Medical Cannabis for Gilles de la Tourette Syndrome: An Open-Label Prospective Study

Abstract

Objectives. Assessing the effectiveness and tolerability of medical cannabis (MC) treatment on Gilles de la Tourette syndrome (GTS) patients. Methods. We report on an open-label, prospective study on the effect of MC on adult GTS patients. MC mode of use was decided by the treating neurologist and the patient. Δ9-Tetrahydrocannabinol (Δ9-THC) and cannabidiol (CBD) content within MC product and monthly dose were titrated during the study. Following treatment initiation, patients were assessed after 4 and 12 weeks for efficacy, tolerability, and side effects. Results. 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. Conclusions. MC treatment demonstrates good efficacy and tolerability in adult GTS patients. Predilection for smoking rather than using oil drops requires further comparative studies to evaluate the efficacy of each. Cognitive and psychiatric side effects have to be monitored and addressed.

El papel de los cannabinoides en los trastornos del neurodesarrollo de niños y adolescentes

“…In 2003, the same authors [ 17 ] published a randomized controlled trial involving 24 patients favoring daily THC treatment compared to placebo with significant reduction in tics ( Table ). While these trials have shown promising results, the effect sizes were not as large and consistent as those reported by patients with regards to inhaled cannabis (smoked or vaporized) [ 20 ]. In 2022, Anis et al [ 20 ] published an open-label clinical trial demonstrating good efficacy and tolerability of medical cannabis in adult Gilles de la Tourette syndrome patients ( Table ).…”

“…Furthermore, they may cause severe side effects, such as parkinsonism, metabolic syndrome, and hyperprolactinemia, compromising the compliance. Two small, controlled trials have investigated the effect of oral THC in adult Gilles de la Tourette syndrome patients [ 17 , 19 , 20 ]. In 2002, Mueller-Vahl et al [ 19 ] published a double-blind, placebo-controlled, crossover trial of 12 patients (18-66 years) suggesting that a single-dose treatment with THC was effective and safe in the therapy of tics and obsessive-compulsive behavior in Gilles de la Tourette syndrome ( Table ).…”

Síndrome de Tourette: uma revisão literária dos tratamentos disponíveis para a amenização dos tiques

“…A Síndrome de Tourette (ST) é um transtorno de primeira infância, considerado um distúrbio do neurodesenvolvimento, prevalente em cerca de 0,3 -0,8% das crianças em idade escolar, marcada pela presença de múltiplos tiques motores e de pelo menos um tique vocal, sendo eles súbitos, rápidos, recorrentes, irregulares, não rítmicos e por vezes acompanhados de comorbidades psiquiátricas, com duração temporal de pelo menos um ano (Anis et al, 2022).…”

“…Estudos recentes sugerem como um dos possíveis fatores desencadeantes da ST, disfunções nas vias córtico estriatotálamo-corticais, em específico, na via dopaminérgica (ANIS et al, 2022). Além disso, tem-se como outra causa possível, o aumento da ligação do receptor D2 da dopamina no núcleo caudado, que é uma estrutura de substância cinzenta do telencéfalo, localizada ao lado da parede dos ventrículos laterais (Hsu et al, 2021).…”

“…Além disso, vale ressaltar que mesmo o tratamento medicamentoso para a ST sendo muito utilizado, ele pode gerar efeitos colaterais com bastante frequência, como parkinsonismo, síndrome metabólica e hiperprolactinemia. Por essa razão, tratamentos como psicoeducação, intervenção comportamental e biofeedback são escolhidos como a primeira linha de tratamento para amenizar os sintomas (Frey & Malaty, 2022;Anis et al, 2022). A farmacoterapia é usada então como segunda linha de tratamento e a estimulação cerebral profunda (ECP) como terceira linha (Wang et al, 2022).…”