Tourette Syndrome

Tourette syndrome is a neuropsychiatric condition, that usually starts in youth and is characterized by motor and vocal tics (uncontrollable urges to perform an specific action or say a specific word or sound). Tics are generally mild and limited to blinking, muscle twitches, or facial movements, but can also be more severe. Furthermore, anxiety and other psychiatric disorders can exacerbate the symptoms of Tourette Syndrome. A diagnosis of Tourette Syndrome does not impact mortality for a patient, but it can still significantly impact their lives due to their tics. As such, treatment is focused on preventing or controlling the tics, as well as any underlying psychiatric condition that could exacerbate the symptoms.

It is unclear exactly what the cause of Tourette Syndrome is, but it appears to be the result of dysfunction between multiple potential areas of the brain, including the thalamus, basal ganglia, and frontal cortex [1]. Research into exact mechanism by which this dysfunction occurs have yet to reveal a single entity, but it appears that neurotransmitters (ex: serotonin) are involved. As such, psychiatric therapies, both medical and non-medical, are shown to be the most effective to date at easing the burden of tics. Many of the cases of this condition are mild, and do not require treatment, and some people even grow out of their tics as they grow older. But for those who do require treatment given the severity of the tics or the impact on the patient’s life, below are some of the most common treatments available.

  • Behavioral therapy: this training enables those with tics to recognize when a tic is about to happen and teaches compensatory responses. This has been shown beneficial compared with control interventions in multiple studies. [2]
  • Antidopamine agents: risperidone and fluphenazine block dopamine receptors in the brain, while tetrabenazine depletes the dopamine available to these receptors. These medications work quite well, reducing tics by 60-80%. Unfortunately, not everyone can tolerate these medications because of potentially serious side effects. [3]
  • Clonidine: this medication is an works on receptors in the central nervous system, but the results of clinical trials are not consistent and some trials suggest that this medication works no better than a placebo. [4]
  • Botox: this injectable medication works directly on the nervous system and prevents neurons from firing properly, disrupting the signaling for tics. Trials have shown benefit for targeted therapy of focal tics, with botox decreasing the frequency of tics [5]

Tourette Syndrome and Cannabis

Overall, there is little research to date on the effect of cannabis on Tourette Syndrome and its potential impact on tics. No large, properly controlled trials have been performed as of yet, but the research that has been done shows potential promise for the use of cannabis-derived products to decrease symptoms. A few studies have shown that THC and cannabis extracts can have a potential positive impact on improving symptoms [6]. Cannabis-based therapy may also benefit patients with Tourette Syndrome by improving underlying exacerbating comorbidities, such as anxiety [7]. As research on this field expands, it is important for patients with Tourette Syndrome, and providers taking care of such patient, to understand the therapies available to them and make the optimal choices as therapeutic options expand.

Conclusions

As is becoming true in all fields of medicine, it is important to tailor the therapy to each individual patient. What works for one patient may not work for another. Many people benefit from the currently available medications for treatment of Tourette Syndrome, but for those who do not receive benefit or are unable to tolerate the medications, cannabis-based therapies should be considered. Additionally, cannabis-based therapies can have many different concentrations of THC and CBD, of which THC is the more psychoactive component. It is important to discuss potential therapies with well-educated pharmacists and dispensary technicians in order to receive the maximal benefit.

References:

  1. Walkup, JT, Mink, JW, Hollenback, PJ, (eds). >Advances in Neurology, Tourette syndrome. Lippincott, Williams & Wilkins, Philadelphia, PA. 2006;99:xv.
  2. McGuire JF, Piacentini J, Brennan EA, Lewin AB, Murphy TK, Small BJ, Storch EA. A meta-analysis of behavior therapy for Tourette Syndrome. J Psychiatr Res. 2014. 50:106.
  3. Kurlan RM. Treatment of Tourette syndrome. Neurotherapeutics. 2014. 11(1):161-5.
  4. Goetz CG, Tanner CM, Wilson RS, Carroll VS, Como PG, Shannon KM. Clonidine and Gilles de la Tourette’s syndrome: double-blind study using objective rating methods. Ann Neurol. 1987. 21(3): 307-10.
  5. Marras C, Andrews D, Sime E, Lang AE. Botulinum toxin for simple motor tics: a randomized, double-blind, controlled clinical trial. Neurology. 2001. 56(5):605.
  6. Muller-Vahl KR. Treatment of Tourete Syndrome with cannabinoids. Behav Neurol. 2013. 27(1): 119-24.
  7. Hemming, Mary and Peter M. Yellowlees. “Effective treatment of Tourette’s syndrome with marijuana.” Journal of psychopharmacology 7 4 (1993): 389-91.