Tourette’s syndrome: treatment with medical cannabis
People with Tourette’s syndrome cannot control the symptoms (tics) of their condition, so they might say obscene words, make grimaces or blink wildly. The level of suffering is usually very high. There is still no adequate treatment available today. At best, the symptoms can be relieved somewhat. However, treatment with medical cannabis can be an alternative therapy option. The trials are very promising.
Tourette’s syndrome: what exactly is it?
In 1885, the French physician Georges Gille de la Tourette described for the first time the neuropsychiatric disease “Gilles de la Tourette syndrome”, in which patients suffer from the so-called tics. A distinction must be made between a vocal tic (sudden sound) and a motor tic (involuntary movement). If there are several motor tics and at least one vocal tic, this is an indication of Tourette’s syndrome.
In addition to the distinction between vocal and motor tics, tics are also divided into simple and complex tics. Simple tics usually involve individual muscle groups (e.g. blinking, twitching, grunting) and complex tics involve several muscle groups (e.g. obscene gestures, echolalia, hopping). The frequency and strength of these can vary. If, for example, stress factors or joy are added, the symptoms usually become stronger. On the other hand, the symptoms usually decrease slightly when concentration is high.
In addition, many people with Tourette’s also can develop attention deficit hyperactivity disorder (ADHD) or suffer from depression, anxiety or obsessive-compulsive disorder.
About 4 to 12 out of every 100 children develop various tics from the age of 6. These usually disappear of their own accord after some time. Only one child in 100 develops a chronic tic disorder (Tourette’s syndrome).
Classification into levels of severity
The severity of Tourette’s Syndrome (TS) can be determined using a severity scale (TSSS):
- A minor impairment is present when the patient is not restricted in school, at work or in everyday life. The course of the disease is unproblematic here, as even outsiders do not notice the tics.
- A moderate impairment is said to exist if the patient suffers from the symptoms at school, at work and in everyday life, and the tics are noticed by outsiders.
- If the patient is severely impaired, the tics are so pronounced that the patient’s performance is massively reduced. The patient experiences the illness as a severe strain and it is not uncommon for social contacts to be disturbed.
Causes of Tourette’s syndrome
The causes are unclear. However, it is known that a genetic predisposition could play a role. This is because the risk of developing Tourette’s is about 100 times higher for children if the syndrome has already occurred once in the family.
Researchers also think that another possible explanation is the neurotransmitter metabolism in the brain, which can be disturbed in people with Tourette’s disease. The neurotransmitter dopamine is responsible for sending information to the brain. Research has shown that Tourette’s patients have a high number of dopamine receptors.
The serotonin, norepinephrine, glutamine and opioid balance also seems to be disturbed in people with Tourette’s disease. The disorder manifests itself mainly in the basal ganglia. These are areas of the brain that are located in both hemispheres and are responsible for regulating impulses and actions. If a disorder occurs here, this could be a possible cause.
Infectious diseases such as scarlet fever (A-streptococci) could also be a possible trigger. But various diseases such as Wilson’s disease or Huntington’s disease could also be a possible cause of tic disorders. In such cases, or when certain drugs (e.g. lamotrigine) trigger tics, they are referenced as secondary tics.
Treatment options for Tourette’s syndrome
There is no cure for the disease so far. Therefore, the goals of therapy are to relieve the symptoms and help patients to cope better with the disease. Behavioural therapy, psychotherapy, participation in a self-help group or learning relaxation techniques could be helpful here.
As part of drug therapy, doctors often prescribe antipsychotics or neuroleptics, such as aripiprazole, tiapride or risperidone. However, the effectiveness of these drugs is limited in Tourette’s syndrome. The tics still happen, but in the best case, the frequency can be reduced. Another problem is that antipsychotics can have serious side effects
Therapy with cannabis as medicine
Several studies suggest that TS patients can benefit from cannabis-based drugs and that the severity and frequency of tics can be reduced. The mechanism responsible for this is not yet completely understood. However, researchers believe that the endocannabinoid system, with its cannabinoid receptors that can also be detected in the brain and can be activated by cannabinoids in the cannabis plant, plays an important role.
Of interest is a German study led by Dr. Kirsten Müller-Vahl from 2017 on two treatment-resistant TS patients. (1) One patient received therapy with medicinal cannabis flowers (0.1 grams daily) and the other received the oily THC solution dronabinol (22.4 to 33.6 milligrams daily). Both subsequently reported a significant improvement in tic symptoms.
Kirsten Müller-Vahl, a professor at the Hanover Medical School, published the results of an individual case study in the same year. (2) A 22-year-old test subject with Tourette’s syndrome was given nabiximol. Initially he was given a dosage of 2.7 milligrams of THC and 2.5 milligrams of CBD, which was then slowly increased to a dose of 24.3 milligrams of THC and 22.5 milligrams of CBD three times a day. Under this therapy, the tic disorder and also the quality of life of the affected person improved.
Other interesting studies
In 2016, New Zealand researchers reported on a person who was treated twice a day with Sativex oral spray (10.8 milligrams THC/10 milligrams CBD). (3) This also had a positive effect on the symptoms.
In a clinical trial conducted by the University of Toronto in 2017, the researchers evaluated the effectiveness of cannabis in 19 people. (4) They observed that the tics in the test subjects decreased by about 60 percent. They also found that 18 out of 19 people said that cannabis was well tolerated for medical purposes.
Treatment of sleep disorders
Those affected often suffer from sleep disorders. During the REM sleep phase, the tic frequency can even increase. (5) Several studies suggest that cannabinoids might have a positive effect on REM sleep. (6) This means that treatment with cannabis-based drugs could be beneficial for people who have REM sleep problems. Sleeping pills or tranquillisers, on the other hand, carry the risk of serious adverse effects.
People with Tourette’s syndrome have a high level of suffering, which can severely limit their quality of life. Adequate treatment with medication does not exist. In most cases, the symptoms can only be marginally relieved with the drugs available.
However, cannabinoids such as tetrahydrocannabinol (THC) and cannabidiol (CBD) have the potential not only to improve the symptoms of the disorder, but also to restore some of the quality of life to those affected without being burdened by severe side effects.
(1) Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany, Jakubovski E1, Müller-Vahl K2, 2017, „Speechlessness in Gilles de la Tourette Syndrome: Cannabis-Based Medicines Improve Severe Vocal Blocking Tics in Two Patients”
(3) Department of Psychiatry, Tauranga Hospital, Tauranga, New Zealand, Trainor D et al., 2016, “Severe motor and vocal tics controlled with Sativex”
(6) National Center for PTSD-Dissemination & Training Division, USA, Babson KA1 et al., 2017, “Cannabis, Cannabinoids, and Sleep: a Review of the Literature”
Several studies suggest that Tourette's syndrome patients can benefit from cannabis-based drugs and that the severity and frequency of tics can be reduced
Using Medical Cannabis to Treat Tourette’s Syndrome
Though it is only one among a group of tic disorders, Tourette’s Syndrome (TS) is by far the best known neurodevelopmental condition. People with Tourette’s generally begin exhibiting motor and/or vocal tics between the ages of five to seven, and while most children grow out of the disorder in adolescence, some continue to show symptoms throughout their lives. Approximately one percent of children in the US are affected by Tourette’s, and while treatment for the disorder is available, current therapies are limited by significant side effects.
Researchers have been exploring the apparently positive effect of cannabis on TS since the 1980s. Today, medical marijuana’s rapid ascent into the political and legal mainstream has breathed new life into this investigation, giving many sufferers hope that some form of the drug might be used to alleviate symptoms without the harsh side effects associated with traditional treatments.
How Cannabis Interacts With Tourette’s
The symptoms of Tourette’s can include “simple” tics, such as grunting or blinking, or more complex ones, like jumping, twirling, repeating back other people’s speech, or repetitively saying a certain phrase. The tic most popularly associated with Tourette’s is coprolalia, a vocal tic that includes a crude or inappropriate phrase, though this only occurs among 10-15 percent of those with the conditions who exhibit complex vocal tics.
Because little is known about the cause of Tourette’s, treatment for the condition is varied, and each form of treatment comes with its own problematic side effects. Dopamine blockers and inhibitors are among the most popular form of treatment, but they are known to cause weight gain and repetitive movements in some sufferers. Botox can be injected into affected muscles in order to stop motor tics, though this can cause stiffness and is a fairly invasive approach for a chronic condition. Medications like Ritalin are sometimes prescribed to treat the ADD that is associated with Tourette’s, but this can have the very unfortunate effect of exacerbating tics.
Many medical professionals believe that Tourette’s is associated with a dysfunction in the brain’s endocannabinoid system, making medical cannabis among the most direct ways of approaching the problem that the condition presents. This hypothesis is strengthened by clinical evidence suggesting that marijuana-based treatments decrease Tourette’s symptoms without negatively impacting patient’s cognition.
Could Cannabis Help Tourette’s Patients?
Various studies testing the effectiveness of several cannabis derivatives have found evidence that the drug helps to relieve tics, premonitory urges, and comorbidities experienced by those with Tourette’s. One retrospective evaluation discovered that cannabis had decreased tics among adult Tourette’s patients by 60%, while another observed a significant treatment effect of THC, the primary psychoactive component of marijuana, on both tics and OCD symptoms for TS patients.
In spite of this promising research, however, much remains to be learned about the relationship between cannabinoids and tic disorders like Tourette’s. The studies cited above both were reviewing prior research, and new research must be conducted in order to definitively conclude anything about marijuana’s efficacy.
What’s more, little is known about precisely which cannabinoid is responsible for the observed benefits of medical marijuana for TS sufferers. Some believe that both THC and the non-psychoactive cannabinoid CBD are partially responsible for lessening the occurrence and duration of tics experienced by patients, while others believe that CBD alone could be used to treat the condition. This would allow patients to treat their tic disorder with CBD oil or pills without having to experience the “high” produced by ingesting standard marijuana.
Little is known about the relationship between Tourette’s and marijuana, but anecdotal evidence and some scientific research both suggest that the drug could improve the experiences of patients by reducing the frequency of tics and alleviating comorbid conditions like ADD. If you suffer from Tourette’s or care for a child with Tourette’s, consider reaching out to Lakewood Medical Clinic for a medical consultation. We can help you decide whether medical marijuana should be a path to treatment you should pursue and determine the best potential course of treatment.
Little is understood about the causes and treatment of Tourette’s Syndrome, a neurodevelopmental condition causing involuntary verbal or physical tics. Luckily, some early research indicates Tourette’s could be treated with some form of medical cannabis.