Marijuana and Tourette's Syndrome
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Tourette’s Syndrome is a neurological disorder that is estimated to affect around 1% of people around the world and has an early onset. While the underlying cause of this debilitating condition still isn’t clear, new research suggests that cannabinoids like THC and CBD may help treat the condition’s severe symptoms.
UNDERSTANDING TOURETTE’S SYNDROME
Tourette’s Syndrome is a complex neurological disorder mainly characterized by repetitive involuntary movements and vocalisations called “tics.” It is usually diagnosed in children before they reach the age of 18, and the average onset for the disease is between 3 and 9 years of age.
Tourette’s syndrome can be a chronic condition. However, most patients experience their worst tics and symptoms in their early teens before finding an improvement in their condition in their late teens which usually continues on into adulthood. An estimated 10-15% of Tourette’s patients are diagnosed with a progressive disease that gets worse over time.
The underlying cause of Tourette’s is unknown. However, there is a general consensus among the medical community that the disease is caused by some kind of malfunction in the brain, especially in the regions of the basal ganglia, the prefrontal cortex, and the thalamus.
Research also suggests that the condition is caused by abnormalities in the neurological pathways connecting these various parts of the brain, as well as neurotransmitters responsible for managing communication between brain cells.
Genetics also play a big role in the development of Tourette’s syndrome. A patient with the condition is believed to have a 50% chance of passing it onto his/her children. However, even though a person may inherit the disease genetically, that does not mean that they will experience the same symptoms as their parent/s, or any symptoms at all. Instead, the genes may express themselves as other related conditions, such as milder tic disorder or obsessive-compulsive behaviors without tics.
Tourette’s affects patients of all ethnicities and is up to 4 times more common in males than females.
THE SYMPTOMS OF TOURETTE'S SYNDROME
The symptoms of Tourette’s syndrome can vary in severity. While most patients with Tourette’s will experience tics to some degree, some may suffer from much more severe motor and vocal problems than others. Some patients, for example, may only experience mild motor tics like blinking and other eye movements, facial grimacing, and shoulder shrugging, or mild vocalizations like repeated involuntary grunting, sniffing, and throat-clearing.
Others, however, may experience much more serious symptoms. These can include motor tics that almost seem voluntary, like jumping, bending, or twisting, or even physical tics that can even lead to self-harm like punching oneself in the face. Sever vocalization tics can include coprolalia (uttering socially inappropriate words such as swearing) or echolalia (repeating the words or phrases of others).
Severe tics can cause localized pain in some patients. Some patients may also feel an urge in a specific muscle group or part of their body before experiencing a tic. While tics are always involuntary, some patients may feel capable of suppressing or masking their tics to some extent. Some patients may also feel a “need’ to complete a tic in a certain way or a certain number of times before feeling a sense of relief.
Tics tend to get worse in situations where a patient feels anxious, nervous, or stressed, and get better during calm, focused activities. In some patients, tics can also be triggered by certain outside influences like tight clothing or even the sound of someone clearing their throat or sniffing.
The first symptoms of Tourette’s syndrome usually occur in the head and neck, and motor tics usually tend to precede vocal ones. Tics may gradually progress to other parts of the body at a later stage of the disease.
DIAGNOSING TOURETTE’S SYNDROME
In order to be diagnosed with Tourette's syndrome a patient must have experienced both motor and vocal tics for at least 1 year. There is no test for Tourette’s, but doctors may use a combination of blood tests, magnetic resonance imaging (MRI scans), computerized tomography (CT scans), and electroencephalogram (EEG) studies to rule out other similar conditions that may be confused with this condition.
REGULAR TOURETTE’S TREATMENT
The treatment for Tourette’s varies depending on how severely it affects a particular patient. Patients with milder symptoms generally do not require medication. However, patients with severe symptoms may be prescribed neuroleptic drugs to help suppress their tics. These include haloperidol and pimozide.
It is important to realize that there is currently no medication that can completely eliminate the tics associated with Tourette’s. Similarly, there is no medication that exhibits positive results in all patients.
The drugs used to manage the symptoms of Tourette’s all produce side effects. These side effects vary from one patient to another, but generally include sedation, weight gain, and cognitive dulling. Some patients may also experience more severe adverse reactions to their medicine, including tremors, dystonic reactions, and other involuntary movements or spasms. These symptoms are usually managed with reduced dosages.
Patients looking to come off their neuroleptic medications must do so gradually in order to avoid a relapse, often characterized by increased tics and spasms caused by withdrawal. The chronic use of neuroleptics has also been linked to the development of tardive dyskinesia, a condition characterized by stiff, jerky movements similar to the tics caused by Tourette’s.
CANNABIS AS A TREATMENT FOR TOURETTE’S SYNDROME
Some anecdotal evidence suggests that cannabis may help reduce the amount and severity of tics produced by Tourette's syndrome. Some common examples are this German news report featuring Billy, a man with a severe case of Tourette’s who relies on cannabis to dull his symptoms.
But the evidence pointing to cannabis as a possible treatment of Tourette’s isn’t just limited to anecdotal reports. In 2001, a team of German researchers from the Hannover Medical School and Heinrich Heine University in Düsseldorf, tested the effects of THC, the main psychoactive compound found in cannabis, on 12 patients suffering from Tourette’s syndrome.
The randomized, double-blind, placebo-controlled study focused on analyzing the effectiveness of three different dosages of THC (5, 7.5, and 10mg) in reducing the symptoms of Tourette's in the participants. The severity of tics were assessed both by the patient’s themselves plus an examiner.
The researchers observed an overall improvement of tic severity in scores from the self-rating systems as well as the analysis of the examiner. They also noticed a significant improvement in obsessive-compulsive behaviour in the patients.
The researchers were careful to note that the THC treatment produced no serious adverse reactions. The main side-effect was described as a “transient feeling” which affected 5 of the 12 patients.
These results suggested that a single dose treatment of THC is both an effective and safe option for treating the tics and obsessive behaviour produced by Tourette's syndrome. The study suggested that one of the key players responsible in reducing tics may be 11-OH-THC (or 11-hydroxy-delta-9-tetrahydrocannabinol), a metabolite of the THC found in cannabis. However, the researchers suggested that more research was needed to confirm this.
The study came after a pilot trial involving one patient with Tourette’s syndrome. The researchers treated this patient once with a single dose of 10mg of THC and analyzed the severity of the patient’s tics using the Tourette’s Syndrome Global Scale. The total tic severity score was 41 before treatment, and dropped to 7 only 2 hours after the THC treatment took place.
The patient involved in the pilot trial was asked to self-evaluate his/her condition after the treatment, and reported feeling 70% better, with noticeable improvements in attention, impulse control, obsessive-compulsive behaviour, and more. The patient didn’t report any side-effects.
In 2016, researchers at the Tauranga Hospital in New Zealand also took a closer look at cannabis and how it may help in the treatment of Tourette's symptoms. Doctor’s used Sativex, a whole plant extract of cannabis made by GW Pharmaceuticals, on a single patient and analyzed the effect it had on the patient’s symptoms over 4 weeks.
The patient was given 2 controlled daily doses (containing 10.8 mg of THC and 10 mg of CBD) of Sativex and was made to undergo a variety of tests to evaluate the severity of his tics. The doctors also videotaped the patient and called in objective observers who were unaware of whether the patient was using Sativex or not.
Both the patient and his observers noted a vast improvement in the intensity and frequency of the patient’s tics after treatment, suggesting that THC and CBD may help manage the symptoms caused by Tourette’s.
CANNABIS AND TOURETTE’S: ANOTHER CALL FOR MORE RESEARCH
Unfortunately the research into how cannabis may serve as an alternative treatment for patients with Tourette’s is extremely limited. As is always the case with small-scale clinical trials like that discussed above and anecdotal evidence, it’s important to consider the limitations of this small body of research.
The lack of information on this topic also makes it clear that there is a need to further investigate the viability of using cannabis as a Tourette's treatment, given that it shows a lot of promise so far.