TREATMENT OF TOURETTE'S SYNDROME WITH DELTA-9-TETRNHYDROCANNABINOL

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)
(1, 2, 3). We report a successful treatment of Tourette's syndrome
with delta-9-tetrahydrocannabinol (delta-9-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 starred as 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
gm/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
delta-9-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 delta-9-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 delta-9-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 -- delta-9-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 delta-9-THC and specific cannabinoid
receptors located in basal ganglia (4). We are planning to confirm
these preliminary results in a doubleblind, placebo-controlled,
crossover study.

REFERENCES

1. Sandyk R. Awerbuch G. Marijuana and Tourette's syndrome. J Clin
Psychopharmacol 1988; 8: 444 - 445

2. Hemming M, Yelllowlees PM: Effective treatment of Tourette's
syndrome with marijuana. J Clin psychopharmacol 1993; 7: 389 - 391

3. Muller-Vahl KR, Kolbe H, Dengler R; Gilles de la Tourette-Syndrom;
Einfluss von Nikotin, Alkohol und marihuana auf die linkische
Symptomatikt. Nervenarz 1997; 68: 985 - 989

4. 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

KIRSTEN R. MULLER-VAHL, M.D.
UD0 SCHNEIDER, M.D.
HANS KOLBE. M.D.
HINDERK M. EMRICH, M.D.