The Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by the presence of motor and vocal tics. The TS is often associated with other neuropsychiatric disorders, such as anxiety, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD).
Current conventional treatments high-potency antipsychotics and alpha-2 receptor agonists – can cause significant adverse effects and provide only partial relief of symptoms, and other pharmacological options have only limited evidence. The search for new and promising therapeutic tools for the management of TS is therefore necessary and very welcome.
Studies cite evidence that cannabidiol (CBD) and delta-9-tetrahydrocannabinol (Δ 9 -THCthe main psychoactive element found in the plant – can be effective in the treatment behavioral problems and tics caused by Tourette Syndrome.
In this post we will present some information related to the use of these substances and their main prescriptive concepts in the treatment for Tourette Syndrome.Read on!
Effectiveness and tolerability of Medical Cannabis in the treatment for Tourette Syndrome
This study published in The Journal Neuropsychiatry and Clinical Neurosciences in 2017 evaluated the tolerability and efficacy of Cannabis in 19 adults with TS.Symptoms related to tics were reduced by 60%. In addition, 18 of the 19 participants experienced significant overall improvements.
All patients also reported improvement in symptoms of psychiatric comorbidities with Cannabis use, including obsessive-compulsive symptoms, attention deficit, impulsivity, anxiety, irritability, anger outbursts, and sleep disorders. Although most participants reported adverse effects, Cannabis was well tolerated.
A survey of patients with the syndrome, reported that 17 out of 64 respondents had an 82% reduction in tics, urges, and comorbidities when taking medical use of Cannabis.
In this way, the authors of the research proved the hypothesis of the efficacy and good tolerability of Cannabis in the treatment of tics and comorbid symptoms in TS.
>> You can read the full study here: Preliminary Evidence on Cannabis Effectiveness and Tolerability for Adults With Tourette Syndrome
Cerebrospinal fluid endocannabinoid levels in Tourette Syndrome
The good responses of these TS patients who use Cannabis have a biochemical-physiological explanation that is beginning to be unraveled.
The Endocannabinoid System (ECS) plays a primary role in basal ganglia function, modulating the activity of key neurotransmitters including dopamine, glutamate, and GABA, and therefore influencing different motor responses. Studies have been underway to understand the tone of ECS functioning in Tourette Syndrome.
A clinical study, published in 2020 in Nature’s journal Neuropsychopharmacology, measured cerebrospinal fluid (CSF) levels of two major endocannabinoids in adult patients with TS compared to a control group. Levels of “N”-araquidonoiletanolamine (AEA, anandamide) and 2-araquidonoilglycerol (2-AG), n = 20),in = 20), as well as the endocannabinoid-like molecule palmitoyl ethanolamide (PEA) and the lipid arachidonic acid (AA) were assessed.
The levels in CSF of AEA, PEA and AA were relatively increased in TS patients compared to controls. This study suggests that due to the complex bidirectional interaction between ECS and several other neurotransmitter systems, one could speculate that elevated endocannabinoid levels represent a secondary mechanism to compensate for dopaminergic hyperinnervation or, alternatively, represent a primary cause of TS and the changes in other neurotransmitter systems are secondary due to the complex interaction between these systems. Making it clear, in any case, the likely involvement of ECS in the pathophysiological processes of TS, as well as, of other neuropsychiatric diseases.
You can read the full review here: Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome
Treatment of Tourette Syndrome with Delta-9-Tetrahydrocannabinol (Δ9-THC)
During the last few years, different clinical trials have shown that cannabinoid derivatives can be useful in the treatment of movement disorders.
Despite the scarcity of double-blind clinical studies, there is clear evidence that cannabinoids may have therapeutic value in the treatment of Parkinson’s disease, in some forms of tremor and dystonia, and also in the tics associated with Tourette Syndrome and some forms of tremor and dystonia.
One of these pieces of evidence was published as recently as 2003 in the Neuropsychopharmacology. The authors investigated the effect of a treatment with up to 10 mg of delta-9-tetrahydrocannabinol (Δ 9-THC) over a 6-week period on neuropsychological performance in 24 patients with TS.
During medication and 6 weeks after withdrawal of Δ9-THC treatment, no detrimental effects were observed on the patients’ learning curve, recall and recognition of word lists, immediate visual memory, and divided attention.
On the contrary, authors of the study further identified a trend of significant improvement in immediate verbal memory ability during and after treatment. Therefore, the previous data suggest that in patients suffering from TS, the THC treatment does not cause acute or long-term cognitive deficits.
>> You can read the full study here: Treatment of Tourette Syndrome with Delta-9-Tetrahydrocannabinol (Δ9-THC): No Influence on Neuropsychological Performance
Another randomized double-blind placebo-controlled study, led by Kirsten Müller-Vahl, a German psychiatrist who is an international reference on the topic, evaluated how different dosages of THC (5.0, 7.5 or 10.0 mg) affected symptoms in 12 adult patients with TS. Tic severity was assessed using a self-rated scale (Tourette Syndrome Symptom List, TSSL) and by examiner assessments (Shapiro Tourette Syndrome Severity Scale, Yale Global Tic Severity Scale, Tourette Syndrome Global Scale). Clinical changes were further correlated with maximal plasma levels of THC and its metabolites 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC) and 11-nor-Δ9-tetrahydrocannabinol-9 carboxylic acid (THC-COOH).
Using the TSSL scale, there was a significant improvement in tics and obsessive-compulsive behavior after treatment with Δ9-THC compared to placebo. Examiner ratings showed a significant difference for “complex motor tics” and a trend toward significant improvement for “motor tics,” “simple motor tics,” and “vocal tics.” There was a significant correlation between tic improvement and the maximum plasma concentration of 11-OH-THC.
>> You can read the full study here: Treatment of Tourette’s syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial
A specialized education in the field is essential to mastery the technical knowledge and make safe and assertive prescriptions in the use of THC and other cannabinoid derivatives in the treatment of Tourette Syndrome and other psychiatric comorbidities.
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Müller-Vahl K.R.a · Kolbe H.b · Schneider U.a · Emrich H.M. Cannabis in Movement Disorders. Complementary Medicine Research. 1999.
Kirsten R Müller-Vahl, Heidrun Prevedel, Karen Theloe, Hans Kolbe, Hinderk M Emrich & Udo Schneider. Treatment of Tourette Syndrome with Delta-9-Tetrahydrocannabinol (Δ9-THC): No Influence on Neuropsychological Performance. Neuropharmacology. 2003.
Kirsten R. Müller-Vahl, Laura Bindila, Beat Lutz, Frank Musshoff, Thomas Skripuletz, Charlotte Baumgaertel & Kurt-Wolfram Sühs. Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome. Neuropsychopharmacology. 2020.
Elia Abi-Jaoude, M.Sc., M.D., F.R.C.P.C., Lei Chen, Ph.D., Patrina Cheung, B.H.Sc., Tracy Bhikram, M.Sc., Paul Sandor, M.D., F.R.C.P.C. Preliminary Evidence on Cannabis Effectiveness and Tolerability for Adults With Tourette Syndrome. Clinical and Research Reports. 2017.
Raphael Mechoulam, Linda A Parker. The endocannabinoid system and the brain. PubMed. 2012.