cbd tourettes

Top 6 Benefits of Cannabis for Tourette’s Syndrome

Tourette’s syndrome is a hereditary neuropsychiatric disorder that manifests in childhood and is typified by physical and vocal tics, such as repetitive jerking movements or (often socially-unacceptable) speech. Cannabis may help with various symptoms of Tourette’s, including reducing anxiety and frequency of tics.

Cannabis research shows it may help ease symptoms of Tourette’s syndrome (TS). With roughly 200,000 Americans alone suffering from severe cases of Tourette’s (and as many as 10% of people experiencing milder symptoms), any possible treatment is worth looking into. Let’s take a look at the six main ways cannabis might be helpful.

1. Cannabis may decrease frequency of tics

There has been considerable interest in the potential for cannabis to reduce the frequency of tics in Tourette’s syndrome (TS) sufferers, and several papers have been published on the subject. A study by researchers in Hanover, Germany (Müller-Vahl et al, 1998) observed that 17 of 64 TS patients reported use of cannabis, and that 14 of those experienced partial or total relief of tics following its use.

The German researchers went on to conduct several further studies into cannabis and the reduction of tics, all of which found that the majority of patients experienced significant relief after using cannabis. They also found that very few patients experienced side-effects. It’s thought that cannabis can reduce TS tics in a similar manner to other dystonia-inducing conditions, such as Parkinson’s.

It’s not clear what this mechanism is, but it’s thought that it may lie in the densely-clustered cannabinoid receptors in the basal ganglia and hippocampus. These areas of the brain are fundamentally involved in the control of behaviour and movement, and are known to be abnormal in those suffering from this syndrome.

2. THC may ease obsessive-compulsive symptoms

Obsessive-compulsive disorder is the most common comorbid condition present in Tourette’s Syndrome patients. TS patients who also have OCD exhibit repetitive counting, touching, and “ordering” behaviours, and may also exhibit increased aggression compared to sufferers of OCD alone.

Another study conducted Müller-Vahl and her team supported the finding that patients treated with THC experienced a decline in obsessive-compulsive symptoms along with a reduction in tics.

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3. Cannabis can increase effectiveness of conventional Tourette’s syndrome drugs

As well as investigating cannabis as a standalone treatment for TS, there has been significant interest in its use as an adjunctive (add-on) therapy alongside certain conventional TS medications. Müller-Vahl et al observed in a 2002 case study of a 24-year-old woman that “THC may be useful in augmenting the pharmacological response to atypical NL such as amisulpride and risperidone in TS patients”, and that “no serious adverse reactions occurred”.

A much earlier study published in the journal Life Sciences in 1989 suggested that both cannabinoids and nicotine could “significantly enhance” the effectiveness of “neuroleptics” (antipsychotics) in motor diseases including TS.

Furthermore, the only two randomized controlled trials that have been conducted on cannabis and TS compare use of a cannabinoid as sole therapy and as adjunctive therapy against placebo. Both found that use alongside other medications yielded the most positive results. However, sample sizes were small for both these studies, and further investigation is required to confirm the results.

Interestingly, cannabis has also been noted since as early as 1988 to be effective in individuals who did not respond to conventional TS treatments at all.

4. Cannabis can alleviate sleep problems associated with Tourette’s Syndrome

Many patients who suffer from Tourette’s also experience sleep disorders. While there’s been no research specifically into the effect of cannabinoids on sleep disturbances in TS patients, there’s plenty of anecdotal evidence suggesting that cannabis can have a positive effect on this aspect of TS too.

For example, TS is known to cause increased sleep latency (delayed onset of sleep), while cannabis has been widely demonstrated to reduce sleep latency and lessen the difficulty of falling asleep in many individuals.

TS sufferers are also shown to have increased tic frequency during REM sleep, while cannabis use has been shown to reduce the duration of REM sleep altogether, which may cause TS sufferers to experience more restful sleep. TS sufferers are also less able to remain asleep through the night, another problem with insomnia that cannabis can help treat.

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5. Cannabis might be an anxiolytic for TS sufferers

Anxiety is a common symptom of TS for many sufferers.

The valuable research conducted by Müller-Vahl et al (and the various other research teams that have investigated the potential for cannabis to treat TS) generally found that cannabis use didn’t help anxiety levels. In one study, it even increased phobic anxiety. However, there are many other anecdotal reports of TS sufferers experiencing subjective improvement of anxiety.

There’s even a trademarked “cannabis pill” named Idrasil™ that is marketed at TS sufferers in the U.S. medical states. According to the manufacturer patients experience reduced tics and anxiety when taking Idrasil regularly.

6. Cannabis might reduce aggression and rage resulting from TS

Another common problem that comes with TS is aggression and rage outbursts. This is particularly common in children (affecting up to 25% of children with TS) but is also present in a significant minority of adults. These outbursts typically manifest as unpredictable displays of aggression that are greatly disproportionate to the perceived provocation, and may often present the risk of serious self-harm or injury to others.

Again, the potential for cannabis to treat symptoms of aggression in TS sufferers hasn’t been formally investigated. But there’s anecdotal evidence from TS sufferers that cannabis use has a positive effect on aggression.

Many individuals suffering from ADHD (a closely-related disorder that is often comorbid with TS) also report a subjectively positive effect on aggression.


62 thoughts on “Top 6 Benefits of Cannabis for Tourette’s Syndrome”

All of you with Tourette’s: be glad that medical marijuana is becoming legal everywhere. But for a different approach, go on the Internet and look up the Marshall Protocol. Trevor Marshall, an aussie, invented this approach to treat his own case of sarcoidosis. The protocol consists in alternating doses of an antibiotic, followed by the drug benicar which is an antagonist of the Vitamin D receptor, which in turn regulates the innate immune system. The way this works is, Tourette’s (and tics and OCD) is thought to be caused by a commensal bacterium such as Streptococcus B (think about how rheumatoid arthritis causes cardiac valve deposits). The antibiotic kills most (but not all) of the bacteria, which go into metabolic arrest to escape the drug, and are held immobilized and metabolically inert by the innate immune system. The benicar then releases the immune block and the bacteria become metabolically active again and hence susceptible to the antibiotic. The problem with this simple cycle is that it may take many as 50(?) turns of the crank at 2 weeks per turn before all the bacteria are killed, and few physicians are willing to carry on this regimen for the 2-3 years it may require for the last of the bugs to die. MJ is easy and quick but is not a cure. MP is lengthy and controversial, but is advertised as a cure. I once knew a man with Tourette’s that manifested as coprolalia. You decide.

My grandson is 15, has tourettes, which affects his speech, He stutters so bad, some days he cannot talk, he has to write things down. Just heard about this oil today, you think it might help? Im not up on this product, does it show up in a drug test?
THanks for info

Thank you for your comment. We are sorry to hear about your situation. As Sensi Seeds is not a medical agency or practitioner, we cannot give any kind of medical advice other than to consult our registered healthcare professional. This article about the potential benefits of medicinal cannabis might be useful for you to show your healthcare provider if they are not familiar with it.

You may also find it helpful to contact a support group for medicinal cannabis patients. In the UK there is the United Patients Alliance, and throughout much of the rest of the world there is NORML, who should be able to put you in touch with a group in your area (search United Patients Alliance or NORML followed by your area name).

This are our pages on medicinal cannabis and medicinal cannabis strains, which you might also find interesting.

With best wishes,

Hello, my son is 14 and just developed vocal tics from TS in Nov 2017. He had some motor tics when he was younger, but this came out of nowhere. Now, here we are trying cannabis. We are trying 1:1 ThcA:CBD. I’m not sure the ThcA is the way to go or if he will need the THC specifically. Anyone else try the ThcA with positive results? It supposedly doesn’t cross the blood brain barrier and has no “high” effect. If this doesn’t work we will try a Thc:CBD 1:1 ratio and see if that has a different effect on his tics.

He has smoked a joint once and his tics completely disappeared for 1 full hour so I know we are at least in the right ballpark.

With vaping he hasn’t seen the same results. We are trying to stay away from smoking vaping to see if the tinctures will help.
Wishing everyone here luck.

My daughter is 10 yrs and has TS, mild OCD, sleep disturbances and anxiety which she has had since she was a toddler and diagnosed at 7. It always gets worse in the winter time and this winter she developed spitting tics, even spits in herself. It has been devastating for her and she cries all the time. She gets bullied endlessly at school. Often asking why she must suffer like that. Her neurologist was pushing for psych meds and I refused. I’ve done extensive research on alternative remedies. Nothing have truly worked. I purchased 550mg cbd oil which came in he mail today. She tried it twice under her tongue and and a couple of hours later the tics stopped. I don’t think she realizes it’s gone and I won’t mention it either as to avoid bringing attention to it. I’m so happy I just want to cry. For parents out there, advocate for your child. Research, research and do your diligent investigative work to help your child and/or yourself. CBD oils are expensive and it’s going to break my bank but helping my child far outweighs cutting costs on far less important things in our lives. Big pharma is not the way to go to help my child with Tourette’s not today and definitely not tomorrow.

Kat- this is so encouraging! I hope a month later your finding the oil to be helping tremendously. If you’d be willing to share an update — please do!
I’ve only heard about the CBD oil this morning and found this thread as I search to understand more.
Thank you !

Can you please share the name of the CBD oil, where you got it and how much you use?

I am a 45 yr old male with Tourette Syndrome. I have had rage symptoms since early childhood, adhd, ocd, and a strong bout of tics for two years (14-16yrs old). I struggled in school because of my attention to controlling my behaviors rather than being able to focus on academics and social interactions. I moved away from home at the age of 19 and this is where my life changed forever. I was introduced to marijuana at a social gathering and I remember being completely amazed at how calm I felt, how I could focus on one thing at a time rather than all sounds and conversations at the same time. For the first time, I felt in control. I began using marijuana to help me focus on academics while boasting a 4.0 gpa. I had never even finished an assignment in high school or middle school but was now crushing college. I realized that I am not stupid, slow, or special. I am the recipient of an inefficient brain that, at times, focuses on what it want rather than what I want. Marijuana changed my life in a medicinal way and once I found it (or it found me) I looked back at my youth and realized how much more academic success and social confidence I may of had if I had been given the option. You are all awesome in your own unique way and don’t ever forget it. Find what works for you and don’t let others stand in your way!

14 year old son. TS/ ADD and anxiety. He is on three meds-abilify/Concerta and clotrolepam(sp?) his tics have increased and now has vocal tics. We are in Canada. Don’t know what to do anymore…

My son developed TS at four. Before junior high I found the American academy of environmental medicine. Within one month his tics and symptoms were gone. My son has a blood disorder called MTHFR which is treated with methyl b12. Also 25 food allergies and nutritional deficiencies. We are very careful what we eat breath and touch. Organic foods and no chemicals.

Hi Guys!
I’m a TS sufferer since about 6 or 7. I have been through the teasing gauntlet, the family gauntlet, and work gauntlet, and worst of all, the MEDICAL gauntlet. Meds RARELY work, and never without side effects often worse than the TS.
Back in the late 70s a friend brought in some of his “special” brownies and gave me one. HALF of that brownie shut down tics by at least 90% AND greatly increased my ability to concentrate and remember. The best year of high school ever! Sadly I have NO IDEA what kind of pot was in those. I just knew I didn’t really have a “high” effect and even my OCD nearly disappeared. Over the years I have worked to inform many doctors and sufferers alike. I have met very many with TS. ONE thing I have noticed about those I have met. EVERY ONE of them ALSO was dealing with OCD. To different degrees, certainly, but we all seem to have it.
Cannabis definitely helps, and CBD alone doesn’t cut it. So, if you are in a place, like I am, in the central US, you suffer or take your chances. Too many draconian lawns, yet we persevere. DON’T GIVE UP!
I’m trying different combinations of stuff to see what works or not. I’m still looking for help as medical doctors are learning from US! WE rarely learn from them. I spent years teaching many doctors what TS was. Now, if you have, as I do, a good doctor who wants to learn, you have to let them know so they can inform others, even if secretly. It is SO sad we cannot get real research, real testing, for a disorder that is largely ignored my the medical community.
BTW, I have some interesting tics. I have the vocal sounds that i have learned to hide in my words, I have others that are annoying. I have the head whip that threatens to break my neck and causes whiplash! I have tics that tie in with the OCD in that I must tic multiple times before I can continue talking. Embarrasing to say the least. Tics that cause a lot of pain and because I am reaching the end of my rope, I am taking chances with the crazy lawns to get the relief that I have needed for so long. Cannabis IS THE WAY TO GO! But finding the right MIX of oils and such is nearly as aggravating.
If you have experience with relief without getting high, pass it along wherever you can. We need your help. The only research being done are those of us willing to try to find out ourselves by trial and error. PLEASE, if you have success, pet us know HOW. I KNOW FULLY we are all different, but it might give us a place to start.
I will rarely smoke, I hate smoking anything. But there are pills, oils, salves, patches, edibles of many many kinds, tinctures and even VAPE options. NO ONE I have talked to knows a dang thing about what WORKS. Most of the people selling it rarely know what Tourettes is! Please don’t be afraid to post on places like this for those of us searching, often vainly, for answers.
Talk to us. There has to be some real “Experts” out there!
Thank You for reading this far. This novel is over…. for now! heh

frustrated, but pressing on!

hi, my son is nearly 9 years old and we live in belfast, northern ireland. we have cannabis oil here and im considering usage. any advise on dosage etc?

Thank you for your comment. We are sorry to hear about your situation. Unfortunately, as Sensi Seeds is not a medical practice, we are not able to provide any advice relating to medical situations other than to consult your doctor or other licensed medical professional. This article, written specifically for healthcare providers who may not be aware of the many properties of cannabis, may be useful to you in talking with your doctor. You could also try to contact local medicinal cannabis support groups, if you have not already done so. In the UK, there is the United Patients Alliance (you can find them on Facebook) and in the US and EU there are many branches of NORML (google NORML followed by your area name). We hope this is helpful.

With best wishes,

Hello we are from Australia. We have a 9 year old son who has been diagnosed with Aspergers, OCD, Schizotypal PD and Tourettes Syndrome. It has been a difficult journey. We have tried many different, medications from Abilify, risperadone being the best but still not effective. We don’t trust the medication 100%.
Our doctor isn’t able to advocate or point us in the right direction in regards to cannibis oil.. We wrote to universities to no avail. we have basically been told ‘it’s too new age, not a lot of research has been done with cannibis oil and it’s effectiveness in Tourettes and scizotypal disorder, and we should perhaps just accept his legacy and continue to use what the pharmacuetical companies allow us to use.
We are beside ourselves in knowing that there could be a natural alternative in allieviating all of these symptoms.
Can someone please help us with alternate information. Or point us in the right direcrion.
Thank you

Thank you for your comment. We are sorry to hear about your situation. Unfortunately, as Sensi Seeds is not a medical practice, we are not able to provide any advice relating to medical situations other than to consult your doctor or other licensed medical professional. This article, written specifically for healthcare providers who may not be aware of the many properties of cannabis, may be useful to you in talking with your doctor. You could also try to contact local medicinal cannabis support groups, if you have not already done so. In the UK, there is the United Patients Alliance (you can find them on Facebook) and in the US and EU there are many branches of NORML (google NORML followed by your area name). We hope this is helpful.

With best wishes,

PS This article might have some helpful links, and the contact details for NORML Australia are here. I really wish I could be more help, good luck x

Hi, my son was diagnosed with complex tourettes syndrom at the age of 8yrs old his doctor tryed several different meds on him and none worked just made them worse…was just wondering about trying this for him his tics have got worse since he has hit teenage years..he is 14 now and gets made fun of and it breaks my heart just grasping for straws here. Willing to try it if it would help him…he pops his neck repeatedly and it scares him and me…please help us.

Thank you for your comment. We are sorry to hear about your situation. Unfortunately, as Sensi Seeds is not a medical practice, we are not able to provide any advice relating to medical situations other than to consult your doctor or other licensed medical professional. This article, written specifically for healthcare providers who may not be aware of the many properties of cannabis, may be useful to you in talking with your doctor. You could also try to contact local medicinal cannabis support groups, if you have not already done so. In the UK, there is the United Patients Alliance (you can find them on Facebook) and in the US and EU there are many branches of NORML (google NORML followed by your area name). We hope this is helpful.

With best wishes,

Hello…I was wondering which one is it that is being said to help seizures & tourettes? Is it the THC or CBD because what my daughter is taking is a 50/50 mixture. We have scene some promising results after only 4 doses, but I feel that I’m not giving her enough maybe?! I’ve looked at the CBD oils and things, but I have no clue what to get her or even how much?? How can I find out how much and how often she can take it, and which one she needs?? Thanks!!

I have a 22 year old daughter who has just started taking the drops,and I really hope it works. I do believe I saw some improvement within an hour after taking her first dropper full.
please keep your fingers crossed that this works!! Thanks.

Thanks for your comment 🙂 Our fingers are crossed for you and your daughter.

With best wishes,

I’m interested in knowing how your daughter is now. Has the drops helped?

I’ve been on every medication known to man for my terets. They have not done anything I’m thinking about suicide everyday how do I try this medical weed.

Thank you for your comment, I am sorry to hear about your condition, please don’t give up! Obtaining medicinal cannabis depends a lot on where you live. If you are in an area with legal medicinal cannabis, you can talk to your doctor (this article, aimed at medical professionals who might not be aware of the things cannabinoids can do, might help). If not, I’m afraid your situation is harder and obviously I cannot recommend or encourage you to break the laws of the area you live in. If you are in the UK, I strongly recommend you contact the United Patients Alliance (they are on Facebook) as you can at least get some moral support and maybe connect with people who share your situation. If you are in the US, NORML have branches almost everywhere (google NORML plus your area).

Something that may well be worth trying and is easier to get than medicinal cannabis is CBD oil, which is still legal and sold as a food supplement. You can order it from us, or if you are in an area we cannot ship to, try in good health food shops. As I am not a medical professional I cannot make any claims that this would definitely help you, but as a fellow human I would say it is worth a try.

With best wishes,

Both my son and I have TS. I’m over 70 and growing up I just thought it was nervous tics. Dealt with teasing in middle school. By the time I was married and had children I was fully aware that I had TS and did quite a bit of research. When my son turned up with it I got the name of a pediatric neurologist that started him on Tenex, which is a blood pressure medication. At first there was not much improvement but over time and with an increased dosage it took affect. In the interim, when it looked like it wouldn’t work, the neurologist prescribed Orap, an anti psychotic. I looked it up and found one of the side effects was tics which would become permanent even after the medication was stopped. I decided not to give to my son. He’s doing very well now with minimal minor tics. From what I was told by our now former pediatrician, kids are too old for one now, Tenex has been reformulated to work better with TS but is not needed by my son anymore. Also I’ve been told that it is only effective on young children that after a certain age it is no longer effective. I still have both minor and gross motor tics which I can keep mostly under control when in the presence of others. When alone they tend to burst out. I am at the point where I will be trying CBD gel caps as I would like to see how it feels not to feel like an out of control wind-up toy when I’m alone.

First, sorry for my english, not is my main lenguage. I like to know if some type / genetic of cannabis is better than other to treat TS. I have a nephew who has 8 years with TS, is to young to smoke. what is the best form to get cannabis treatment without get high? CBD helps? or only THC? has several problems to sleep, agression episodes and self injured inside his mouth.

Thank you for your comment. We are sorry to hear about your nephew. As Sensi Seeds is not a licensed medical practitioner, we cannot give medical advice, and must recommend that you consult your doctor or other registered healthcare professional for all medical matters. When you do so, you might find this article which was written specifically for professionals who might not have researched cannabis as a medicine. Depending on what country you are in, you may be able to order our CBD Oil which is sold as a food supplement and has been known to have relaxing properties but I cannot recommend its use as a medicine or make any claims about if it would help with TS or not.

With best wishes,

I’ve had the worst case of Tourette’s since I was seven years old. I’ve tried all the pills there are and the only one that slightly works is Ability. Only cannabis works 100%.and marinol doesn’t. Too synthetic and missing too many cannibinoids. also I notice I’m highly allergic to 74 different things especially blue and red dyes in food plus aspartame and other sugars. I’ve used cannabis since I was seven in the early sixties. I was one of the first medical marijuana patients licensed in California. I help build 2 dispensaries. I went through the Air Force with full blown T.S. they took me even though they knew I had it because I had a high I.Q. now I have trouble paying for mm .I’ve been on S S d I(social security) since age 23 for t.S. because of Tourette syndrome.

Thank you for your comment and sharing your story! I fixed the autocorrect error 😉 so I’ve removed your other comment asking for the correction.

With best wishes,

Great article thank you for breaking down the study.

Did anyone get an answer about then strain and ratio?
I also have a child with TS.


I’m now in my late thirties and had very bad tics. I started using canabis at 18 and have significantly overcome/reduced my tics since then. If i stop usage, my wife and I notice my tics return, albeit I’ve learned to control them to a degree in comparison to my youth. Unfortunately, my state has not legalized usage (yet) and I must obtain canabis with risk of legal action. None the less, I am a fully functional adult with a solid career record, brilliant children and a strong desire to stay far away from the pharma industry.

Ugh! My son was diagnosed at age 3 (the youngest TS patient ever diagnosed at Dell Children’s in Austin). ADD meds made his tics worse and sleeping almost impossible. The only thing that has worked for him in the last few years is cannabis; he’s 19. He is currently facing a possession charge for having a joint in his backpack while driving through a small town here in south Texas. This is a nightmare. Now looking for an attorney so this doesn’t ruin his life.

My son was diagnosed at 3 as well. He’s 9 now and his tics are so bad he’s screaming profanities. I’m looking into every avenue possible to help him.

My brother has tourettes, hes 11 years old and the tics are really bad at the moment. And none of theses pills there giving him are working they want to put him on adhd meds and I don’t think that’s the answer. I live in Wisconsin. Do I have any options at this moment.

Try a magnesium powder like Natural Calm. Also a b-complex and omega. Tell him to try and stay away from any artificial flavors and colors as those can increase frequency of tics. Doing all of these things has improved my sons ticks tremendously.

I would recommend he stay off wheat as well. GMO foods. Has he been tested for allergies by an environmental doctor??

My son had mild TS and they put him on adhd meds. They made his tics 100 times worse! He is now the worst case of Tourette’s. I called the doctor and asked him about the add medicine my son had been taken and he said that that is the reason my sons tics got worse. Don’t do it.
He was taking focalin

Based on neuroscientific evidence, ADD/ADHD medications will very likely exacerbate tics in a person with Tourette’s. This is because these medications work in the direct opposite way that TS medications work. TS medications work by decreasing the level of dopamine transmission in your brain. Most ADD/ADHD medications are classified as amphetamines, and these have the opposite effect of increasing dopamine transmission. Please be cautious when a doctor recommends putting a TS patient on ADD/ADHD medication!

Ask your son’s Doctor about the marijuana based pill called Israel. Read up about it.My son also has mild TS, marijuana helps bring his tics from a 9 down to a -1,i s how he describes it.

My son has Tourettes also and if you had read up on Focalin, it clearly states not to give to children with tics. Next maybe you research your son’s medications before you give them to him. My daughter takes Focalin and it’s working wonders for her. She doesn’t have Tourettes. My son takes Concerta but it doesn’t make his tics worse, you have to see what works for your child. I am interested in trying this for my son since he is on slot of meds bc of his Tourettes

My son was diagnosed with TS last year, at 10yrs old. Our pcp and neurologist tried to push meds on us but I wasn’t about to pump his body full of chemicals that may or may not work. So we tried acupuncture. It did amazing things for him! His tics were far less severe and further between, and his OCD was calmed dramatically! He was nervous about the needles at first but they seriously are so small he couldn’t feel them.

Adult TS patient who recently finished graduate school with a Phd. I look back on my younger years when I was misdiagnosed and my family didn’t want to put me on medications. I almost failed out of high school and failed out of my first college. It wasn’t until my mid-20s, when symptoms settled down considerably, that I returned to college. I graduated with a 4.0GPA, 2 degrees and a fellowship to graduate school where I got my Phd. I can only imagine how different my life would have been if I’d been treated earlier in life. I probably could have earned scholarships to undergrad instead of drowning in debts. I wouldn’t have felt like a defective, horrible person because I didn’t turn in schoolwork and was an inattentive disruption in class. I was embarrassed by my tics and suffered torment from the OCD and anxiety. Seriously, work with your doctors and treat your children. Yes, you have to be careful of what medications they get, but going med-free can have lifelong consequences.

Halez – I feel your brother’s pain!! I’m 44 years old with severe Tourette’s, and I was diagnosed at Mayo Clinic when I was 12. I’ve been on every medication known to man for Tourette’s, and the only one I’ll ever recommend again is Cannabis!! Cannabis has put my physical & verbal tics’ into 95% remission, or there about. I use a homemade tincture 4 – 6x daily, and fill in with smokeable form in between tincture doses. Without it, I’d most likely snap my neck. I could go on forever!! Tell your brother to hold his head up high, ’cause he’s no different than anyone else. I know its really hard to ignore other people, but just laugh with ’em. Cannabis is the best direction for your brother. Take Care & GOD BLESS. Jeffrey

Cannabis may help with various symptoms of Tourette's, a hereditary neuropsychiatric disorder which causes anxiety and frequent tics.

Treatment of patients with tic disorders and Tourette syndrome with cannabis-based medication

By Kirsten Müller-Vahl

Dr. Kirsten R. Müller-Vahl is a Professor of Psychiatry at the Department of Psychiatry, Socialpsychiatry and Psychotherapy at the Hannover Medical School (MHH), Germany. She is a specialist in both neurology and adult psychiatry. From 1997 to 2003 she was a grant holder of the German government (Dorothea-Erxleben-Stipendium) for scientific research related to Tourette syndrome (TS). During the last 20 years she has investigated more than 1500 patients with TS (children and adults) and is the head of the Tourette-Syndrome outpatient department (since 1995). From, 2012-2016 she was the vice president of the European Society of the study of Tourette syndrome (ESSTS). She was a German representative of the COST Action BM0905 (“European Network for the Study of Gilles de la Tourette Syndrome”). She is a full partner and a working group leader in the EU funded programmes “European Multicentre Tics in Children Studies” (EMTICS) and “TS-EUROTRAIN-Interdisciplinary training network for Tourette Syndrome”. She is a member of the Medical Advisory Board of the Tourette Association of America (TAA) and an author of the guidelines for the treatment of TS of both ESSTS and the American Academy of Neurology. Since 1998, she is a member and 2. Chairwoman of the Association for Cannabinoid Medicines (ACM). She was a founding member of the International Association for Cannabinoid Medicines (IACM) and from 2007-2009 1. Chairwoman and since 2015 vice president of the IACM.

Tic disorders are defined by the presence of motor and/or vocal tics. Motor tics are simple or more complex abrupt involuntary movements that can occur all over the body, but most often are located in the face and head. Vocal tics are characterized by meaningless “simple” sounds or noises, but also can be more “complex” including obscene words. Tourette syndrome (TS) is complex neurological-psychiatric disorder defined by the presence of both multiple motor and at least one vocal tic.

Tic disorders and Tourette syndrome

TS is a neurodevelopmental disorder and therefore age at onset is in childhood – most typically at age 6 to 8 years. The vast majority of patients with TS, however, suffer not only from motor and vocal tics, but also from one or more behavioral problems such as attention deficit/hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), anxiety, depression, rage attacks, self-injurious behavior, sleeping disorder, but also leaning problems and autism spectrum disorder. Therefore, in many patients quality of life is substantially impaired.

Treatment of patients with tic disorders and Tourette syndrome

Due to the complex symptomatology and changes in clinical presentation over time, treatment of patients with TS is often challenging. Until today, tics cannot be cured. Established treatment strategies for tics include either behavioral therapy or pharmacotherapy with anti-psychotic drugs. While behavioral therapy does not cause adverse events, on average a tic improvement of only 30% can be achieved. Compared to behavioral therapy, pharmacotherapy with antipsychotics is more effective and often results in a tic reduction of about 50%. However not all patients benefit from antipsychotic medication and in many patients it is associated with relevant side effects such as sedation, weight gain, and sexual dysfunction. Patients, who suffer in addition from clinically relevant psychiatric disorders, need a combined treatment, since until today there is no therapeutic approach known that improves not only tics, but also psychiatric comorbidities. Therefore, many patients with TS are unsatisfied with available treatment strategies and seek for alternative medicine.

Against this background, new treatment strategies are urgently needed for this group of patients. Ideally, these new treatments (i) are associated with lesser side effects compared to available substances, (ii) result in a better improvement – or even a complete remission – of tics, (iii) are also effective in otherwise treatment resistant and severely affected patients, and (iv) improve not only tics, but the whole spectrum of the disease including different psychiatric symptoms such as ADHD, OCB, and depression.

annabis-based medication for patients with tic disorders and Tourette syndrome

Case reports

In 1988, for the first time it has been suggested that cannabis might be such an alternative treatment option for patients suffering from TS. In this report, three male patients at ages 15, 17 and 39 years were described, who experienced a reduction in motor tics and premonitory urge sensations, an improvement in self-injurious behavior tendencies, attention, and hypersexual behavior as well as a generalized feeling of relaxation when smoking cannabis. No side effects occurred and treatment effect was stable over time and did not decrease. Since this initial report, a small number of case studies has been published describing beneficial effects of cannabis as well as other cannabis-based medications in patients with TS. There are no reports available about severe side effects or cannabis addiction. In most of these case studies, the authors report about beneficial effects on both tics and psychiatric symptoms. In many of the patients pharmacotherapy with other substances (such as antipsychotics for the treatment of tics, methylphenidate for the treatment of ADHD, or antidepressants for the treatment of depression, anxiety, and OCB) could be stopped.

Retrospective studies of cannabis

In 1998, in Germany a survey has been performed among patients with TS exploring the frequency and effect of (illegal) cannabis use. Of 64 patients, who were interviewed, 17 (27%) reported the use of cannabis and of these 14 (82%) reported that they felt cannabis improved their tics and premonitory urges as well as behavioral symptoms such as OCB and ADHD.

In line with this data, only recently researchers from Canada reported results from a retrospective evaluation on the effectiveness and tolerability of cannabis in 19 adults with TS. On average, they found a tic reduction of 60%, and 95% of patients were rated as at least “much improved.” In several patients, in addition, an improvement of psychiatric problems was reported. Cannabis was generally well tolerated and only mild side effects occurred such as decreased concentration, motivation and short-term memory, anxiety, increased appetite, sedation, and dry mouth and eyes.

In a retrospective study, we analyzed data from 98 patients with TS (mean age = 28.2 (+13.7) years) treated with different cannabis-based medications in our specialized Tourette outpatient clinic at Hannover Medical School, Hannover, Germany (unpublished data). Most of our patients used illegal cannabis (from different sources) (71%) for the treatment of TS. Only 37% of patients were treated with tetrahydrocannabinol (THC, dronabinol, the most psychoactive ingredient in cannabis), 32% received treatment with nabiximols (Sativex®, a cannabis extract standardized for THC and cannabidiol (CBD) at a 1:1 ratio), and 22% had access to (standardized) medicinal cannabis (from a pharmacy). The high percentage of illegal cannabis use – compared to the low percentage of treatments with medicinal cannabis – is related to the fact that in Germany only in March 2017 national laws changed and only since that time cannabis can be prescribed by medical doctors. Before March 2017, treatment with medical cannabis was restricted to a small group of patients, who have had received a specific permission by the German federal opium agency. However, when asking patients about the preferred kind of cannabis-based medication (if available), interestingly, 2/3 of patients answered that they would prefer inhaled medicinal cannabis (from a pharmacy) over other cannabis-based medications. In line with this preferred choice, medicinal cannabis was reported as more effective in reducing tics than other cannabis-based medications (in descending order): in 100% (N=21) of patients using medicinal cannabis, in 90% (=67) using illegal cannabis, in 77% (N=35) using THC (dronabinol), and in 76% (N=33) using nabiximols (Sativex®) (multiple answers possible). Accordingly, patients also assessed cannabis (both from illegal sources and medicinal cannabis from a pharmacy) more effective than nabiximols (Sativex®) and THC (dronabinol) in reducing psychiatric symptoms including OCB, ADHD, depression, anxiety disorders, self-injurious behavior, rage attacks, and sleeping problems. Altogether, patients assessed cannabis superior compared to both nabiximols (Sativex®) and THC (dronabinol).

Placebo-controlled trials using THC

Currently, only two preliminary controlled trials have been conducted to investigate the efficacy and safety of orally administered THC (dronabinol) in patients with TS. In a pilot study, a single dose of THC was compared to placebo in a crossover study of 12 adults. In a follow-up study, efficacy and tolerability of THC was compared to placebo in a 6 week trial of 24 adults. In both studies, treatment with THC resulted in a significant improvement of tics. No severe side effects occurred, but transient mild adverse events such as dizziness and tiredness.

Side effects profile of cannabis-based medication

Interestingly, there is some evidence that tolerability and side effects profile of cannabis and cannabis-based medication may be different in patients with TS compared to healthy people. In parallel to the above mentioned controlled trials, neuropsychological performance and cognitive function have been investigated before, during and after treatment with THC (dronabinol). In these studies, no detrimental effects of THC were seen on any of assessments used. Measuring immediate verbal memory span, there was even a trend towards an improvement during treatment with THC (dronabinol). Completely in line with these findings, in a single case study, treatment of a 42 year old patient with TS with THC resulted not only in a 75% tic reduction, but also in an improvement of his driving ability as measured by standardized driving tests.

Summary and perspective

Based on these results from clinical reports and preliminary controlled studies, it has been suggested that cannabis-based medication may be a new and promising treatment strategy for patients with TS. However, it has also been speculated that TS might be caused by a dysfunction in the endocannabinoid system in the brain. This hypothesis fits perfectly with the clinical observation that treatment with cannabis-based medication results in an improvement of both tics and behavioral problems without causing clinically relevant impairment on concentration and psychomotor functions. Since it is well-known that the endocannabinoid system modulates several other neurotransmitter systems in the brain (including the dopaminergic, GABAergic, serotonergic and glutaminergic systems), a dysfunction in the central endocannabinoid system will result in imbalances in several other transmitter system and, thus, may explain the complex clinical symptomatology in TS.

Motivated by these promising data, several clinical studies have been initiated to further investigate the efficacy and tolerability of different cannabis-based medications in the treatment of patients with TS including nabiximols (Sativex®), THC (dronabinol) , and medicinal cannabis. In addition, pilot studies have already been initiated or are in preparation investigating the effects of cannabinoid modulators as well as the so called “entourage effect” in this group of patients. The entourage effect can be achieved by substances that enhance the action of endogenous cannabinoids such as anandamide. These studies are funded by either pharmaceutical companies or the German Research Society (DFG). Thus, our knowledge about the effects of cannabis-based medicine in patients with TS will definitely increase within the next few years. This is important and will be very helpful for patients with TS, because until today – at least in Germany and many other European countries – many doctors hesitate to prescribe medicinal cannabis, health insurances often refuse to cover the costs for this kind of treatment, and patients are often stigmatized as recreational cannabis users and cannabis-addicted, instead of being generally accepted as patients simply using that medication that is most effective for the treatment of their symptoms.

Tic disorders are defined by the presence of motor and/or vocal tics. Motor tics are simple or more complex abrupt involuntary movements that can occur all over the body, but most often are located in the face and head. Vocal tics are characterized by meaningless "simple" sounds or noises, but also can be more "complex" including obscene words. Tourette syndrome (TS) is