Cannabidiol (CBD) oil is generated by mixing a carrier oil like hemp seed oil with the extracts of the Cannabis sativa plant.
CBD is a phytocannabinoid capable of activating specific receptors of the endocannabinoid system (ECS) which modulates a host of bodily responses by altering the activity of certain neurotransmitters.
CBD is not psychoactive and has been proven to confer several health benefits.
Overview of Tourette Syndrome
Tourette syndrome or Tourette’s is a neuropsychiatric disorder that develops in early childhood.
It falls under the class of ‘tic’ disorders wherein tic denotes an unexpected, nonrhythmic motor movement or vocalization that involves certain muscle groups.
Tics in Tourette’s are characterized by rapid eye blinking, facial contortions, repetitive throat clearing, and at least one vocal tic which might involve an outburst of taboo speech.
Benefits of CBD in Tourette syndrome
The major benefits of using CBD to treat Tourette syndrome are linked with its ability to mediate neurotransmission and act on specific parts of the brain concerned with motor function. CBD reduces both the frequency and intensity of motor and verbal tics. It also helps in treating behavioural disorders such as hyperactivity and aggression. CBD also alleviates obsessive-compulsive tendencies and treats generalized anxiety disorders by activating serotonin receptors in the nervous system.
This action exerts an anxiolytic effect which, in turn, prevents the worsening of tic disorders. CBD usage also increasing the efficacies of conventional TS medical therapies.
1. CBD Reduces the Frequency of Tics
Tourette’s is marked by frequent and severe tics.
A tic denotes an involuntary and unexpected movement or speech which usually lasts for a brief spell and is non-rhythmic. The tics generally imitate regular, everyday behaviour often in the midst of daily activities.
They are commonly associated with a ‘premonitory urge’ or build up sensation to execute such actions and a sense of relief prevails after performing them.
Tics can be categorized as motor or vocal (phonetic). As the names suggest, motor tics are associated with movement whereas vocal tics involve particular sounds.
They can also be simple or complex depending upon the number and type of muscle groups used to perform the actions. Depending upon the onset and duration, they can be clonic (rapid), tonic (gradual), and dystonic (slow).
Simple motor tics include persistent blinking, shrugging, and neck stretching. However, complications arise when these tics include jaw clenching or copropraxia which entails performing socially obscene gestures.
Similarly, vocal tics might range from echolalia (repeating someone else’s speech) to coprolalia which involves spontaneous utterance of taboo or vulgar words.
Reducing the frequency of tics is one of the main areas of interest in TS research. Cannabis-derived compounds have shown considerable potential in this sphere.
A 1998 clinical study by the Medical School Hannover showed that CBD usage reduced the frequency of tics in TS patients by a staggering 82%. Several patients also reported the complete remission of both motor and vocal tics.
As per the results of the study, it was inferred that CBD mediates this effect via cannabinoid receptors present in the nervous system.
The conglomerate of cannabinoid receptors present in the basal ganglia and hippocampus of the brain is intrinsically involved in behavioural and motor control. CBD acts upon these receptors to lower the frequency and severity of tics.
CBD helps in lowering the frequency and intensity of TS-associated tics via the cannabinoid receptors present in the brain.
2. CBD Reduces Aggression and Hyperactivity Disorders
Tourette syndrome is associated with a host of behavioural symptoms including hyperactivity as well as aggression or outbursts of rage.
Around 25% of children suffering from TS are affected by such disorders but behavioural symptoms are sometimes observed in adults as well.
Such sudden bursts of aggression are usually unpredictable and often seem greatly disproportionate when compared with the provocative stimulus.
While the reasons might seem inadequate but the outcome is dangerous as patients often run the risk of severe self-harm and even injury to others.
Barring aggression, TS is often associated with other behavioural problems as 90% of the cases exist in conjunction with hyperactivity disorders like ADHD.
Attention-Deficit/Hyperactivity Disorder is characterized by a host of problems such as difficulties in concentrating and impulsive tendencies marked by periods of hyperactivity.
Such manifestations are quite similar to the tics seen in Tourette’s. A 2014 study conducted by the Yale School of Medicine has revealed that both TS and ADHD might have similar genetic components and occur in conjunction due to perinatal risk factors.
The research showed that children exposed to risk factors such as low birth weights and maternal smoking exhibited a greater tendency of developing both Tourette’s and ADHD.
Curbing the expression of unwarranted aggression and excessive hyperactivity will provide symptomatic relief in case of a neuropsychiatric disorder like TS.
Several studies have been conducted that promote the use of cannabis products like CBD in relieving the behavioural symptoms of TS.
A 2017 randomized placebo-controlled clinical study by the King’s College London showed that CBD usage helped in reducing the symptoms of ADHD and associated aggressive behaviour as seen in TS patients.
As CBD reduces the hyperactive and aggressive behaviour, it helps in relieving the complications associated with Tourette’s.
3. CBD Alleviates Obsessive-Compulsive Disorders
Tourette syndrome is often accompanied by another set of complicated behavioural problems known as obsessive-compulsive behaviour or, simply, OCD.
This disorder is often characterized by repetitive behaviour wherein individuals feel the need to constantly go over certain routines or obsess over certain thoughts.
OCD is often linked with the onset of tics as seen in TS. In fact, several patients suffering from Tourette’s develop OCD at some point in time.
While initially the obsessive rituals and thoughts are often an extension of the tics but gradually they tend to negatively affect the quality of life. The obsessive behaviour usually includes repeated handwashing, counting, and many more.
The need for such compulsive behaviour or thoughts is to overcome any anxiety or prevent the occurrence of some stressful event.
Patients may not often realize that performing these routines might not have any fruitful outcome. These behaviours are time-consuming and often adversely affect the person’s life.
Complicated motor tics in TS patients are aggravated by the development of OCD.
Hence, such compulsive behaviour must be overcome in order to reduce the symptoms of Tourette’s. Lowering OCD is, therefore, an active area of interest in the field of medical research.
A 2012 review by the Universidade Federal de Minas Gerais evaluated the role of CBD in the treatment of psychiatric disorders, particularly anxiety disorders like OCD.
It was established that cannabidiol alleviates such disorders by stimulating 5-HT1A(hydroxytryptamine)-mediated neurotransmission. As a result, TS patients can enjoy symptomatic relief.
As CBD helps in promoting neurotransmission, it helps in alleviating problems relating to OCD as seen in some TS patients.
4. CBD Relieves TS-induced Anxiety
Anxiety can exacerbate the symptoms of Tourette’s. A noteworthy percentage of school-going children suffering from Tourette’s often have to deal with associated stress and anxiety disorders.
Most children experience from social anxiety as they get worried about the perceptions regarding their tics.
Therefore, in order to their diagnosis of TS, they might also be suffering from a spectrum of anxiety disorders.
Barring social anxiety, children might also feel separation anxiety which is further aggravated by the diagnosis of obsessive-compulsive disorders. Generalized anxiety disorders are marked by feelings of nervousness, fear, and constant worrying.
Getting diagnosed with anxiety might initiate a vicious cycle for TS patients. Tic disorders actually create stressful situations that increase feelings of anxiety and nervousness and these sensations, in turn, increase the frequency and intensity of the tics.
Extreme anxiety attacks might result in palpitations, increased heart rates, generalized motor tics, and violent outbursts of aggressive behaviour.
A 2010 study by the University at Buffalo identified anxiety and panic attacks as the most serious comorbid disorders associated with Tourette syndrome.
Generalized anxiety can lead to the development of severe disabilities and alcohol/drug dependency in TS patients.
To counter this problem, significant research has been conducted to find anxiolytic drugs.
A 2015 study by the New York University School of Medicine has investigated the role of cannabidiol in the treatment of anxiety and panic disorders. The anxiolytic effect of CBD was attributed to its ability to activate the 5-HT1A (hydroxytryptamine) serotonin receptor.
As CBD promotes the serotonin receptor, it has an anti-anxiety effect and helps in reducing TS-induced anxiety attacks.
5. CBD Increases the Efficacies of Conventional TS Drugs
There is no known cure for Tourette syndrome. The treatment is mostly directed against the onset of tics and aims to lower the frequency and severity of such events.
Medication is also administered to treat the comorbid disorders associated with Tourette’s such as ADHD, OCD, and generalized anxiety disorders. Behavioural therapies are aimed at reducing aggression.
The conventional drug therapies for TS include medications that block the neurotransmitter, dopamine, which has been implicated in tic disorders.
Haloperidol and pimozide control tics but the side effects include weight gain and some involuntary movement. Botulinum injections might also help in treating the affected muscle groups.
Methylphenidate can help increase concentration and treat TS-associated ADHD. However, in some cases, such medications might actually increase the frequency of the tics.
Central adrenergic inhibitors might help in improving behavioural control by preventing rage attacks. However, the side-effects include drowsiness. Antidepressants can also control symptoms of anxiety.
However, research has shown that CBD has great potential in alleviating all the major symptoms and comorbid disorders associated with TS without causing any mind-altering side-effects.
An early study published in the Life Sciences journal established that cannabinoids like CBD increase the effectiveness of conventional TS drugs when administered as adjuncts to them.
As CBD helps in increasing the efficiencies of conventional TS drugs, it helps in reducing symptoms like tic disorders as well as comorbid disorders.
It is advisable to consult a medical practitioner before consuming medications containing THC. The dosage depends on the mode of delivery as the CBD products can be orally ingested or inhaled by a vaporizer.
There is no prescribed dosage for using CBD oil to completely treat Tourette syndrome as it has no cure.
Nevertheless, symptomatic relief can still be provided. Small doses of 40-50mg should be consumed, initially, and the optimum dose should be decided as per the individual’s tolerance capacity.
Vaporizers containing CBD oil can be used to provide an immediate relief from motor tics as well as anxiety attacks and 10 mg should be inhaled.
The plant-derived cannabinoid, CBD, has very few known side-effects. Regular oral doses of up to 500mg can be had for as long as 5-6 months.
A 2011 review stated that even high doses of 1500mg can be tolerated daily for a period of almost 3 months without producing any unwarranted complications.
CBD products usually contain variable amounts of the psychotropic agent, tetrahydrocannabinol (THC), which is responsible for some of the side-effects.
While the quantity of THC permitted in medicinal products is quite scarce but sensitive individuals might still experience the hallucinatory effect.
CBD inhibits the activity of cytochrome p450, a class of liver enzymes involved in the metabolism of drugs and therefore, CBD usage lessens the efficacies of certain medications.
They might also cause tachycardia, a condition wherein the heart rate gets abnormally raised for a short duration.
Cannabis products which have a moderate amount of THC should not be accompanied by alcohol.
Pregnant and lactating women should consult a gynaecologist before consuming CBD-containing medicines. Caution should also be maintained while administering THC-containing products to children and adolescents as it might affect their CNS differently.
To summarize, it can be said that CBD confers several benefits in relieving the symptoms of Tourette’s.
Most importantly, it helps in lowering the frequency of motor and vocal tics by acting upon specific areas of the brain.
It also helps in treating behavioural complications such as ADHD and aggressive outbursts.
By activating the 5-HT1A serotonin receptor, it helps in exerting an anxiolytic effect which combats the development of OCD and anxiety disorders.
Using CBD as an adjunct therapy to conventional approaches helps in enhancing the effectiveness of the more common TS drugs.