0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Treatment of Tourette’s Syndrome With Delta-9-Tetrahydrocannabinol
KIRSTEN R. M�LLER-VAHL, M.D.; UDO SCHNEIDER, M.D.; HANS KOLBE, M.D.; HINDERK M. EMRICH, M.D.
Am J Psychiatry 1999;156:495-495.

To the Editor: Tourette’s syndrome is a complex neuropsychiatric disorder of unknown etiology. Earlier reports suggested beneficial effects in Tourette’s syndrome when smoking marijuana (Cannabis sativa) R1563BABBAGEI, R1563BABDIDFB, R1563BABCIBCD. We report a successful treatment of Tourette’s syndrome with delta-9-tetrahydrocannabinol (Δ9-THC), the major psychoactive ingredient of marijuana.

Mr. A, a 25-year-old man, was diagnosed with attention deficit hyperactivity disorder at age 6. Motor and vocal tics started at age 10. During adolescence, he developed obsessive-compulsive behavior, anxiety, lack of impulse control, and self-injurious behavior. The diagnosis of Tourette’s syndrome according to DSM-IV criteria was made at age 22. At age 19, he started smoking marijuana. When using 2–3 g/day, he noted a marked improvement of both vocal and motor tics and associated behavioral disorders. Therefore, he stopped less effective medical treatment with pimozide.

In an uncontrolled open clinical trial, we investigated whether Δ9-THC is effective in the therapy of Tourette’s syndrome. Written informed consent was obtained from the patient after complete description of the study. The local ethics committee approved the study.

Mr. A was treated once with 10 mg of Δ9-THC. (He was unmedicated and had stopped smoking marijuana 3 days before.) Using the section on tic symptoms of the Tour­ette’s Syndrome Global Scale, we found that Mr. A’s total tic severity score was 41 before treatment and was reduced to 7 just 2 hours after treatment. Both motor and vocal tics improved and coprolalia disappeared. The improvement began 30 minutes after treatment and lasted for about 7 hours; no adverse effects occurred. To measure cognitive functions, we performed neuropsychological tests, which showed improved signal detection and sustained attention and reaction time after treatment. Mr. A himself noted an improvement of motor and vocal tics of about 70%. Furthermore, he felt an amelioration in attention, impulse control, obsessive-compulsive behavior, and premonitory feeling.

This is the first report of a successful treatment of Tourette’s syndrome with Δ9-THC. Furthermore, for the first time, patients’ subjective experiences when smoking marijuana were confirmed by using a valid and reliable rating scale and by excluding the fact of using an illegal drug. In addition, our findings give evidence that beneficial effects of marijuana may be due to the most psychoactive ingred­ient—Δ9-THC. So far, it is unclear whether beneficial effects are caused by unspecific mechanisms like reduction of anxiety, sedation, or placebo effects. We hypothesize, however, that there may be an interaction between Δ9-THC and specific cannabinoid receptors located in basal ganglia R1563BABJBCHG. We are planning to confirm these preliminary results in a double-blind, placebo-controlled, crossover study.

Sandyk R, Awerbuch G: Marijuana and Tourette’s syndrome. J Clin Psychopharmacol  1988; 8:444–445
[PubMed]
[CrossRef]
 
Hemming M, Yellowlees PM: Effective treatment of Tourette’s syndrome with marijuana. J Clin Psychopharmacol  1993; 7:389–391
 
M�ller-Vahl KR, Kolbe H, Dengler R: Gilles de la Tourette-Syndrom: Einflu� von Nikotin, Alkohol und marihuana auf die linkische Symptomatikt. Nervenarz  1997; 68:985–989
[CrossRef]
 
Herkenham M, Lynn AB, Little MD, Johnson MR, Melvin LS, de Costa BR, Rice KC: Cannabinoid receptor localization in brain. Proc Natl Acad Sci USA  1990; 87:1932–1936
[PubMed]
[CrossRef]
 
+

References

Sandyk R, Awerbuch G: Marijuana and Tourette’s syndrome. J Clin Psychopharmacol  1988; 8:444–445
[PubMed]
[CrossRef]
 
Hemming M, Yellowlees PM: Effective treatment of Tourette’s syndrome with marijuana. J Clin Psychopharmacol  1993; 7:389–391
 
M�ller-Vahl KR, Kolbe H, Dengler R: Gilles de la Tourette-Syndrom: Einflu� von Nikotin, Alkohol und marihuana auf die linkische Symptomatikt. Nervenarz  1997; 68:985–989
[CrossRef]
 
Herkenham M, Lynn AB, Little MD, Johnson MR, Melvin LS, de Costa BR, Rice KC: Cannabinoid receptor localization in brain. Proc Natl Acad Sci USA  1990; 87:1932–1936
[PubMed]
[CrossRef]
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 21.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 9.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 15.  >
Topic Collections
Psychiatric News
Read more at Psychiatric News >>
PubMed Articles