Tourette Syndrome

General Tourette syndrome (TS, aka Tourette’s, Gilles de la Tourette Syndrome) is a relatively rare neuropsychiatric disorder that usually starts in childhood. TS is characterized by at least one vocal (phonic) tic and multiple motor tics. These tics can come and go throughout a person’s life, be suppressed temporarily, and be preceded by an unwanted urge or sensation in the affected muscle. Common tics include blinking, coughing, throat clearing, sniffing, and facial movements.

What is Tourette Syndrome?

When many people think of a person with Tourette Syndrome, they typically think of someone who swears or uses inappropriate language at inopportune moments (coprolalia), with little-to-no control over their vocalisms. However, coprolalia is a rare symptom of TS, and most people with Tourette Syndrome go undiagnosed throughout their lives because their tics aren’t severe.

According to the CDC, 1 out of every 333 children (0.3%) aged 3-17 suffer from TS, and children aged 12-17 are twice as likely to suffer from TS than children aged 6-11. 44% of TS sufferers have moderate to severe Tourette’s. Males are three to five times more likely than females to have TS, although females may be more likely to display tics. It is thought that 1 out of 162 (0.6%) children have TS, meaning that up to half of sufferers are undiagnosed, and around 174,000 children have been diagnosed.

The exact cause of TS is unknown, but it is thought that there is a combination of genetic and environmental triggers. Most cases of TS are inherited, and there seems to be a dopaminergic gene polymorphism that causes TS. Still, the exact mode of inheritance is not known yet.

Refined sugar, caffeine, and gluten may exacerbate tics. Tourette’s syndrome may be related to obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). Autism spectrum disorders, depression, and anxiety are also comorbid with TS. The CDC has noted the following comorbidities:

• 5 in 6 (83%) children with ADHD have been diagnosed with at least one other mental, behavioral, or developmental disorder.
• 61% had anxiety problems.
• 52% had ADHD.
• 34% had behavioral problems, such as oppositional defiant disorder (ODD) or conduct disorder (CD).
• 34% had learning disabilities.
• 26% had developmental delays.
• 21% had autism spectrum disorder (ASD).
• 20% had depression.
• 15% had speech or language problems.
• 8% had intellectual disabilities.

Brief Summary of Current Treatments

Treatment methods for TS include psychotherapy, cognitive-behavioral therapy (CBT), planned activities, and neuro-linguistic programming (NLP). Medications are usually used in more severe cases of TS. They can include adrenergic agonists such as clonidine (Catapres, Nexiclon, Kapvay), as well as antipsychotic medications that dampen dopamine production, such as:

• Fluphenazine
• Haloperidol (Haldol)
• Pimozide (Orap)
• Tetrabenazine (Xenazine, Nitoman).

TS usually improves as the sufferer ages due to management techniques but may remain severe in some.

How Might Medical Cannabis Help?

Some studies show that THC may induce relaxation due to its sedative effects, which can calm tics associated with Tourette syndrome. CBD may help reduce anxiety, which increases the likelihood of tics. However, most reports are anecdotal, so the therapeutic aspects of medical cannabis for Tourette syndrome need to be explored more thoroughly.

Medical cannabis may also help reduce the intake of anxiolytic (anti-anxiety), antidepressant, stimulant, and antipsychotic medications that may be prescribed for ADHD, anxiety, depression, and/or autism that presents alongside Tourette’s.

Cannabinoids

Tetrahydrocannabinol THC and possibly tetrahydrocannabivarin THCV may have uses for Tourette Syndrome. Moreover, only low doses may be needed. Microdosing THC may also be beneficial, but some suggest that one or several higher-dose THC treatments may be more appropriate, particularly for older people with TS.

Cannabidiol (CBD) can be used to mitigate and help tone down THC’s psychoactive effects and prevent anxiety. Cannabinol (CBN) could be helpful for its sedative properties.

Cannabinoid Ratios

• THC:CBD 1:20
• THC:CBD 1:3
• THC:CBD 1:2
• THC:CBD 1:1

Terpenes and Terpenoids

Pinene, limonene, myrcene, linalool, and beta-caryophyllene may be of particular use for reducing the intake of stimulants and helping those with Tourette’s relax.

Flavonoids

Flavonoids that could help manage Tourette’s due to their ability to modulate neurotransmitter pathways include:

• Cannflavin A, B, and C
• Quercetin
• Luteolin
• Anthocyanins

Effective Ways of Taking Medical Cannabis for Tourette Syndrome

Routes of Administration

• Inhalation
• Ingestion
• Sublingual

Special Formulations

A CBD, CBN, linalool, myrcene, pinene, beta-caryophyllene, and limonene-rich cannabis cultivar (strain), extract, or product may be ideal for managing Tourette’s.

Dosing Methods

• Vaporization
• Inhaler
• Tincture
• Edible

What are the Pros and Cons of Taking Medical Cannabis for Tourette Syndrome?

Potential Pros

• Many medications prescribed for TS can have side effects such as dizziness, depression, diarrhea/constipation, nausea, and, for specific medications, addiction.
• THC may help in stopping tics.
• TS may be comorbid with conditions like ADHD. Dextroamphetamine-based ADHD medications can increase the occurrence of tics, and cannabinoids may prove to be an alternative. Other conditions like anxiety (in particular Obsessive Compulsive Disorder, or OCD) and autism are often comorbid with TS.

Potential Cons

• Evidence for cannabis’s efficacy is primarily anecdotal at the moment. There are few studies to assess cannabinoids’ efficacy for TS, but there is some good quality evidence that merits research involving larger sample sizes.
• Too much THC may induce anxiety or panic attacks in some, which may exacerbate tics.

Useful Anecdotal Information

“Mother Of Teen With Tourette’s Pushes For Medical Cannabis In Schools.” WCCO – CBS Minnesota. Apr. 4, 2017

“Child finds relief from Tourette’s using medical marijuana.” ABC 7 News, Feb. 28 2020

Scientific Data Overview and Studies

• Total Studies = 27
• Positive Studies = 24
• Inconclusive Studies = 3
• Negative Studies = 0
• 20 Meta-Analyses (17 positive, 3 inconclusive); 5 Double-Blind Human Trials (all positive); 2 Human Trials (all positive);
• 6 studies include CBD (all positive); 13 studies include THC (all positive); 2 studies includes a THC:CBD 1:1 ratio (both positive)
• Possible Overall Efficacy: Moderate

Quotes from Studies

“We performed a randomized double-blind placebo-controlled crossover single-dose trial of Delta(9)-THC (5.0, 7.5 or 10.0 mg) in 12 adult TS patients. Tic severity was assessed using a self-rating scale (Tourette’s syndrome Symptom List, TSSL) and examiner ratings (Shapiro Tourette’s syndrome Severity Scale, Yale Global Tic Severity Scale, Tourette’s syndrome Global Scale). Using the TSSL, patients also rated the severity of associated behavioral disorders. Clinical changes were correlated to maximum plasma levels of THC and its metabolites 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) and 11-nor-Delta(9)-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). Using the TSSL, there was a significant improvement of tics (p=0.015) and obsessive-compulsive behavior (OCB) (p = 0.041) after treatment with Delta(9)-THC compared to placebo. Examiner ratings demonstrated a significant difference for the subscore “complex motor tics” (p = 0.015) and a trend towards a significant improvement for the subscores “motor tics” (p = 0.065), “simple motor tics” (p = 0.093), and “vocal tics” (p = 0.093). No serious adverse reactions occurred. Five patients experienced mild, transient side effects. There was a significant correlation between tic improvement and maximum 11-OH-THC plasma concentration. Results obtained from this pilot study suggest that a single-dose treatment with Delta(9)-THC is effective and safe in treating tics and OCB in TS. It can be speculated that clinical effects may be caused by 11-OH-THC. A more long-term study is required to confirm these results. ” Müller-Vahl KR, Schneider U, Koblenz A, Jöbges M, Kolbe H, Daldrup T, Emrich HM. “Treatment of Tourette’s syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial.” Pharmacopsychiatry. 2002 Mar;35(2):57-61. doi: 10.1055/s-2002-25028. PMID: 11951146.

“Eighteen patients entered the study. Baseline Yale Global Tic Severity Scale- (YGTSS) Total (range 0-100) was 60.3 ± 17.1. Three patients did not reach the end of follow-up period. The most common mode of administration was smoking (80%). Following twelve weeks of treatment, a significant 38% average reduction (p = 0.002) of YGTSS-Total and a 20% reduction (p = 0.043) of Premonitory Urge for Tic Scale (PUTS) were observed. Common side effects were dry mouth (66.7%), fatigue (53.3%), and dizziness (46.7%). Three patients suffered from psychiatric side effects including worsening of obsessive compulsive disorder (stopped treatment), panic attack, and anxiety (resolved with treatment modification). Six patients (40%) reported cognitive side effects regarding time perception, visuospatial disorientation, confusion, slow processing speed, and attention.”

Source: Anis S, Zalomek C, Korczyn AD, Rosenberg A, Giladi N, Gurevich T. “Medical Cannabis for Gilles de la Tourette Syndrome: An Open-Label Prospective Study.” Behav Neurol. 2022;2022:5141773. Published 2022 Mar 9. doi:10.1155/2022/5141773

Conclusion

Medical cannabis could provide some therapeutic benefits for those managing Tourette’s. Both THC and CBD could be beneficial. However, sample sizes for the studies are minor and adverse effects (panic, oversensitivity to THC) have been noted, meriting further investigation.

Related Articles

Anxiety and Medical Cannabis

ADHD and Medical Cannabis

Autism and Medical Cannabis

Depression and Medical Cannabis

Note: the information in this article does not constitute medical advice.

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