A Double-Blind, Randomized, Controlled Crossover Trial of Cannabis in Adults with Tourette Syndrome. 2023

Elia Abi-Jaoude, and Tracy Bhikram, and Ferdous Parveen, and Jody Levenbach, and Myriam Lafreniere-Roula, and Paul Sandor
Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.

Background: The number of effective evidence-based treatment options for patients with Tourette syndrome (TS) is limited. Emerging evidence shows cannabinoids as promising for the treatment of tics. Objectives: To compare the efficacy and tolerability of single doses of three vaporized medical cannabis products and placebo in reducing tics in adults with TS. Methods: In a randomized, double-blind, crossover design, each participant received a vaporized single 0.25 g dose of Δ9-tetrahydrocannabinol (THC) 10%, THC/cannabidiol (CBD) 9%/9%, CBD 13%, and placebo at 2-week intervals. Our primary outcome was the Modified Rush Video-Based Tic Rating Scale (MRVTRS), taken at baseline and at 0.5, 1, 2, 3, and 5 h after dose administration. Secondary measures included the Premonitory Urge for Tics Scale (PUTS), Subjective Units of Distress Scale (SUDS), and Clinical Global Impression-Improvement (CGI-I). Correlations between outcomes and cannabinoid plasma levels were calculated. Tolerability measures included open-ended and specific questions about adverse events (AEs). Results: Twelve adult patients with TS were randomized, with nine completing the study. There was no statistically significant effect of product on the MRVTRS. However, there was a significant effect of THC 10%, and to a lesser extent THC/CBD 9%9%, versus placebo on the PUTS, SUDS, and CGI-I. As well, there were significant correlations between plasma levels of THC and its metabolites, but not CBD, with MRVTRS, PUTS, and SUDS measures. There were more AEs from all cannabis products relative to placebo, and more AEs from THC 10% versus other cannabis products, particularly cognitive and psychomotor effects. Most participants correctly identified whether they had received cannabis or placebo. Conclusions: In this pilot randomized controlled trial of cannabis for tics in TS, there was no statistically significant difference on the MRVTRS for any of the cannabis products, although the THC 10% product was significantly better than placebo on the secondary outcome measures. Also, THC and metabolite plasma levels correlated with improvement on all measures. The THC 10% product resulted in the most AEs. ClinicalTrials.gov ID: NCT03247244.

UI MeSH Term Description Entries
D002185 Cannabidiol Compound isolated from Cannabis sativa extract. 1,3-Benzenediol, 2-(3-methyl-6-(1-methylethenyl)-2-cyclohexen-1-yl)-5-pentyl-, (1R-trans)-,Epidiolex
D002188 Cannabis The plant genus in the Cannabaceae plant family, Urticales order, Hamamelidae subclass. The flowering tops are called many slang terms including pot, marijuana, hashish, bhang, and ganja. The stem is an important source of hemp fiber. Bhang,Ganja,Hashish,Hemp,Cannabis indica,Cannabis sativa,Hemp Plant,Marihuana,Marijuana,Bhangs,Cannabi,Ganjas,Hashishs,Hemp Plants,Hemps,Plant, Hemp,Plants, Hemp
D005879 Tourette Syndrome A neuropsychological disorder related to alterations in DOPAMINE metabolism and neurotransmission involving frontal-subcortical neuronal circuits. Both multiple motor and one or more vocal tics need to be present with TICS occurring many times a day, nearly daily, over a period of more than one year. The onset is before age 18 and the disturbance is not due to direct physiological effects of a substance or another medical condition. The disturbance causes marked distress or significant impairment in social, occupational, or other important areas of functioning. (From DSM-IV, 1994; Neurol Clin 1997 May;15(2):357-79) Gilles de la Tourette Disorder,Gilles de la Tourette's Disease,Tic Disorder, Combined Vocal and Multiple Motor,Chronic Motor and Vocal Tic Disorder,Combined Multiple Motor and Vocal Tic Disorder,Combined Vocal and Multiple Motor Tic Disorder,Gilles De La Tourette's Syndrome,Gilles de la Tourette Syndrome,Multiple Motor and Vocal Tic Disorder, Combined,Tourette Disease,Tourette Disorder,Tourette's Disease,Tourette's Disorder,Tourette's Syndrome,Syndrome, Tourette,Tourettes Disease,Tourettes Disorder,Tourettes Syndrome
D006213 Hallucinogens Drugs capable of inducing illusions, hallucinations, delusions, paranoid ideations, and other alterations of mood and thinking. Despite the name, the feature that distinguishes these agents from other classes of drugs is their capacity to induce states of altered perception, thought, and feeling that are not experienced otherwise. Hallucinogen,Hallucinogenic Agent,Hallucinogenic Drug,Hallucinogenic Substance,Psychedelic,Psychedelic Agent,Psychedelic Agents,Psychotomimetic Agent,Psychotomimetic Agents,Hallucinogenic Agents,Hallucinogenic Drugs,Hallucinogenic Substances,Psychedelics,Agent, Hallucinogenic,Agent, Psychedelic,Agent, Psychotomimetic,Agents, Hallucinogenic,Agents, Psychedelic,Agents, Psychotomimetic,Drug, Hallucinogenic,Drugs, Hallucinogenic,Substance, Hallucinogenic,Substances, Hallucinogenic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013759 Dronabinol A psychoactive compound extracted from the resin of Cannabis sativa (marihuana, hashish). The isomer delta-9-tetrahydrocannabinol (THC) is considered the most active form, producing characteristic mood and perceptual changes associated with this compound. THC,Tetrahydrocannabinol,delta(9)-THC,9-ene-Tetrahydrocannabinol,Marinol,Tetrahydrocannabinol, (6a-trans)-Isomer,Tetrahydrocannabinol, (6aR-cis)-Isomer,Tetrahydrocannabinol, (6aS-cis)-Isomer,Tetrahydrocannabinol, Trans-(+-)-Isomer,Tetrahydrocannabinol, Trans-Isomer,delta(1)-THC,delta(1)-Tetrahydrocannabinol,delta(9)-Tetrahydrocannabinol,9 ene Tetrahydrocannabinol,Tetrahydrocannabinol, Trans Isomer
D018592 Cross-Over Studies Studies comparing two or more treatments or interventions in which the subjects or patients, upon completion of the course of one treatment, are switched to another. In the case of two treatments, A and B, half the subjects are randomly allocated to receive these in the order A, B and half to receive them in the order B, A. A criticism of this design is that effects of the first treatment may carry over into the period when the second is given. (Last, A Dictionary of Epidemiology, 2d ed) Cross-Over Design,Cross-Over Trials,Crossover Design,Crossover Studies,Crossover Trials,Cross Over Design,Cross Over Studies,Cross Over Trials,Cross-Over Designs,Cross-Over Study,Crossover Designs,Crossover Study,Design, Cross-Over,Design, Crossover,Designs, Cross-Over,Designs, Crossover,Studies, Cross-Over,Studies, Crossover,Study, Cross-Over,Study, Crossover,Trial, Cross-Over,Trial, Crossover,Trials, Cross-Over,Trials, Crossover
D020323 Tics Habitual, repeated, rapid contraction of certain muscles, resulting in stereotyped individualized actions that can be voluntarily suppressed for only brief periods. They often involve the face, vocal cords, neck, and less often the extremities. Examples include repetitive throat clearing, vocalizations, sniffing, pursing the lips, and excessive blinking. Tics tend to be aggravated by emotional stress. When frequent they may interfere with speech and INTERPERSONAL RELATIONS. Conditions which feature frequent and prominent tics as a primary manifestation of disease are referred to as TIC DISORDERS. (From Adams et al., Principles of Neurology, 6th ed, pp109-10) Habit Spasm,Tic, Motor,Tic, Vocal,Habit Chorea,Habituation Spasm,Tic,Tic, Gestural,Tic, Transient,Chorea, Habit,Choreas, Habit,Gestural Tic,Gestural Tics,Habit Choreas,Habit Spasms,Habituation Spasms,Motor Tic,Motor Tics,Spasm, Habit,Spasm, Habituation,Spasms, Habit,Spasms, Habituation,Tics, Gestural,Tics, Motor,Tics, Transient,Tics, Vocal,Transient Tic,Transient Tics,Vocal Tic,Vocal Tics
D063386 Cannabinoid Receptor Agonists Compounds that interact with and stimulate the activity of CANNABINOID RECEPTORS. Cannabinoid Agonist,Cannabinoid Receptor Agonist,Cannabinoid Agonists,Cannabinoid Receptor Activators,Activators, Cannabinoid Receptor,Agonist, Cannabinoid,Agonist, Cannabinoid Receptor,Agonists, Cannabinoid,Agonists, Cannabinoid Receptor,Receptor Activators, Cannabinoid,Receptor Agonist, Cannabinoid,Receptor Agonists, Cannabinoid

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