A new case report out of Europe shows a man’s severe tics from Tourette Syndrome (TS) were dramatically reduced after he began using Nabiximols, an oromucosal spray containing various cannabinoids.
“Based on our case, and in line with previous reports, we propose that buccal Nabiximols might be an effective addition to ‘acute’ or ‘as required’ tic treatment under specialist guidance,” authors of the case report write.
This will especially be the case “for predictable situations in the short term when severely disabling or stigmatizing tics are anticipated,” they note in the report published last month.
Containing a standardized extract of THC, CBD, other minor cannabinoids, flavonoids and terpenes, the National Cancer Institute reports that the “cannabinoids interact with G protein-coupled cannabinoid 1 (CB1) receptors in the central nervous system, resulting in analgesic, euphoric and anti-convulsive effects.”
Noting that TS can manifest “with motor and vocal tics that can reach disabling intensity,” authors report a 25-year-old man reported that over a week, he had rapidly progressive simple and complex motor and vocal tics. These included nodding, pointing, head shaking and turning, looking, blinking, hitting, shouting and humming, symptoms he attributed to stopping his year-long, daily use of recreational cannabis a few weeks prior.
A video pre-treatment demonstrates some of the tics.
“At the time of presentation, he had continuous tics, consisting mainly of head and upper extremity movements, which he could suppress for up to 10 seconds,” the case report states. Otherwise healthy and not on medication, “neurological examination revealed no further pathological signs and psychiatric assessment was not suggestive of relevant cognitive or psychiatric co-morbidities besides the current social isolation,” they add.
Doctors first tried prescribing 300 mg daily of Tiaprid, but it did not ease symptoms of the chronic neurodevelopmental disorder. They then opted for three doses in 15-minute intervals of buccal Nabiximols, resulting in a dramatic decrease in symptoms.
“Premonitory feeling vanished and intensity of motor and phonic tics were reduced clearly,” described by the patient as more than 90 per cent. The effects lasted for about four hours and the patient did not report any side effects.
One dose of the spray includes 2.7 mg of THC and 2.5 mg of CBD, notes GW Pharmaceuticals, makers of Sativex. Positive effects start just minutes after application, lasting two to four hours, and “up to 12 puffs per day can be used,” the case report cites the company as reporting.
The need exists for well-tolerated, broadly available and effective treatments, authors write. They suggest Nabiximols “could be an adjunct treatment in TS for situations where tics are severely disabling.” Indeed, the treatment has “already been shown to be effective when used as a longer-term-medication in case reports.”
There are other treatments for TS, including comprehensive behavioural intervention, habit reversal, pharmacological therapies and even surgical techniques like deep brain stimulation in very severely affected and otherwise treatment-refractory cases. But these have resulted in “insufficient symptom reduction or unwanted side effects of medications,” case report authors contend.
A study published in 2017, this time involving a 22-year-old patient, found that “treatment with nabiximols resulted in major improvements of both tics and premonitory urges, but also global impairment and health-related quality of life according to all used measurements without causing relevant adverse effects.”
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