS) in MS spasticity and its associated symptoms. Sharing their clinical experiences about the silent progression of the disease, in patients with Relapse-Free Multiple Sclerosis (RFMS), treated with HETs, authors propose a new algorithm to treat residual disease in RFMS, by enhancing ECS with both cannabinoid agents and lifestyle interventions (diet and physical activity).