Tourette Syndrome (TS) and Medical Cannabis

Tourette Syndrome (TS, Tourette’s) and Medical Cannabis

Definition

General Tourette Syndrome (TS, aka Tourette’s) 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 over the course of a person’s life, can be suppressed temporarily, and can be preceded by an unwanted urge or sensation in the affected muscle. Common tics include blinking, coughing, throat clearing, sniffing and facial movements.

Potential Efficacy / Quality of Evidence (Low, Average, High) of Medical Marijuana for Tourette Syndrome

Average

Cannabinoids, Terpenes/Terpenoids, Strains and Ratios that May Help

THC (and possibly THCV) may have uses for Tourette Syndrome. Moreover, only single doses may be needed. Tinctures may be helpful. CBD can be used to mitigate and help tone down THC’s psychoactive effects and prevent anxiety. Microdosing THC may also be of use, but some would suggest that one or several higher-dose THC treatments may be more appropriate, in particularly for older people with TS.

Medical Cannabis Pros

• Many medications prescribed for TS can have side-effects such as dizziness, depression, diarrhea/constipation, nausea and, for certain 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 also often comorbid with TS.

Medical Cannabis Cons

• Evidence for cannabis’s efficacy is mostly anecdotal at the moment. There are few studies to assess cannabinoids’ efficacy for TS, but there is some good quality evidence that merit research involving larger sample sizes.

More About the Condition

When many people think of a Tourette’s patient, they think of someone who swears or uses inappropriate language at inopportune moments (coprolalia), with little-to-no control over their vocalisms. This is a rare symptom of TS, and most people with Tourette’s go undiagnosed throughout their lives due to the fact that their tics aren’t severe.

The exact cause of TS is unknown, but it is thought that there is a combination of genetic and environmental triggers. The majority of cases of TS are inherited, and there does seem to be a dopaminergic gene polymorphism that causes TS, but 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.

According to the CDC, 1 out of every 360 children (0.3%) aged 6 – 17 suffer from TS, and children aged 12 – 17 are twice as likely to suffer from TS than children aged 4 – 11.298 37% 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 at the moment around 138,000 children have been diagnosed.

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, and can include adrenergic agonists such as clonidine (Catapres, Nexiclon, Kapvay), antipsychotic medications that dampen dopamine production such as fluphenazine, haloperidol (Haldol) and pimozide (Orap), and tetrabenazine (Xenazine, Nitoman). TS usually improves as the sufferer ages due to management techniques, but may still remain severe in some.

Quotes from Experts

“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.