According to researchers, in a potential breakthrough that could bring relief to millions of people around the world, cannabis-based medications may help reduce the severity of tics in people with Tourette Syndrome.
These findings, coming from a comprehensive systematic review and meta-analysis in the European Journal of Clinical Pharmacology, may signal a paradigm shift in therapeutic approach for a condition baffling clinicians and plaguing those afflicted for so long.
The Tourette Enigma. A Neurological Puzzle
The disorder has retained the 19th-century French neurologist Gilles de la Tourette during its most mysteries in neurological annals since the turn of the last century.
Involuntary motor movements and vocalizations are characteristic features of this neurodevelopmental disorder, estimated to affect 0.3%-0.7% of children worldwide. For many, the condition will persist into adulthood with enormous associated social, emotional, and functional impairment.
Although the investigations into this disorder have been going on for the past several decades, little is known about the true causes of Tourette syndrome.
Scientists believe Tourette syndrome may be caused by several factors. These include changes in how certain brain areas connect and communicate, as well as imbalances in brain chemicals. One key chemical that might be involved is dopamine, which helps control movement and behavior.
This has made effective treatment quite elusive so far, and existing options usually fail to provide any comprehensive relief.
Consistent with this, Dr. Ibrahim Serag, lead researcher of the study and a researcher at Mansoura University in Egypt, explains that Tourette syndrome is not so much about the tics people see.
However, it can be a whole-body experience with uncomfortable sensory phenomena. In most cases, it goes along with obsessive-compulsive disorder and attention deficit hyperactivity disorder.
A Green Revolution in Neurology?
Enter cannabis—a plant whose history is as complicated and controversial as the condition it may help to treat.
Long since viewed with distrust and still under legal ban in some countries, the cannabis plant has recently undergone remarkable rehabilitation both in popular opinion and in scientific circles.
This has in turn ended up sparking a surge of research interest in its potential therapeutic applications, particularly with respect to neurological and psychiatric conditions.
This systematic review of data from nine studies involving 401 patients with Tourette syndrome was conducted with regard to the effects of different cannabis-based medicines on the severity of tics, premonitory urges, and obsessive-compulsive symptoms. Results, preliminary at best, are nevertheless very promising.
According to Dr. Serag, they found prominent reductions in the severity of tics but more importantly, premonitory urges among patients treated with cannabis-based medicines.
This was evidenced by the improvements on both the Yale Global Tic Severity Scale and Premonitory Urge for Tics Scale scores.
These findings are all the more remarkable given the modest efficacy of current first-line treatments for Tourette syndrome: only three medications—haloperidol, pimozide, and aripiprazole—have Food and Drug Administration approval for tic control and frequently have unpleasant side effects.
Beyond Tics. Addressing the Whole Patient
Perhaps what is most interesting about the findings of this research is the potential of cannabis-based medicines to treat not just the obvious tics but, importantly, also the more distressing internal experiences that seem to bother people with Tourette syndrome the most.
According to the study’s co-author, Dr. Mona Mahmoud Elsakka of Damanhour University, premonitory urges themselves—the uncomfortable sensations that precede tics—can be more bothersome.
Their analysis noticed considerable diminishing in these urges with the consumption of cannabis-based medicine, which will drastically improve the quality of life for Tourette syndrome patients.
This holistic effect is important, as Tourette’s rarely occurs in pure form. Many patients also suffer from obsessive-compulsive symptoms and attention deficits, and from anxiety.
While this study did not find any significant effect on obsessive-compulsive symptoms, measured by the Yale-Brown Obsessive Compulsive Scale, the researchers feel this is an area for further research.
Though results in respect of obsessive-compulsive disorder symptoms were not statistically significant, they hint at a potential benefit which needs to be explored in larger, more targeted studies.
Caution Amidst Optimism. The Road Ahead
Although exciting, such findings make the researchers hasten to caution against over excitement and point to the fact that more research is called for.
The study analyzed data from only a small number of patients. Also, different studies used various types of cannabis-based medicines, making it difficult to draw strong conclusions from the combined results.
The road ahead is laid out by the study’s co-author Dr. Mohamed Abouzid of the Poznan University of Medical Sciences.
He says they now need large-scale placebo-controlled trials using standardized cannabis formulations to figure out optimal dosing, long-term safety, and identify which patients are most likely to benefit.
Another challenge is the legal and regulatory environment related to cannabis.
While many countries have moved toward legalizing medical cannabis, even in those instances, policies vary in nature, and significant stigma is still attached to cannabis in many cases.
