Images In a survey of 64 TS patients, 25% indicated they had used cannabis, with over 80% of those individuals indicating that it helped reduce tics.
Tourette syndrome (TS) is a neurological disorder that develops in an early age in patients and is defined by involuntary movements and vocalizations, known as tics. These tics can be painful, embarrassing, and functionally impairing. At the present time, there is no known cure for TS. Current treatments aim to help control tics to improve quality of life. However, they have also been known to produce negative side effects.1
Some of the more common medications that are used to treat TS include clonidine, risperidone, haloperidol, and topiramate. While these drugs provide relief for many patients, they also have a plethora of side effects associated with their use. These side effects may include hypotension, drowsiness, weight gain, depression, and potentially kidney stones. In addition to pharmacological treatments, there is evidence that comprehensive behavioral treatment can be effective in reducing tics and helping in TS.2
The use of cannabis in the treatment of TS is a relatively new idea. In a survey of 64 TS patients who were interviewed at Hannover Medical School, 25% indicated they had used cannabis, with over 80% of those individuals indicating that it helped in reducing tics. Following this, several additional small-scale studies comparing THC containing products against placebo demonstrated statistically significant improvements in TS related tics. Additionally, most of the patients who found success with cannabis had failed at least one pharmacological intervention.3
It is theorized that either modulation of dopamine transmission or dysregulation of the endocannibinoid system (specifically due to interactions between CB1 receptors and other neurotransmitter systems). Strains that are high in limonene or with tangerine lineage appear to assist in modulating dopamine dysregulation linked to TS.1
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The proposed oral starting dose is 2.5mg daily, increased by 2.5mg every three to five days, up to a maximum dose of 30mg daily.1 Of note, it appears that inhaled cannabinoids provide faster onset and relief of symptoms. Unfortunately, there is not a lot of information directly comparing the effects of inhaled cannabis to oral formulations, so patients typically experience some trial and error in treatment.3
Due to its status as a Schedule I drug, as well as an absence of federal laws sanctioning medical marijuana in the United States, large-scale controlled research studies are virtually non-existent at the present time. However, in Germany a placebo-controlled study designed to investigate the efficacy and safety of cannabis in patients with TS is currently underway.4
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Because patients in studies typically stayed on their prescription medications while using cannabis, further investigation is necessary in order to confirm the value of cannabis as a solo treatment option. Ultimately, cannabis appears to be a promising option in the treatment of tics and associated symptoms of TS, though additional research is necessary to confirm efficacy and safety.3
1. Backes, M. (2014). Cannabis pharmacy: the practical guide to medical marijuana. New York: Black Dog & Leventhal Publishers. 43, 283
2. Kumar A, Duda L, Mainali G, Asghar S, Byler D. A Comprehensive Review of Tourette Syndrome and Complementary Alternative Medicine. Curr Dev Disord Rep. 2018;5(2):95–100. doi:10.1007/s40474-018-0137-2
3. Eddy CM, Rickards HE, Cavanna AE. Treatment strategies for tics in Tourette syndrome. Ther Adv Neurol Disord. 2011;4(1):25–45. doi:10.1177/1756285610390261
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