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.
Highlights
Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterized by the presence of multiple motor and one or more phonic tics that continue for at least one year [1]
Comorbidities in our cohort included a diagnosis of attention deficit/hyperactivity disorder (ADHD) for 14 patients (77.8%), obsessive compulsive symptoms/disorder (OCS/ OCD) for 12 patients (66.7%), history of depressive episodes for 7 patients (38.9%), and anxiety for 10 patients (55.6%)
One patient had to stop the study due to worsening of his OCD, as mentioned above. The results of this pilot open-label prospective study are in line with our clinical impression that medical cannabis (MC) may be an effective treatment for patients with GTS
Summary
Gilles de la Tourette syndrome (GTS) is a childhood-onset neuropsychiatric disorder characterized by the presence of multiple motor and one or more phonic tics that continue for at least one year [1]. Tics have a pattern of waxing and waning course with a wide range of frequencies and intensities. Environmental factors such as stress, anxiety, and fatigue may transiently exacerbate tics [4]. Current research suggests alterations to the corticostriato-thalamo-cortical pathways, the dysfunction of the dopaminergic pathway, in the pathophysiology of GTS [5, 6]. Dopaminergic activity is found to be increased in GTS. Animal trials have demonstrated that specific disinhibition of the striatum, altering the release of dopamine, generated motor and vocal tics demonstrative of those in GTS [7]. Due to the significant role of dopamine in the development of tics, the current Food and Drug Administration (FDA) approved pharmacotherapy for GTS has been centered
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