The Potential of Cannabinoid-Based Treatments in Tourette Syndrome
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LEADING ARTICLE
The Potential of Cannabinoid‑Based Treatments in Tourette Syndrome Bekir B. Artukoglu1 · Michael H. Bloch2 © Springer Nature Switzerland AG 2019
Abstract Novel pharmacological treatments are needed for Tourette syndrome. Our goal was to examine the current evidence base and biological rationale for the use of cannabis-derived medications or medications that act on the cannabinoid system in Tourette syndrome. We conducted a comprehensive literature search of PubMed for randomized controlled trials or clinical trials of cannabis-derived medications in Tourette syndrome. Data regarding the population, intervention, safety profile, and outcomes for each trial were extracted and reported and the evidence supporting use of individual cannabis-derived medications was critiqued. There is a strong biological rationale regarding how cannabis-derived medications could affect tic severity. Anecdotal case reports and series have noted that many patients report that their tics improve after using cannabis. However, only two small randomized, placebo-controlled trials of Δ9-tetrahydrocannabinol have been published; these suggested possible benefits of cannabis-derived agents for the treatment of tics. Trials examining other agents active on the cannabinoid system for tic disorders are currently ongoing. Cannabinoid-based treatments are a promising avenue of new research for medications that may help the Tourette syndrome population. However, given the limited research available, the overall efficacy and safety of cannabinoid-based treatments is largely unknown. Further trials are needed to examine dosing, active ingredients, and optimal mode of administration of cannabis-derived compounds, assuming initial trials suggest efficacy. Clinical use for refractory patients should at the very least be restricted to adult populations, given the uncertain efficacy and risk of developmental adverse effects that cannabinoids may have in children. Even in adult populations, cannabis-derived medications are associated with significant issues such as the effects they have on driving safety and the fact that they cause positive urine drug screens that can affect employment.
Key Points There is a strong biological rational for the use of cannabinoid-based treatments in the Tourette syndrome population. Limited research has been conducted so far (including two randomized, placebo-controlled trials of Δ9tetrahydrocannabinol [Δ9-THC] and case studies on cannabidiol, palmitoylethanolamide, and Δ9-THC). The findings suggest that these medications may improve tics. Further trials are needed to examine the overall efficacy and safety of cannabis-derived medications. * Bekir B. Artukoglu [email protected] 1
Yale University, Yale Child Study Center, PO Box 207900, New Haven, CT 06520, USA
Department of Psychiatry, Yale University, Yale Child Study Center, New Haven, CT, USA
2
1 Introduction Tourette syndrome (TS) is a pediatric-onset neuropsychiatric disorder characterized by motor and vocal tics, lasting for at least
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