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Serag I, Elsakka MM, Moawad MHED, Ali HT, Sarhan K, Shayeb S, Nadim I, Abouzid M. Efficacy of cannabis-based medicine in the treatment of Tourette syndrome: a systematic review and meta-analysis. Eur J Clin Pharmacol 2024; 80:1483-1493. [PMID: 38985199 PMCID: PMC11393157 DOI: 10.1007/s00228-024-03710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/09/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Tourette syndrome (TS) is a neurodevelopmental disorder characterized by motor and phonic tics. It is a condition that affects between 0.3% and 0.7% of children, and its pathophysiology remains largely elusive. TS is associated with structural and functional alterations in corticostriatal circuits and neurochemical imbalances. Even though TS is currently incurable, there are established treatment options available, including behavioral therapy and neuroleptics. The use of cannabis-based medicine for tic management is an emerging therapeutic strategy, although its efficacy is still under investigation. It is hypothesized to interact with the endogenous cannabinoid system, but further research is required to ascertain its safety and effectiveness in TS. AIM In our systematic review and meta-analysis, we aim to assess the effectiveness of cannabis-based medicine in the treatment of TS. METHODS We searched PubMed, Cochrane, Scopus, and Web of Sciences until February 2024. We included clinical trials and cohort studies investigating the efficacy of cannabis-based medicine in the treatment of TS. Data extraction focused on baseline characteristics of the included studies and efficacy outcomes, including scores on the Yale Global Tic Severity Scale (YGTSS), Premonitory Urge for Tics Scale (PUTS), and Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We conducted the meta-analysis using Review Manager version 5.4. software. We compared the measurements before and after drug intake using mean difference (MD) and 95% confidence interval (CI). RESULTS In total, 357 articles were identified for screening, with nine studies included in the systematic review and 3 in the meta-analysis. These studies involved 401 adult patients with TS treated with cannabis. YGTSS revealed a significant reduction in total scores (MD = -23.71, 95% CI [-43.86 to -3.55], P = 0.02), PUTS revealed a significant decrease in scores (MD = -5.36, 95% CI [-8.46 to -2.27], P = 0.0007), and Y-BOCS revealed no significant difference in score reduction (MD = -6.22, 95% CI [-12.68 to 0.23], P = 0.06). CONCLUSION The current study indicates promising and potentially effective outcomes with the use of cannabis-based medicine in mitigating the severity of tics and premonitory urges. However, there is a need for larger, placebo-controlled studies with more representative samples to validate these findings.
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Affiliation(s)
- Ibrahim Serag
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Mostafa Hossam El Din Moawad
- Alexandria Main University Hospital, Alexandria, Egypt
- Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Khalid Sarhan
- Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sally Shayeb
- Faculty of Public Health, Al-Quds University, Jerusalem, Palestine
| | - Islam Nadim
- Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Mohamed Abouzid
- Department of Physical Pharmacy and Pharmacokinetics, Faculty of Pharmacy, Poznan University of Medical Sciences, Rokietnicka 3 St., 60-806, Poznan, Poland.
- Doctoral School, Poznan University of Medical Sciences, 60-812, Poznan, Poland.
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Müller-Vahl KR. Cannabinoids in the Treatment of Selected Mental Illnesses: Practical Approach and Overview of the Literature. PHARMACOPSYCHIATRY 2024; 57:104-114. [PMID: 38428836 PMCID: PMC11076106 DOI: 10.1055/a-2256-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 01/17/2024] [Indexed: 03/03/2024]
Abstract
Although an increasing number of patients suffering from mental illnesses self-medicate with cannabis, current knowledge about the efficacy and safety of cannabis-based medicine in psychiatry is still extremely limited. So far, no cannabis-based finished product has been approved for the treatment of a mental illness. There is increasing evidence that cannabinoids may improve symptoms in autism spectrum disorder (ASD), Tourette syndrome (TS), anxiety disorders, and post-traumatic stress disorder (PTSD). According to surveys, patients often use cannabinoids to improve mood, sleep, and symptoms of attention deficit/hyperactivity disorder (ADHD). There is evidence suggesting that tetrahydrocannabinol (THC) and THC-containing cannabis extracts, such as nabiximols, can be used as substitutes in patients with cannabis use disorder.Preliminary evidence also suggests an involvement of the endocannabinoid system (ECS) in the pathophysiology of TS, ADHD, and PTSD. Since the ECS is the most important neuromodulatory system in the brain, it possibly induces beneficial effects of cannabinoids by alterations in other neurotransmitter systems. Finally, the ECS is an important stress management system. Thus, cannabinoids may improve symptoms in patients with mental illnesses by reducing stress.Practically, cannabis-based treatment in patients with psychiatric disorders does not differ from other indications. The starting dose of THC-containing products should be low (1-2.5 mg THC/day), and the dose should be up-titrated slowly (by 1-2.5 mg every 3-5 days). The average daily dose is 10-20 mg THC. In contrast, cannabidiol (CBD) is mainly used in high doses>400 mg/day.
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Affiliation(s)
- Kirsten R. Müller-Vahl
- Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover
Medical School, Hannover, Germany
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Alves C, Tamagno WA, Vanin AP, Pompermaier A, Barcellos LJG. Cannabis sativa-based oils against aluminum-induced neurotoxicity. Sci Rep 2023; 13:9813. [PMID: 37330587 PMCID: PMC10276866 DOI: 10.1038/s41598-023-36966-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/13/2023] [Indexed: 06/19/2023] Open
Abstract
The use of terpenoid compounds in different neural-related conditions is becoming useful for several illnesses. Another possible activity of these compounds is the reduction of nervous impairment. Cannabis sativa plants are known for their concentration of two important terpenoids, the delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). CBD and THC have central peripheral activities already described and their usage in different brain diseases, such as Alzheimer's and multiple sclerosis. Aluminum (Al) is known as an important neurotoxic compound, the physiological action of Al is not known already, and in high concentrations can lead to intoxication and cause neurotoxicity. Here we evaluated the potential effect of two different doses of CBD- and THC-rich based oils against Al-induced toxicity, in the zebrafish model. We evaluated behavioral biomarkers of the novel tank test (NTT) and social preference test (SPT), and biochemical markers: the activity of the enzyme acetylcholinesterase (AChE) and the antioxidant enzymes-catalase, superoxide dismutase, and glutathione-S-transferase. CBD- and THC-based oils were able to increase the AChE activity helping the cholinergic nervous system actuate against Al toxicity which was reflected by the behavioral biomarkers changes. We concluded that the oils have a protective effect and might be used with proposals for neurological and antioxidant impairment avoidance caused by Al intoxications.
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Affiliation(s)
- Carla Alves
- Biochemistry and Molecular Biology Laboratory Rosilene Rodrigues Kaizer, Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Sertão, Sertão, RS, Brazil
- Bioexperimentation Graduate Program, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Wagner Antonio Tamagno
- Biochemistry and Molecular Biology Laboratory Rosilene Rodrigues Kaizer, Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Campus Sertão, Sertão, RS, Brazil.
- Pharmacology Graduate Program, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil.
| | - Ana Paula Vanin
- Civil and Environmental Engineering Graduate Program, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Aline Pompermaier
- Bioexperimentation Graduate Program, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
| | - Leonardo José Gil Barcellos
- Bioexperimentation Graduate Program, Universidade de Passo Fundo, Passo Fundo, RS, Brazil
- Pharmacology Graduate Program, Universidade Federal de Santa Maria, Santa Maria, RS, Brazil
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4
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A Systemic Review of Medical Cannabinoids Dosing in Human. Clin Ther 2022; 44:e39-e58. [DOI: 10.1016/j.clinthera.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 11/19/2022]
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Vanin AP, Tamagno WA, Alves C, Mesacasa L, Santin LF, Sutorillo NT, Bilibio D, Müller C, Galon L, Kaizer RR. Neuroprotective potential of Cannabis sativa-based oils in Caenorhabditis elegans. Sci Rep 2022; 12:15376. [PMID: 36100636 PMCID: PMC9470673 DOI: 10.1038/s41598-022-19598-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/31/2022] [Indexed: 11/21/2022] Open
Abstract
Substances from the Cannabis sativa species, especially cannabidiol (CBD) and Delta-9-tetrahydrocannabinol (Δ9-THC), have attracted medical attention in recent years. The actions of these two main cannabinoids modulate the cholinergic nervous system (CholNS) involving development, synaptic plasticity, and response to endogenous and environmental damage, as a characteristic of many neurodegenerative diseases. The dynamics of these diseases are mediated by specific neurotransmitters, such as the GABAergic nervous system (GNS) and the CholNS. The nematode Caenorhabditis elegans is an important experimental model, which has different neurotransmitter systems that coordinate its behavior and has a transgene strain that encodes the human β-amyloid 1-42 peptide in body wall muscle, one of the main proteins involved in Alzheimer´s disease. Therefore, the objective of this study was to evaluate the protective potential of terpenoids found in C. sativa in the GNS and CholNS of C. elegans. The effect of two C. sativa oils with variations in CBD and THC concentrations on acetylcholinesterase (AChE) activity, lipid peroxidation, and behavior of C. elegans was evaluated. C. sativa oils were efficient in increasing pharyngeal pumping rate and reducing defecation cycle, AChE activity, and ROS levels in N2 strains. In the muscle:Abeta1-42 strain, mainly when using CBD oil, worm movement, body bends, and pharyngeal pumping were increased, with a reduced AChE activity. Consequently, greater investments in scientific research are needed, in addition to breaking the taboo on the use of the C. sativa plant as an alternative for medicinal use, especially in neurodegenerative diseases, which have already shown positive initial results.
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Affiliation(s)
- Ana Paula Vanin
- Universidade Federal da Fronteira Sul, Erechim, RS, 99.700-000, Brazil
| | - Wagner Antonio Tamagno
- Universidade Federal de Santa Maria, Santa Maria, RS, 97.105-900, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Sertão, RS, 99.170-000, Brazil
| | - Carla Alves
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Sertão, RS, 99.170-000, Brazil
- Universidade de Passo Fundo, Passo Fundo, RS, 99.052-900, Brazil
| | - Letícia Mesacasa
- Universidade de Santa Cruz do Sul, Santa Cruz do Sul, RS, 96.815-900, Brazil
| | - Luciani Figueiredo Santin
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Sertão, RS, 99.170-000, Brazil
| | - Nathália Tafarel Sutorillo
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Sertão, RS, 99.170-000, Brazil
| | - Denise Bilibio
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Sertão, RS, 99.170-000, Brazil
| | - Caroline Müller
- Universidade Federal da Fronteira Sul, Erechim, RS, 99.700-000, Brazil.
| | - Leandro Galon
- Universidade Federal da Fronteira Sul, Erechim, RS, 99.700-000, Brazil
| | - Rosilene Rodrigues Kaizer
- Universidade Federal da Fronteira Sul, Erechim, RS, 99.700-000, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Rio Grande do Sul, Sertão, RS, 99.170-000, Brazil
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Gorberg V, McCaffery P, Anavi-Goffer S. Different responses of repetitive behaviours in juvenile and young adult mice to Δ 9 -tetrahydrocannabinol and cannabidiol may affect decision making for Tourette syndrome. Br J Pharmacol 2020; 178:614-625. [PMID: 33125731 DOI: 10.1111/bph.15302] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/20/2020] [Accepted: 10/22/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND AND PURPOSE Medicinal cannabis is in increasing use by patients with Tourette syndrome, a neuropsychiatric disorder that affects about 1% of the general population and has a childhood onset. However, the pharmacological effects of Δ9 -tetrahydrocannabinol (Δ9 -THC) and cannabidiol (CBD) have not been systematically screened or compared between juvenile and young adult rodents in a model of Tourette syndrome. EXPERIMENTAL APPROACH The administration of 2,5-dimethoxy-4-iodoamphetamine (DOI) increases head twitch response (HTR) and ear scratch response (ESR) and has been proposed as an animal model useful to respectively study motor tics and premonitory urges associated with tic disorders. KEY RESULTS Comparing the potency of Δ9 -THC to inhibit DOI-induced repetitive behaviours, the rank order was ESR > grooming > HTR versus ESR = grooming > HTR in young adult versus juvenile mice. Δ9 -THC (5 mg·kg-1 ) induced severe adverse effects in the form of cataleptic behaviour in control mice and significantly increased ESR in juveniles. The pharmacological effects of CBD have not been studied in models of Tourette syndrome. In juveniles, CBD had no effect on DOI-induced ESR and grooming behaviours. CBD alone induced side effects, significantly increasing the frequency of HTR in juveniles and young adults. CONCLUSION AND IMPLICATIONS Δ9 -THC efficaciously reverses peripheral but not central motor tics. Δ9 -THC may reduce ambulatory movements and evoke premonitory urges in some paediatric patients. The small "therapeutic window" in juveniles suggests that CBD may not effectively treat motor tics in children and may even exacerbate tics in a population of patients with Tourette syndrome.
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Affiliation(s)
- Victoria Gorberg
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Peter McCaffery
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
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Khan R, Naveed S, Mian N, Fida A, Raafey MA, Aedma KK. The therapeutic role of Cannabidiol in mental health: a systematic review. J Cannabis Res 2020; 2:2. [PMID: 33526132 PMCID: PMC7819291 DOI: 10.1186/s42238-019-0012-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 12/13/2019] [Indexed: 12/16/2022] Open
Abstract
Background The therapeutic application of cannabidiol (CBD) is gaining interest due to expanding evidence for its use. Objective To summarize the clinical outcomes, study designs and limitations for the use of CBD and nabiximols (whole plant extract from Cannabis sativa L. that has been purified into 1:1 ratio of CBD and delta-9-tetrahydrocannabinol) in the treatment of psychiatric disorders. Materials and method A systematic review was conducted including case reports, case series, open-label trials, non-randomized and randomized controlled trials (RCTs). The search resulted in 23 relevant studies on CBD and nabiximols in the treatment of a wide range of psychiatric disorders. The quality of evidence was judged by using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence that ranges from Level 1 to Level 5 based on the quality and study design. These levels of evidence help in grading the recommendations, including Grade A (strong), Grade B (moderate), Grade C (weak), and Grade D (weakest). Results CBD and CBD-containing compounds such as nabiximols were helpful in alleviating psychotic symptoms and cognitive impairment in patients with a variety of conditions, and several studies provided evidence of effectiveness in the treatment of cannabis withdrawal and moderate to severe cannabis use disorder with Grade B recommendation. There is Grade B recommendation supporting the use of CBD for the treatment of schizophrenia, social anxiety disorder and autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD). Grade C recommendation exists for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. These recommendations should be considered in the context of limited number of available studies. Conclusion CBD and CBD-containing compounds such as nabiximols were helpful in alleviating symptoms of cannabis-related disorders, schizophrenia, social anxiety disorder, and comorbidities of ASD, and ADHD with moderate recommendation. However, there is weaker evidence for insomnia, anxiety, bipolar disorder, posttraumatic stress disorder, and Tourette syndrome. The evidence for the use of CBD and CBD-containing compounds for psychiatric disorders needs to be explored in future studies, especially large-scale and well-designed RCTs.
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Affiliation(s)
- Rabia Khan
- Dow University of Health Science, Karachi, Pakistan
| | - Sadiq Naveed
- Psychiatry and Behavioral Sciences, Kansas University Medical Center, 3901 Rainbow Blvd, Kansas City, KS, KS 66160, USA.
| | | | - Ania Fida
- King Edward Medical University, Lahore, Pakistan
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Milosev LM, Psathakis N, Szejko N, Jakubovski E, Müller-Vahl KR. Treatment of Gilles de la Tourette Syndrome with Cannabis-Based Medicine: Results from a Retrospective Analysis and Online Survey. Cannabis Cannabinoid Res 2019; 4:265-274. [PMID: 31872061 DOI: 10.1089/can.2018.0050] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder that is characterized by motor and vocal tics and psychiatric comorbidities, including attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive behavior/disorder (OCB/OCD). From anecdotal reports and preliminary controlled studies, it is suggested that cannabis-based medicine (CBM) may improve tics and comorbidities in adults with GTS. This study was designed to further investigate efficacy and safety of CBM in GTS and specifically compare effects of different CBM. Materials and Methods: First, we performed a retrospective data analysis including all those adult patients seen at our clinic, who had used CBM for the treatment of GTS at some time. All these patients were asked to complete an online survey (second study part) to receive more detailed data about treatment with CBM. Results: From medical records, we identified 98 patients who had used CBM (most often street cannabis followed by nabiximols, dronabinol, medicinal cannabis) for the treatment of GTS: Of the 38 patients who were able to judge, 66% preferred treatment with medicinal cannabis, 18% dronabinol, 11% nabiximols, and 5% street cannabis. Altogether, CBM resulted in a subjective improvement of tics (of about 60% in 85% of treated cases), comorbidities (55% of treated cases, most often OCB/OCD, ADHD, and sleeping disorders), and quality of life (93%). The effects of CBM appear to persist in the long term. Adverse events occurred in half of the patients, but they were rated as tolerable. Dosages of all CBM varied markedly. Patients assessed cannabis (with a preference for tetrahydrocannabinol [THC]-rich strains) as more effective and better tolerated compared with nabiximols and dronabinol. These data were confirmed by results obtained from the online survey (n=40). Conclusion: From our results, it is further supported that CBM might be effective and safe in the treatment of tics and comorbidities at least in a subgroup of adult patients with GTS. In our sample, patients favored THC-rich cannabis over dronabinol and nabiximols, which might be related to the entourage effect of cannabis. However, several limitations of the study have to be taken into considerations such as the open uncontrolled design and the retrospective data analysis.
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Affiliation(s)
- Leonie M Milosev
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Nikolas Psathakis
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warszawa, Poland.,Department of Bioethics, Medical University of Warsaw, Warszawa, Poland
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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Kwan Cheung KA, Peiris H, Wallace G, Holland OJ, Mitchell MD. The Interplay between the Endocannabinoid System, Epilepsy and Cannabinoids. Int J Mol Sci 2019; 20:E6079. [PMID: 31810321 PMCID: PMC6929011 DOI: 10.3390/ijms20236079] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 12/25/2022] Open
Abstract
Epilepsy is a neurological disorder that affects approximately 50 million people worldwide. There is currently no definitive epilepsy cure. However, in recent years, medicinal cannabis has been successfully trialed as an effective treatment for managing epileptic symptoms, but whose mechanisms of action are largely unknown. Lately, there has been a focus on neuroinflammation as an important factor in the pathology of many epileptic disorders. In this literature review, we consider the links that have been identified between epilepsy, neuroinflammation, the endocannabinoid system (ECS), and how cannabinoids may be potent alternatives to more conventional pharmacological therapies. We review the research that demonstrates how the ECS can contribute to neuroinflammation, and could therefore be modulated by cannabinoids to potentially reduce the incidence and severity of seizures. In particular, the cannabinoid cannabidiol has been reported to have anti-convulsant and anti-inflammatory properties, and it shows promise for epilepsy treatment. There are a multitude of signaling pathways that involve endocannabinoids, eicosanoids, and associated receptors by which cannabinoids could potentially exert their therapeutic effects. Further research is needed to better characterize these pathways, and consequently improve the application and regulation of medicinal cannabis.
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Affiliation(s)
- Keith A. Kwan Cheung
- Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology (QUT), Centre for Children’s Health Research (CCHR), 62 Graham Street, South Brisbane, Queensland 4101, Australia; (K.A.K.C.); (H.P.); (O.J.H.)
| | - Hassendrini Peiris
- Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology (QUT), Centre for Children’s Health Research (CCHR), 62 Graham Street, South Brisbane, Queensland 4101, Australia; (K.A.K.C.); (H.P.); (O.J.H.)
| | - Geoffrey Wallace
- Children’s Health Queensland (CHQ) and University of Queensland (UQ), Centre for Children’s Health Research, 62 Graham Street, South Brisbane, Queensland 4101, Australia;
| | - Olivia J. Holland
- Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology (QUT), Centre for Children’s Health Research (CCHR), 62 Graham Street, South Brisbane, Queensland 4101, Australia; (K.A.K.C.); (H.P.); (O.J.H.)
- School of Medical Science, Griffith University, 1 Parklands Dr, Southport, Queensland 4215, Australia
| | - Murray D. Mitchell
- Institute of Health and Biomedical Innovation (IHBI), Faculty of Health, Queensland University of Technology (QUT), Centre for Children’s Health Research (CCHR), 62 Graham Street, South Brisbane, Queensland 4101, Australia; (K.A.K.C.); (H.P.); (O.J.H.)
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Abstract
Novel pharmacological treatments are needed for Tourette syndrome. Our goal was to examine the current evidence base and biological rationale for the use of cannabis-derived medications or medications that act on the cannabinoid system in Tourette syndrome. We conducted a comprehensive literature search of PubMed for randomized controlled trials or clinical trials of cannabis-derived medications in Tourette syndrome. Data regarding the population, intervention, safety profile, and outcomes for each trial were extracted and reported and the evidence supporting use of individual cannabis-derived medications was critiqued. There is a strong biological rationale regarding how cannabis-derived medications could affect tic severity. Anecdotal case reports and series have noted that many patients report that their tics improve after using cannabis. However, only two small randomized, placebo-controlled trials of Δ9-tetrahydrocannabinol have been published; these suggested possible benefits of cannabis-derived agents for the treatment of tics. Trials examining other agents active on the cannabinoid system for tic disorders are currently ongoing. Cannabinoid-based treatments are a promising avenue of new research for medications that may help the Tourette syndrome population. However, given the limited research available, the overall efficacy and safety of cannabinoid-based treatments is largely unknown. Further trials are needed to examine dosing, active ingredients, and optimal mode of administration of cannabis-derived compounds, assuming initial trials suggest efficacy. Clinical use for refractory patients should at the very least be restricted to adult populations, given the uncertain efficacy and risk of developmental adverse effects that cannabinoids may have in children. Even in adult populations, cannabis-derived medications are associated with significant issues such as the effects they have on driving safety and the fact that they cause positive urine drug screens that can affect employment.
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Affiliation(s)
- Bekir B Artukoglu
- Yale University, Yale Child Study Center, PO Box 207900, New Haven, CT, 06520, USA.
| | - Michael H Bloch
- Department of Psychiatry, Yale University, Yale Child Study Center, New Haven, CT, USA
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Abstract
PURPOSE OF REVIEW This article was written in order to bring the reader up to date with developments that have occurred in the treatment of Tourette disorder (TD) over the last 5 years. RECENT FINDINGS Despite the fact that TD has been recognized for over a century, the understanding of the underlying mechanisms remains poor. There has been limited development in the last 5 years for new therapeutic options. Aripipazole is the only newly approved pharmaceutical therapy for TD in the last 5 years, although several medications are under active study. For the most severely affected individuals, there is increasing experience with surgical interventions. One of the most promising areas of research is the work of genetic consortiums currently looking into identifying the underlying pathogenetic basis which in turn will hopefully lead to the development of safer and more effective therapies.
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