Can cannabis help dystonia?

Overview

Cannabis has been used as an alternative therapy for dystonia. Although the findings are inconclusive, early research suggests that both cannabis and CBD may hold potential for treating this movement disorder.  

Such evidence points to the involvement of the body’s endocannabinoid system in healthy movement control. Indeed, this system is abundant in parts of the brain whose dysfunction plays a central role in dystonia and is known to influence dopamine and other neurotransmitters involved in the condition.

Also, symptoms associated with dystonia, which may include pain, anxiety, and difficulty sleeping, are more frequently treated with cannabis.

Research on dystonia and cannabis

Little research has been done to investigate the benefits of cannabis in dystonia. Although the existing evidence is mixed, the outlook remains promising. 

One 2002 clinical trial compared the effects of the synthetic THC drug nabilone and a placebo in 15 people with dystonia. A single dose of nabilone (0.03 mg/kg of body weight) failed to improve dystonia. Similarly, a 2011 clinical trial compared the synthetic THC drug dronabinol with placebo in nine people with dystonia. Dronabinol (15 mg) given daily for three weeks failed to produce any benefits over placebo. 

It could be that the negative results in these studies were due to several factors unrelated to cannabis in general, such as the small number of participants, short study duration, insufficient dose, or the use of pure THC instead of whole-plant cannabis. Whole-plant preparations sometimes benefit from the entourage effect: the synergy between all of the cannabinoids, terpenes, and other beneficial components of the plant.

Nonetheless, we do see multiple anecdotal reports of dystonia sufferers who saw significant improvement by using cannabis. One 2002 report described a 42-year-old woman with central pain syndrome and dystonia who experienced remarkable benefits from smoking cannabis. She reported significant improvement of dystonia and zero pain for 48 hours after smoking. Other therapies she tried only partially improved her symptoms. She continued to find relief by using cannabis daily and stopped taking opioids.

Meanwhile, a 2004 report discussed the case of a 25-year-old man with dystonia caused by Wilson’s disease who experienced significant relief by smoking cannabis. 

Another 2004 report described a 38-year-old pianist who experienced significant improvement of focal dystonia in his hand for three hours after taking 5 mg of THC. In comparison, placebo treatment had no effect. 

A 2008 paper outlined the case of a 52-year-old woman with multiple sclerosis who significantly improved her sleep, anxiety, and dystonia by taking dronabinol (2.5 mg twice daily). Finally, a 2019 paper discussed a 44-year-old woman with dystonia who failed to find relief with standard treatments but experienced ongoing improvement and was eventually symptom-free after smoking cannabis daily.

There’s also overwhelming evidence that cannabis can relieve chronic pain, a major symptom of dystonia. For instance, a 2018 paper that reviewed decades of study findings concluded that “evidence from current research supports the use of medical cannabis in the treatment of chronic pain.”

CBD and dystonia

There’s limited evidence that cannabidiol (CBD) can improve dystonia or its symptoms. One 1986 study found that 100–600 mg doses of pure CBD given daily alongside standard medication resulted in a 20%–50% improvement of dystonia in five people. 

CBD has pain-relieving properties that can relieve dystonia pain. Another way CBD can help is by improving sleep problems, anxiety, and depression, and there is a growing body of clinical evidence backing its effectiveness. 

These issues are not only more likely to occur in people with dystonia, but also tend to worsen its symptoms.

How cannabis works on dystonia

The endocannabinoid system (ECS) exists in all vertebrates and helps regulate crucial functions such as sleep, pain, and appetite. The human body produces its own cannabinoids, which modulate and activate its various functions, but as its name suggests, the endocannabinoid system can also be modulated and activated by cannabinoids found in the cannabis plant. Because the entire system was only discovered in the past 30 years, scientists still have much to learn about the myriad ways cannabis affects the human body.

There isn’t much research looking at the ECS in dystonia. However, there’s strong evidence that this system regulates the brain pathways involved in causing the condition.

Endocannabinoid CB1 receptors are plentiful in the basal ganglia, the part of the brain involved in motor control, and whose malfunction is believed to play the central role in dystonia and other movement disorders, such as Tourette’s syndrome. 

Recent research has also implicated the cerebellum, another part of the brain involved in motor control, in dystonia. CB1 receptors are abundant here as well. These findings suggest that the endocannabinoid system helps maintain healthy movement control and can be harnessed to treat dystonia.

The ECS is known to regulate the three main neurotransmitters (brain chemicals) involved in dystonia: dopamine, GABA, and acetylcholine.

There’s evidence that the ECS influences neurons that produce and release dopamine. Similarly, studies have shown that the endocannabinoid system interacts with GABA and acetylcholine receptors.

Available evidence suggests that the endocannabinoid system regulates the major neurological pathways involved in dystonia. This offers an explanation as to why cannabis is beneficial for many people with this and other movement disorders.

Using cannabis for dystonia

Cannabis may relieve dystonia, but what is the best way to use it? At this time, there isn’t enough research evidence to recommend the ideal form, dose, or method. 

Having said that, available findings suggest that smoked, whole-plant cannabis provides better, more consistent results than synthetic THC capsules.

Smoked cannabis is also backed by a large volume of research evidence for relieving chronic pain, a major symptom of dystonia.

CBD has less scientific evidence behind it but provides a viable alternative for people who want to avoid cannabis intoxication. It also has the advantage of helping with other issues associated with dystonia, such as anxiety, depression, and difficulty sleeping. 

The only available study used very high doses of pure CBD (100–600 mg), so large amounts of CBD isolate or smaller dosages of full-spectrum CBD oil may be necessary for optimal relief.

Potential side effects of cannabis use

Although cannabis is a promising option for dystonia, it does have some side effects. These are mostly caused by tetrahydrocannabinol (THC), the main psychotropic cannabinoid.

Standard, whole-plant cannabis contains high THC levels and can cause temporary side effects such as impaired memory and reaction time, increased heart rate, red eyes, dry mouth, blurred vision, sleepiness, lightheadedness, and dizziness. Some people might also experience feelings of paranoia and anxiety. These side effects have been noted in studies of dystonia but were considered insignificant in most cases.

CBD-rich preparations are non-intoxicating but may cause minor side effects such as diarrhea, low blood pressure (hypotension), dry mouth, lightheadedness, sedation, and changes in appetite. Such effects have only been reported in studies using high doses (100–600 mg). 

The only study of CBD in dystonia reported worsening of hypokinesia (reduced bodily movement) and resting tremors in two patients with Parkinson’s disease.