Can Cannabis Help Treat Tourette Syndrome?
Tourette (too-RET) syndrome is a nervous system (neurological) disorder that starts in childhood. It involves unusual repetitive movements or unwanted sounds that can’t be controlled (tics). For instance, you may repeatedly blink your eyes, shrug your shoulders or jerk your head. In some cases, you might unintentionally blurt out offensive words.
Signs and symptoms of Tourette syndrome typically show up between ages 2 and 12.
TS is diagnosed according to the presence of multiple motor and phonic tics. Specific tics related to the above include coprophenomena (such as coprolalia: the uttering of obscene language), echophenomena (copying behaviours) and paliphenomena (repetitive behaviours).
They also generally suffer from obsessive-compulsive disorder (OCD) and sometimes ADHD as well.
There exists a dangerous tic such as hitting one’s head repeatedly against a wall that can cause a serious threat to bodily injury.
Treatment for the movement disorders involves the use of several drugs. The worst of which are the powerful neurolept medications such as the older, classic antipsychotic Haldol®, or the atypical antipsychotics. Both the classic and the atypical antipsychotic drugs themselves can cause disastrous Parkinsonian symptoms or the devastating disorder tardive dyskinesia in chronic users. In other words there are no effective and safe drugs to use in treating these patients.
It’s a terribly debilitating movement disorder. To get an idea on how bad it can become watch the video below where a man uses cannabis to placate his disease. It’s quite remarkable to watch.
In 1998 a possible role for cannabis was already being explored by Müller-Vahl KR in their publication: Cannabinoids: possible role in patho-physiology and therapy of Gilles de la Tourette syndrome.
Their conclusion: our results provide more evidence that marijuana improves tics and behavioural disorders in TS.
A pilot study was performed more recently, by Muller-Vahl et al. It involved a randomized, double-blind, crossover trial [Muller-Vahl et al. 2002]. In conclusion both motor tic severity and OCSs were significantly improved by THC.
In a follow up 6-week study [Muller-Vahl et al. 2003] they used doses of THC up to 10 mg. Small improvements in tic frequency and severity were evident according to assessment using different measures of tic severity.
They concluded: our results provide more evidence that THC is effective and safe in the treatment of tics. It, therefore, can be hypothesized that the central cannabinoid receptor system might play a role in TS pathology. The side effects associated with the use of THC were reported to be mild and transient.
In 2009 Curtis and colleagues, attempted a meta-analysis of current data. Only two trials met their criteria. Based on a paucity of available data they concluded that there was not enough evidence to support the use of cannabinoids in treating tics and obsessive-compulsive behaviour in people with Tourette’s syndrome.[ref]Cochrane Database Syst Rev. 2009 Oct 7;(4):CD006565.[/ref]
Although both trials reported a positive effect from Delta(9)THC, the improvements in tic frequency and severity were small and were only detected by some of the outcome measures. These include the possibility that effect sizes could be artificially inflated, as those participants who drop out may do so due to lack of treatment response [Curtis et al. 2009].[ref]Ther Adv Neurol Disord. 2011 Jan; 4(1): 25–45.[/ref]
CONCERN FOR COGNITIVE DYSFUNCTION
Muller-Vahl and colleagues reported no deterioration in verbal or visual memory, reaction time, intelligence, sustained attention, divided attention, vigilance or mood, with the use of THC [Muller-Vahl et al. 2001].
Presently some data exists that demonstrates a decrease in the severity of tics and other TS symptoms using THC. It appeared to be safe and did not cause cognitive decline. However, some trials were disappointing and more work clearly is needed.
Dr Muller-Vahl suggests: if well-established drugs either fail to improve tics or cause significant adverse effects, in adult patients, therapy with Delta9-THC should be tried. At present, it remains unclear whether herbal cannabis, different natural or synthetic cannabinoid CB1-receptor agonists or agents that interfere with the inactivation of endocannabinoids, may have the best adverse effect profile in TS.
A search of the literature for the use of pure CBD, which acts as a powerful neurolept drug, was futile. There do not appear to be any trials that used pure CBD, only THC. I believe CBD would have produced better outcomes. The neurolepts are some of the only drugs that help but sadly come with intolerable side effects. CBD has a nearly side effect free profile especially when compared to any of the current antipsychotic medications, or other drugs used in this challenging condition.