Can Cannabis Help Tourette's Syndrome?

Overview

Cannabis is arguably the most popular alternative treatment for Tourette syndrome. And it’s also true that a growing volume of clinical evidence suggests that cannabis-based medicine not only improve tics that characterize the condition but also the psychological conditions that often occur along with it, such as OCD, ADHD, anxiety, and depression.

Current findings have led researchers to speculate that the endocannabinoid system may be involved in Tourette’s syndrome. In addition, an ever-growing body of clinical evidence points to the efficacy of cannabis-based medicine in relieving not only tics in Tourette’s but also the associated psychiatric issues (among them anxiety, depression, sleep problems, OCD, and ADHD) in both adults and children. In this sense, cannabis appears to be a breakthrough therapy for Tourette’s syndrome that addresses the broad range of symptoms accompanying this disorder. 

Research also indicates that cannabis is a safe substance for Tourette’s patients. Published reports have only mentioned minor side effects, and some studies even suggest that cannabis use by those with Tourette’s can even improve their cognitive performance, as in measures of attention.  

Although clinicians in many parts of the world are still wary of prescribing cannabis for Tourette’s, this may very well change as more high-quality research evidence comes to light and laws around cannabis use continue to loosen. 

The Endocannabinoid System

Consisting of molecules called endocannabinoids, the receptors they act on, and the enzymes that build and break them down, the endocannabinoid system helps the body maintain homeostasis, a healthy state of balance.

Accordingly, this system helps regulate a wide range of processes critical to our health, including cognitive function, immunity, mood, sleep, pain, and metabolism. 

Anandamide and 2-AG, the two main endocannabinoids produced by our bodies, are the main components of this system. They exert their effects through two known cannabinoid receptors: CB1 and CB2. These receptors are found everywhere in the body, with CB1 being particularly abundant in the central nervous system and CB2 in immune cells.

CB1 and CB2 can also interact with phytocannabinoid, molecules produced by plants but structurally similar to the endocannabinoids produced by our bodies. The most prominent of these, THC and CBD, are found in large amounts in cannabis. Their similarity to endocannabinoids helps explain how cannabis can produce medicinal effects.

At this time, there isn’t a lot of direct proof for the involvement of the endocannabinoid system in Tourette’s syndrome. However, there is plenty of indirect and correlational evidence.

For starters, researchers know that CB1 receptors are abundantly found in the basal ganglia, a part of the brain associated with motor control whose malfunctioning is believed to play a central role in Tourette’s. This suggests that the endocannabinoid system is involved in regulating movement control.

In addition, there’s strong evidence that Tourette’s involves dysfunction of the dopaminergic (dopamine) system. The endocannabinoid system is known to exert significant influence on dopamine neurotransmission. Therefore, therapies targeting the endocannabinoid system may help with disorders characterized by dopamine dysfunction, including Tourette’s.

In particular, researchers speculate that the endocannabinoid system may play a role in suppressing overactive dopamine signaling in parts of the brain associated with the lack of movement control that results in Tourette’s tics; the hallmark of Tourette syndrome. 

Furthermore, there’s some evidence that Tourette’s syndrome may involve dysfunction of other neurotransmitters in the brain, namely glutamate and GABA. As it happens, some studies have shown these neurotransmitters are also influenced by the endocannabinoid system.

Taken together, this evidence provides a plausible explanation for why cannabis-based medicine acting through the endocannabinoid system can be effective for many people with Tourette.

Cannabis Treatment

There’s a body of evidence indicating that cannabis can not only improve tics but also the co-occurring mental disorders that affect almost 90% of Tourette’s patients, including ADHD, anxiety disorders, depression, and obsessive-compulsive disorder (OCD).

The two most notable clinical studies of using cannabis to treat Tourette’s and related mental conditions were headed by Dr. Müller-Vahl, a leading expert on Tourette’s and other tic disorders. 

In the first 2002 trial, 12 adults with Tourette were given one of three doses of pure THC or a placebo. THC treatment significantly improved tics.  It also improved obsessive-compulsive behavior, one of the most common comorbid conditions that occur along with Tourette’s. 

A follow-up trial in 2003 included 24 adult Tourette’s patients who were given placebo or up to 10 mg of THC a day for 6 weeks. Again, THC significantly improved tics.

In addition, a 1998 survey of 64 Tourette patients found that among the 14 who had used cannabis, 82% experienced tic reduction or complete remission, as well as improvement of premonitory urges and obsessive-compulsive symptoms. Similarly, a 2017 report examined the effectiveness of cannabis in 19 adults with Tourette’s. On average, tics were reduced by 60%, with 18 out of 19 people experiencing significant improvement. These studies showing cannabis consistently improving tics and other manifestations of Tourette’s is very encouraging. 

Furthermore, there’s a large number of published case reports of Tourette’s sufferers who found relief for tics and co-occurring mental issues through cannabis use. One 1993 report described a 36-year-old man who smoked cannabis daily and reported being completely tic-free for a year. 

Another 1999 report discussed a 25-year-old patient with advanced TS as well as ADHD, OCB, anxiety, and impulsivity who experienced improvement of all symptoms by smoking cannabis. This patient was then given a single 10 mg dose of THC, resulting in an 80% reduction of tics and other symptoms as well as improved attention and reaction time.

Meanwhile, a 2011 case study described a 42-year-old man who experienced a 75% tic reduction with THC treatment, as well as improvement in his concentration and visual ability.

A 2017 report described a 16-year-old boy with complex tics and related mental issues such as sleeping problems, anxiety, OCD, depression, and rage attacks. He was prescribed THC in vape form, experiencing significant improvement of both tics and the related mental conditions. The same report discussed a similar case of a 19-year-old boy with a rare form of Tourette’s who also experienced significant improvement when given medical cannabis daily.

There is also a report of a 7-year-old boy with severe TS and related ADHD and depression who was given THC after all other medications failed. The boy took THC daily alongside two Tourette’s medications, experiencing significant improvement of tics and related mental issues without any side effects, despite the large THC dose.

Case reports of Tourette’s patients using nabiximols (also known as Sativex), a cannabis-based spray drug containing THC and CBD, have also reported similar improvements.

Some research has shown that pure CBD alone without THC is not effective for improving Tourette’s tics, and that whole-plant cannabis preparations with medium-to-high THC levels are superior to THC-only medicines. 

Potential side effects of cannabis use

It’s widely known that cannabis use is associated with side effects that include anxiety, dizziness, tiredness, sleepiness, nausea, dry mouth, impaired memory, and that “high.”

Virtually all published reports of cannabis use in Tourette’s patients have noted these same effects. However, in every case, these effects were considered minor and temporary, with no serious adverse effects being reported.

It’s interesting to note that cannabis doesn’t necessarily worsen cognitive performance in people with Tourette’s. This is contrary to the decrease in mental performance reported in healthy individuals.

For example, one study found that patients with Tourette’s taking THC did not experience a decrease in reaction time, intelligence, attention, or other markers of cognitive performance. And another study found that THC actually improved verbal memory in subjects with  Tourette’s. Lastly, there are even reports that THC can improve concentration and visual ability, resulting in improved driving ability in those with  Tourette’s.

Taken together with improvements in attention and related cognitive issues reported by other studies, these findings suggest that people with Tourette may actually experience enhanced cognitive function with cannabis use.