Tic disorders may be caused by a problem in the Endocannabinoid System.
Tic disorders involve sudden movements, twitches, or sounds. The patient repeats these, often in a pattern, against their will. Some motor tics are painful with an intensity that is debilitating. Further, tics are termed ‘unvoluntary’ because many patients can suppress them only for a short time. Patients can’t hold back tics forever though. Eventually, the tic compulsion overwhelms personal will.
Tourette Syndrome is a neuropsychiatric disorder that usually begins in childhood and peaks during adolescence. It should be noted, however, that adult-onset can and does occur. The disorder affects approximately 1% of the population with males more commonly afflicted.
Accepted treatments include: Comprehensive Behavioral Intervention (CBIT), Habit Reversal (HRT), and pharmaceuticals (neuroleptics and anti-dopaminergic). Additionally, according to a review published in Neurotherapeutics (2020), [1]A Billnitzer, J Jankovic. Current Management of Tics and Tourette Syndrome: Behavioral, Pharmacologic, and Surgical Treatments (2020). Neurotherapeutics 17(1681-1693). … Continue reading if none of these treatments help, patients may see benefit from deep brain stimulation. This treatment, however, is still very new and would not be a first try.
Despite these options, many patients continue to suffer from a lack of symptom reduction. Additionally, for some, the side effects from pharmaceuticals are unbearable. All of this underscores the need for new and effective treatments for tic disorders. While cannabis research is still evolving, the reports about its effectiveness in stopping tics is promising.
Does Cannabis Work for Tic Disorders?
Adult patients with tic disorders have anecdotally reported relief from smoking whole plant cannabis. This has led researchers to investigate the Endocannabinoid System as a potential target for treatment. Fortunately, pharmaceutical cannabis drugs exist. These include dronabinol (THC), also known as Marinol, for the treatment of nausea and vomiting in cancer chemotherapy. And a class of drugs called nabiximols (ratio of THC:CBD at 1:1), commonly sold as Sativex. The latter is prescribed as an oral spray for the treatment of neuropathic pain, spasticity, overactive bladder, and other symptoms of multiple sclerosis.
The existence of approved cannabis-based pharmaceuticals is important as it allows researchers to push forward with cannabis medicine. While some will find these drugs not as effective as the plant, the existence of an approved, dosed medicine is important for furthering research in medical cannabis.
Case Study of Young Adult Using Cannabis for Tics
A case study, published in the journal Tremor and Other Hyperkinetic Movements (2021), found that nabiximol was able to help a man with, “stigmatizing motor and phonic tics after cessation of daily cannabis use.” [2]M Schwittay, A Steinbrecher, E Lobsien. Tic Reduction in Adult Onset Gilles de la Tourette Syndrome as Required Nabiximol Sprays. Tremor and Other Hyperkinetic Movements. 2021; 11(1):33. DOI: … Continue reading
The report outlines that the 25-year old patient had started smoking cannabis as a way to reduce restless legs, but had recently stopped. After cessation, his motor and vocal tics became more severe and almost continuous. Finally, he was no longer able to leave his house as he could only suppress the head and upper extremity movements by ten seconds. The Yale Global Tic Severity Scale (YGTSS) measured severity as 75/100.
Since cannabis had provided prior benefit, the doctor treated him with a trial of nabiximol in the form of a Sativex spray – three doses, with fifteen minute intervals. The response was dramatic (see the video here)! The patient saw a reduction in tics by ninety per cent and the effects lasted four hours. Additionally, no negative side effects were reported, only a feeling of “cheerfulness and relaxation.”
The Latest Research on Cannabis for Tic Disorders
A study published in the British Journal of Pharmacology (2020), [3]V Gorberg, P McCaffery, and S Anavi-Goffer. Different Response of Repetitive Behaviours in Juvenile and Young Adult Mice to THC and CBD May Effect Decision Making for Tourette syndrome. (2020) … Continue readingfound that THC reversed, “peripheral but not central motor tics.”
Importantly, rodents receiving CBD (alone) experienced increased side effects, including an increased frequency of head-twitch response. Based on these results, it is possible that CBD will not be recommended for future human trials in paediatric patients. Whole plant and THC-based medicines are more promising, these are difficult as a pediatric option due to the psychoactive effects of THC.
Pilot Study Tries THC for Tourette Syndrome in Adults
In 2021, the results of a phase 2 pilot study, featuring THC, were published in the Journal of Neuropsychiatry and Clinical Neurosciences (2021), [4]M Bloch, A Landeros-Weisenberger, J Johnson, J Leckman. A Phase 2 Pilot Study of a Therapeutic Combination of Delta-9-Tetrahydracannabinoi and Palmitoylethanolamide for Adults with Tourette’s … Continue readingwith excellent results. The 12-week uncontrolled trial involved sixteen adults with Tourette’s syndrome. To each, the researchers administered the drug combination THX-110 (a maximum daily dose of 10mg THC and a constant 800mg dose of Palmitoyethanolamide (PEA)).
The Yale Global Tic Severity Scale (YGTSS) measured outcomes. Patients saw significant improvement from baseline after only one week of treatment. The average tic improvement was 20% (7 points on YGTSS). Additionally, sixteen of the twenty-four participants elected to continue into the extension phase of the pilot study (24 weeks). All side effects were easily managed by decreasing THC, titrating more slowly, or shifting dose to nighttime.
While these results are very encouraging, there is still the requirement of randomized, double-blind placebo trials. Importantly, there is a special challenge in blinding trials with THC due to its psychoactive properties.
How Does Cannabis Work on Tic Disorders?
Disruption in the Endocannabinoid System is speculated to be the cause of tic disorders, including Tourette Syndrome. While the pathophysiology is not clear, the disorder involves changes to neurotransmitter systems. This is particularly obvious in the dopaminergic system, which is a group of cells existing in the midbrain. These cells include the “function of movement, cognition, executive functions, reward, motivation, and neuroendocrine control”. (Wikipedia)
Importantly, there is a high concentration of CB1 receptors in the basal ganglia, located at the top of the midbrain. This suggests that the ECS has an important role to play in the regulation of movement. Since we know that the clinical effects of THC are due to its action on the CB1 receptor, researchers are busy studying the connection between THC, ECS, and tic disorders. It is very probable that this is the pathway by which cannabis has positive benefit for patients with tics.
Which Method of Cannabis Consumption is Best for Tics?
Research points to THC as the main helper cannabinoid for symptoms of tic disorders. And in looking at the anecdotal report of the 25-year old patient who received four hours of relief following administration of the oral spray Sativex, it may be beneficial for patients to try a combination of slow-release and long-acting options.
Taking cannabis under the tongue or using an oral spray are methods with rapid onset of relief from symptoms. Patients looking for longer term relief will try patches and edibles. Used together, these methods give both quick and sustained relief.
In conclusion, research into cannabis for tic disorders is very promising. Researchers are matching results with anecdotal reports and this is advancing theories at a more rapid pace. As legalization expands, there will be greater access to cannabis for research purposes as well as a greater willingness for governments to invest.
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