Comprehensive Behavioral Intervention for Tics (CBIT) is considered a first-line therapy for tics. However, availability of CBIT is extremely limited due to a lack of qualified therapists. This study is a multicenter (n = 5), randomized, controlled, observer-blind trial including 161 adult patients with chronic tic disorders (CTD) to provide data on efficacy and safety of an internet-delivered, completely therapist-independent CBIT intervention (iCBIT Minddistrict®) in the treatment of tics compared to placebo and face-to-face (f2f) CBIT. Using a linear mixed model with the change to baseline of Yale Global Tic Severity Scale-Total Tic Score (YGTSS-TTS) as a dependent variable, we found a clear trend towards significance for superiority of iCBIT (n = 67) over placebo (n = 70) (−1.28 (−2.58; 0.01); p = 0.053). In addition, the difference in tic reduction between iCBIT and placebo increased, resulting in a significant difference 3 (−2.25 (−3.75; −0.75), p = 0.003) and 6 months (−2.71 (−4.27; −1.16), p < 0.001) after the end of treatment. Key secondary analysis indicated non-inferiority of iCBIT in comparison to f2f CBIT (n = 24). No safety signals were detected. Although the primary endpoint was narrowly missed, it is strongly suggested that iCBIT is superior compared to placebo. Remarkably, treatment effects of iCBIT even increased over time.

Background: Tourette syndrome (TS) is a childhood-onset neuropsychiatric disorder characterized by motor and vocal tics. In severe treatment-resistant cases of TS, cannabis-based medicine could be used alternatively as a therapy of last choice. Case Presentation:We present the case of an 7-year-old boy with severe TS and comorbid attention deficit/hyperactivity disorder (ADHD), who significantly benefitted from treatment with cannabis-based medicine. During an episode with increased tics, he became depressed, developed suicidal ideation, and exhibited separation anxiety resulting in social isolation. As treatment with various antipsychotics and Habit Reversal Training turned out to be unsuccessful, we implemented therapy with oral delta-9-tetrahydrocannabinol (THC) as oil-based drops. Starting dose was as low as 0.7 mg THC/day once a day and was gradually increased up to a maximum dose of 29.4 mg THC/day, resulting in a significant improvement of both tics and behavioral symptoms. Follow-up visits over a period of 4 months demonstrated a sustained treatment effect without any adverse events. Conclusion:From this single case report, it is suggested that THC is effective and safe in the treatment of tics, depression, and ADHD in children with severe and otherwise treatment-resistant TS.