Disease Description

“Tourette syndrome is a rare disorder that causes people to make unusual movements or sounds, called “tics.” Common examples of tics include blinking and throat clearing. People with the disorder have little or no control over their tics. Many people with Tourette syndrome have mild symptoms, but some have more severe ones. Most people with Tourette syndrome start showing signs of the disorder before they are 11 years old. In about half of children with Tourette syndrome, the tics go away by the time they turn 18. Tics that continue into adulthood gradually improve over time in many people. But in some people, the tics return later in life.” - Uptodate.com

Prevalence

“In a meta-analysis of 13 studies that specifically assessed TS in children, the prevalence of TS was 7.7 per 1000 children (95% CI 3.9-1.51) [18]. The prevalence was higher in boys compared with girls (10.6 versus 2.5 per 1000).” - Uptodate.com

Current Treatment Options

“Children and adults with Tourette syndrome don’t need medical treatment unless their tics are severe. A person with Tourette syndrome might need treatment if he or she is having problems:

●Talking with other people

●Attending school or working at a job

●Doing everyday things such as bathing, dressing, and eating Treatments include:

●Medicines – Certain medicines used to treat different mental health conditions can lower the number of tics a person has.

●Botulinum toxin (brand name: Botox) – This is a medicine that is given by injection. It works by blocking or calming the nerve signals that make the muscles jerk or twitch.

●Habit reversal training – This treatment involves working with a therapist who teaches people with Tourette syndrome to recognize when they are about to have a tic. Then, the people train themselves to do a different movement that makes it hard to do the tic. This treatment is not available everywhere.” -uptodate.com

Evidence for and Proposed Mechanism for Cannabinoids Therapeutics

"Anecdotal reports have suggested beneficial effects of marijuana (Cannabis sativa) in TS. Sandyk and Awerbuch (2) reported that three TSpatients experienced a significant amelioration of symptoms when using marijuana. These 15- to 39- year-old male patients had noted an improvement of tic severity, urge to tic, self-mutilatory behaviour, attention span, hypersexuality and a generalized relaxation when they smoked half to two marijuana cigarettes per day. Hemming and Yellowlees (3) described a single case of a 36- year-old man who had reported that he had been symptom free for more than 1 year while he was taking one 'cone' of marijuana per night.

Retrospective chart review. Our results provide more evidence that marijuana improves tics and behavioural disorders in TS. It can be speculated that cannabinoids might act through specific receptors, and that the cannabinoid system might play a major role in TS pathology." -Emrich HM, et al. Treatment of Tourette’s Syndrome with Δ9-Tetrahydrocannabinol (THC): A Randomized Crossover Trial. Pharmacopsychiatry 2002; 35: 57-61

In Germany, a study conducted at the Medical School Hannover stated:

"Previous studies provide evidence that marijuana (Cannabis sativa) and Δ9-tetrahydrocannabinol (Δ9-THC), the major psychoactive ingredient of marijuana, respectively, are effective in the treatment of tics and behavioral problems in Tourette syndrome (TS). It, therefore, has been speculated that the central cannabinoid receptor system might be involved in TS pathology. However, in healthy marijuana users there is an ongoing debate as to whether the use of cannabis causes acute and/or long-term cognitive deficits. In this randomized double-blind placebo-controlled study, we investigated the effect of a treatment with up to 10 mg Δ9-THC over a 6-week period on neuropsychological performance in 24 patients suffering from TS. During medication and immediately as well as 5-6 weeks after withdrawal of Δ9-THC treatment, no detrimental effect was seen on learning curve, interference, recall and recognition of word lists, immediate visual memory span, and divided attention. Measuring immediate verbal memory span, we even found a trend towards a significant improvement during and after treatment. Results from this study corroborate previous data suggesting that in patients suffering from TS, treatment with Δ9-THC causes neither acute nor long-term cognitive deficits. Larger and longer-duration controlled studies are recommended to provide more information on the adverse effect profile of THC in patients suffering from TS."