Content area
Full Text
http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = Neurotherapeutics (2015) 12:788792 DOI 10.1007/s13311-015-0376-4
http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = http://crossmark.crossref.org/dialog/?doi=10.1007/s13311-015-0376-4&domain=pdf
Web End = REVIEW
Cannabis in the Treatment of Dystonia, Dyskinesias, and Tics
Barbara S. Koppel1
Published online: 14 August 2015# The American Society for Experimental NeuroTherapeutics, Inc. 2015
Abstract Cannabis has been used for many medicinal purposes, including management of spasms, dystonia, and dyskinesias, with variable success. Its use for tetanus was described in the second century BCE, but the literature continues to include more case reports and surveys of its beneficial effects in managing symptoms of hyperkinetic movement disorders than randomized controlled trials, making evidence-based recommendations difficult. This paper reviews clinical research using various formulations of cannabis (botanical products, oral preparations containing 9-tetrahydrocannabinol and/or cannabidiol) and currently available preparations in the USA (nabilone and dronabinol). This has been expanded from a recent systematic review of cannabis use in several neurologic conditions to include case reports and case series and results of anonymous surveys of patients using cannabis outside of medical settings, with the original evidence classifications marked for those papers that followed research protocols. De-spite overlap in some patients, dyskinesias will be treated separately from dystonia and chorea; benefit was not established beyond individual patients for these conditions. Tics, usually due to Tourettes, did respond to cannabis preparations. Side effects reported in the trials will be reviewed but those due to recreational use, including the dystonia that can be secondary to synthetic marijuana preparations, are outside the scope of this paper.
Keywords Cannabis . Marijuana . THC . Cannabidiol . Dystonia . Dyskinesias . Chorea . Tics
Introduction
Endocannabinoid receptors (CB1R and CB2R) are plentiful in the basal ganglia [1], implying they play a role in normal motor function and that pharmaceutical (or recreational) cannabis formulations, which are agonists at both sites, might alleviate symptoms of movement disorders. CB1R are expressed in -aminobutyric acid (GABA)ergic neurons of the caudate and striatum, presynaptic terminals in the globus pallidus externa and interna, substantia nigra pars reticulate and pars compacta, and are present in glutamatergic projections to and from the cortex and the subthalamic nucleus. In addition to GABAergic and glutamatergic pathways,...