Delta-9-tetrahydrocannabinol for the treatment of a child with Tourette syndrome: case report

Szejko, Natalia; Jakubovski, Ewgeni; Fremer, Carolin; Kunert, Katja; Mueller-Vahl, Kirsten

doi:10.24911/ejmcr/2/11

Cited by 12 publications

(9 citation statements)

References 5 publications

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“…Since many patients are dissatisfied with established therapies, they seek for alternative treatments including cannabis-based medications. From open uncontrolled studies [1][2][3][4][5][6][7] and two small randomized controlled trials [8,9], it is suggested that delta-9-tetrahydrocannabinol (THC, dronabinol), the most psychoactive ingredient of cannabis, but also cannabis and the cannabis extract nabiximols are effective in the treatment of tics and psychiatric comorbidities including ADHD, depression, anxiety, rage attacks, and OCD in patients with TS.…”

Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome

Müller‐Vahl

Bîndilă

Lutz

et al. 2020

Neuropsychopharmacol.

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Gilles de la Tourette syndrome (TS) is a complex neurodevelopmental disorder characterized by the presence of motor and vocal tics as well as psychiatric comorbidities such as attention-deficit/hyperactivity disorder (ADHD), obsessive-compulsive disorder (OCD), depression, and anxiety. The underlying cause of the disease is still unknown, but several lines of evidence suggest a paramount role of the dopaminergic system. Based on the clinical observation that cannabis-based medicine including cannabis and delta-9-tetrahydrocannabinol (THC, dronabinol) may improve TS, alternatively, an involvement of the endocannabinoid system (ECS) has been suggested. In this study we measured cerebrospinal fluid (CSF) levels of the two most important endocannabinoids "N"-arachidonoylethanolamine (AEA, anandamide) and 2-arachidonoylglycerol (2-AG), the endocannabinoid-like molecule palmitoyl ethanolamide (PEA), and the lipid arachidonic acid (AA) in a sample of adult patients with TS (n = 20) compared with controls (n = 19) using liquid-liquid lipid extraction and simultaneous quantification by liquid chromatography multiple reaction monitoring (LC/MRM). CSF levels of AEA (p = 0.0018), 2-AG (p = 0.0003), PEA (p = 0.02), and AA (p < 0.0001) were significantly increased in TS compared with controls. Levels of 2-AG correlated with the severity of comorbid ADHD (p < 0.01). This is the first study, demonstrating alterations in the ECS suggesting an involvement of this system in the pathophysiology of TS. It can be speculated that elevated endocannabinoid levels either represent secondary changes in order to compensate for alterations in other neurotransmitter systems such as the dopaminergic system, are simply an epiphenomenon or, alternatively, represent the primary cause of TS.

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Section: Introductionmentioning

confidence: 99%

Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome

Müller‐Vahl

Bîndilă

Lutz

et al. 2020

Neuropsychopharmacol.

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“…Therefore, a substantial number of patients seek for alternative treatments including cannabis-based medicines (CBM). While there is increasing evidence that different CBM might be effective in the treatment of adults with TS [1-4], in minors only two single case reports are available suggesting beneficial effects of orally administered pure delta-9-tetrahydrocannabinol (THC) – the most psychoactive ingredient of cannabis – in 8- and 15-year-old boys with TS and comorbid attention-deficit/hyperactivity disorder [5, 6]. …”

Section: Introductionmentioning

confidence: 99%

Vaporized Cannabis Is Effective and Well-Tolerated in an Adolescent with Tourette Syndrome

Szejko

Jakubovski

Fremer

et al. 2019

Med Cannabis Cannabinoids

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We present the case of a 12-year-old boy diagnosed with Tourette syndrome, who was successfully treated with a combination of vaporized medicinal cannabis and oral pure tetrahydrocannabinol (THC). Due to severe motor tics resulting in insomnia, the parents – both of whom were medical doctors – decided to initiate treatment with 0.02 g vaporized cannabis (Bedrocan with a THC content of 22% and a cannabidiol content of 1%; corresponding to a dose equivalent to 4.4 mg THC) without prior consultation of a Tourette expert. This treatment resulted – according to the parents’ report – in an immediate and nearly complete remission of the tics. Due to a further increase in tics, the parents therefore decided to implement a regular treatment with a combination of vaporized medicinal cannabis (up to 0.1 g cannabis per day, varieties Bedrocan and Amnesia Haze, corresponding to 22 mg THC/day) plus orally administered oil-based THC drops (maximum daily dose = 12.5 mg THC) resulting in a marked tic reduction. During a visit in our clinic, we were able to observe the reported beneficial effects 30 min after vaporization of 0.15 g cannabis (Amnesia Haze, equivalent to 33 mg THC; in addition, 7 mg oral THC were taken at home 6 h before the visit): tics, premonitory urges, and overall impairment significantly improved according to self-ratings, parent and clinician questionnaires. Importantly, no adverse events were reported. From this single case study, it is suggested that cannabis-based medicines and their combination (such as oral THC plus vaporized medicinal cannabis) are effective and safe in the treatment of severe tics in minors with TS. However, long-term follow-up is needed to confirm the beneficial treatment effects. We want to emphasize that in this boy treatment with cannabis was initiated by the parents before a consultation in our clinic has taken place. In our opinion, treatment with cannabis-based medicine in children should be regarded as a last-line treatment, when well-established treatments have failed to improve tics.

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“…Darüber hinaus wurde über eine erfolgreiche Therapie eines 7-jährigen Jungen mit schwerem GTS berichtet [19]. Nachdem Therapieversuche mit Risperidon, Aripiprazol, Tiaprid, Methylphenidat und Guanfacin nicht zu einer Verbesserung der Tics und der ADHS geführt hatten, verschlechterte sich der Zustand des Jungen und es kam zu einem sozialen Rückzug, Schulverweigerung sowie einer Depression mit Suizidgedanken.…”

Section: Behandlungen Von Kindern Und Jugendlichenunclassified

“…Schließlich findet sich in der Literatur die Schilderung eines 12-jährigen Jungen mit GTS, dessen Eltern -beide ebenfalls Ärzte -eine Behandlung mit inhalativem Medizinalcannabis (0,02 g Sorte Bedrocan ® pro Tag, entsprechend 4,4 mg THC) zur Therapie einer schweren Schlaflosigkeit eingeleitet hatten. Die Eltern und der Junge berichteten nicht nur über eine Verbesserung des Schlafs, sondern auch der Tics und des vorangehenden Dranggefühls [19].…”

Section: Behandlungen Von Kindern Und Jugendlichenunclassified

“…In praktisch allen veröffentlichten Fallberichten, Fallserien und Studien wird interessanterweise nicht nur über eine Verminderung der Tics, sondern gleichzeitig auch eine Verbesserung zahlreicher psychiatrischer Symptome berichtet. Dies reicht von Symptomen der ADHS [11] über Zwänge [11][12][13]20] bis hin zu einer Verbesserung von Schlafstörungen [11], Ängsten [11], Wutanfällen [11] und Depression [19]. Interessanterweise wurde jüngst in einer randomisierten placebokontrollierten Studie bei Patienten mit ADHS ebenfalls über eine Symptomverbesserung durch eine Behandlung mit Nabiximols berichtet [23].…”

Section: Wirkung Auf Psychiatrische Komorbiditätenunclassified

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Behandlung des Tourette-Syndroms mit cannabisbasierten Medikamenten

Müller-Vahl¹

2020

Nervenheilkunde

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ZUSAMMENFASSUNGDie Behandlung von Patienten mit Gilles-de-la-Tourette-Syndrom (GTS) ist bis heute unbefriedigend, da etablierte Therapien nur zu einer partiellen Reduktion der Tics und nicht zu einer Verbesserung psychiatrischer Komorbiditäten führen. Die medikamentöse Behandlung mit Antipsychotika führt oft zu relevanten Nebenwirkungen. Daher besteht großes Interesse, neue Behandlungsstrategien zu entwickeln. Basierend auf anekdotischen Berichten und kleinen Studien, in denen über positive Effekte durch Cannabis und cannabisbasierte Medikamente bei Patienten mit GTS berichtet wurde, wird in kontrollierten Studien untersucht, ob Medikamente, die durch unterschiedliche Mechanismen zu einer Stimulation des Endocannabinoidsystems führen, wirksam und verträglich in der Therapie von Tics und Komorbiditäten sind. In dieser Übersicht werden bisherige Studienergebnisse vorgestellt. Es werden Hypothesen diskutiert, warum Cannabinoide in der Behandlung des GTS wirksam sein könnten. Schließlich werden praktische Empfehlungen zur Therapie mit cannabisbasierten Medikamenten gegeben.

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Delta-9-tetrahydrocannabinol for the treatment of a child with Tourette syndrome: case report

Cited by 12 publications

References 5 publications

Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome

Cerebrospinal fluid endocannabinoid levels in Gilles de la Tourette syndrome

Vaporized Cannabis Is Effective and Well-Tolerated in an Adolescent with Tourette Syndrome

Behandlung des Tourette-Syndroms mit cannabisbasierten Medikamenten

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