Behandlung des Tourette-Syndroms mit cannabisbasierten Medikamenten

ZUSAMMENFASSUNG

Die Behandlung von Patienten mit Gilles-de-la-Tourette-Syndrom (GTS) ist bis heute unbefriedigend, da etablierte Therapien nur zu einer partiellen Reduktion der Tics und nicht zu einer Verbesserung psychiatrischer Komorbiditäten führen. Die medikamentöse Behandlung mit Antipsychotika führt oft zu relevanten Nebenwirkungen. Daher besteht großes Interesse, neue Behandlungsstrategien zu entwickeln. Basierend auf anekdotischen Berichten und kleinen Studien, in denen über positive Effekte durch Cannabis und cannabisbasierte Medikamente bei Patienten mit GTS berichtet wurde, wird in kontrollierten Studien untersucht, ob Medikamente, die durch unterschiedliche Mechanismen zu einer Stimulation des Endocannabinoidsystems führen, wirksam und verträglich in der Therapie von Tics und Komorbiditäten sind. In dieser Übersicht werden bisherige Studienergebnisse vorgestellt. Es werden Hypothesen diskutiert, warum Cannabinoide in der Behandlung des GTS wirksam sein könnten. Schließlich werden praktische Empfehlungen zur Therapie mit cannabisbasierten Medikamenten gegeben.

ABSTRACT

The treatment of patients with Gilles de la Tourette syndrome (GTS) is still unsatisfactory, since established therapies reduce tics only partially and do not improve psychiatric comorbidities. Drug treatment with antipsychotics often results in relevant side effects. Therefore, there is great interest in developing new treatment strategies. Based on anecdotal reports and small clinical studies reporting about beneficial effects of cannabis and cannabis-based medicines in the treatment of tics and comorbidities in patients with GTS, controlled trials are currently under way investigating efficacy and tolerability of drugs that stimulate the endocannabinoid system through different mechanisms. This overview presents all previous study results. Hypotheses are discussed as to why cannabinoids may be effective in the treatment of GTS. Finally, practical recommendations are given for treatment with cannabis-based medications.

Schlüsselwörter

Tourette-Syndrom - Tics - Cannabis - Cannabinoide

Key words

Tourette syndrome - tics - cannabis - cannabinoids

• Literatur

• 1 Müller-Vahl K. Tourette-Syndrom und andere Tic-Erkrankungen im Kindes- und Erwachsenenalter. 2. Auflage. Berlin: Medizinisch Wissenschaftliche Verlagsgesellschaft; 2014
• 2 Pringsheim T, Okun MS, Müller-Vahl K. et al Practice guideline recommendations summary: Treatment of tics in people with Tourette syndrome and chronic tic disorders. Neurology 2019; 92 (19) 896-906
• 3 Verdellen C, van de Griendt J, Hartmann A. et al European clinical guidelines for Tourette syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. Eur Child Adolesc Psychiatry 2011; 20 (04) 197-207
• 4 Roessner V, Plessen KJ, Rothenberger A. et al European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment. Eur Child Adolesc Psychiatry 2011; 20 (04) 173-96
• 5 Müller-Vahl KR, Cath DC, Cavanna AE. et al European clinical guidelines for Tourette syndrome and other tic disorders. Part IV: deep brain stimulation. Eur Child Adolesc Psychiatry 2011; 20 (04) 209-17
• 6 Kompoliti K, Fan W, Leurgans S. Complementary and alternative medicine use in Gilles de la Tourette syndrome. Mov Disord 2009; 24 (13) 2015-9
• 7 Szejko N, Jakubovski E, Müller-Vahl K. Possible Role of the Endocannabinoid System in Tourette Syndrome. Recent Advances in Cannabinoid Research [Internet]. 2018 Nov 5 [cited 2019 May 19]; Available from https://www.intechopen.com/books/recent-advances-in-cannabinoid-research/possible-role-of-the-endocannabinoid-system-in-tourette-syndrome
• 8 Sandyk R, Awerbuch G. Marijuana and Tourette’s syndrome. J Clin Psychopharmacol 1988; 8 (06) 444-5
• 9 Hemming M, Yellowlees PM. Effective treatment of Tourette’s syndrome with marijuana. J Psychopharmacol 1993; 7 (04) 389-91
• 10 Müller-Vahl KR, Kolbe H, Schneider U. et al Cannabinoids: possible role in patho-physiology and therapy of Gilles de la Tourette syndrome. Acta Psychiatr Scand 1998; 98 (06) 502-6
• 11 Abi-Jaoude E, Chen L, Cheung P. et al Preliminary Evidence on Cannabis Effectiveness and Tolerability for Adults With Tourette Syndrome. J Neuropsychiatry Clin Neurosci 2017 appineuropsych16110310
• 12 Jakubovski E, Müller-Vahl K. Speechlessness in Gilles de la Tourette Syndrome: Cannabis-Based Medicines Improve Severe Vocal Blocking Tics in Two Patients. Int J Mol Sci 2017; 18: 8
• 13 Müller-Vahl KR, Schneider U. et al Treatment of Tourette’s syndrome with delta-9-tetrahydrocannabinol. Am J Psychiatry 1999; 156 (03) 495
• 14 Müller-Vahl K, Schneider U, Emrich H. Combined treatment of Tourette-Syndrome with delts-9-THC and dopamine receptor antagonists. J Cannabis Therap 2002; 2: 145-54
• 15 Brunnauer A, Segmiller FM. et al Cannabinoids improve driving ability in a Tourette’s patient. Psychiatry Res 2011; 190 2–3 382
• 16 Trainor D, Evans L, Bird R. Severe motor and vocal tics controlled with Sativex^® . Australas Psychiatry 2016 Aug 24
• 17 Kanaan AS, Jakubovski E, Müller-Vahl K. Significant Tic Reduction in An Otherwise Treatment-Resistant Patient with Gilles de la Tourette Syndrome Following Treatment with Nabiximols. Brain Sci 2017; 7: 5
• 18 Hasan A, Rothenberger A, Münchau A. et al Oral delta 9-tetrahydrocannabinol improved refractory Gilles de la Tourette syndrome in an adolescent by increasing intracortical inhibition: a case report. J Clin Psychopharmacol 2010; 30 (02) 190-2
• 19 Szejko N, Jakubovski E, Fremer C. et al Delta-9-tetrahydrocannabinol for the treatment of a child with Tourette syndrome—case report. European Journal of Medical Case Reports 2018; 2 (01) 43-6
• 20 Müller-Vahl KR, Schneider U, Koblenz A. et al Treatment of Tourette’s syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry 2002; 35 (02) 57-61
• 21 Müller-Vahl KR, Schneider U, Prevedel H. et al Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry 2003; 64 (04) 459-65
• 22 Abide Therapeutics Reports Positive Topline Data from Phase 1b Study of ABX-1431 in Tourette Syndrome | Abide therapeutics [Internet]. [cited 2019 Jul 10]. Available from http://abidetx.com/news/abide-therapeutics-reports-positive-topline-data-from-phase-1b-study-of-abx-1431-in-tourette-syndrome/
• 23 Cooper RE, Williams E, Seegobin S. et al Cannabinoids in attention-deficit/hyperactivity disorder: A randomised-controlled trial. Eur Neuropsychopharmacol 2017; 27 (08) 795-808
• 24 Whiting PF, Wolff RF. et al Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA 2015; 313 (24) 2456-73
• 25 Abrams DI. The therapeutic effects of Cannabis and cannabinoids: An update from the National Academies of Sciences, Engineering and Medicine report. Eur J Intern Med 2018; 49: 7-11
• 26 MacCallum CA, Russo EB. Practical considerations in medical cannabis administration and dosing. Eur J Intern Med 2018; 49: 12-9
• 27 Müller-Vahl KR, Koblenz A. et al Influence of treatment of Tourette syndrome with delta9-tetrahydrocannabinol (delta9-THC) on neuropsychological performance. Pharmacopsychiatry 2001; 34 (01) 19-24
• 28 Worbe Y, Marrakchi-Kacem L, Lecomte S. et al Altered structural connectivity of cortico-striato-pallido-thalamic networks in Gilles de la Tourette syndrome. Brain 2015; 138 Pt 2 472-82
• 29 Singer HS. The neurochemistry of Tourette syndrome. In Martino D, Leckman JF. eds Tourette syndrome. New York: Oxford University Press; 2013: 276-300
• 30 Mechoulam R, Parker LA. The endocannabinoid system and the brain. Annu Rev Psychol 2013; 64: 21-47
• 31 García C, Palomo-Garo C, Gómez-Gálvez Y. et al Cannabinoid-dopamine interactions in the physiology and physiopathology of the basal ganglia. Br J Pharmacol 2016; 173 (13) 2069-79