Oral delta 9-tetrahydrocannabinol improved refractory Gilles de la Tourette syndrome in an adolescent by increasing intracortical inhibition: a case report.
OBJECTIVE
To describe the clinical course of the Delta 9-tetrahydrocannabinol (Delta 9-THC) treatment of a boy with Gilles de la Tourette Syndrome (TS) and comorbid attention-deficit/hyperactivity disorder (ADHD) in relation to Delta 9-THC plasma levels and intracortical inhibition measured by transcranial magnetic stimulation.


METHODS
The clinical course and pharmacological and neurophysiological measures are reported in a 15-year-old boy with treatment refractory TS plus ADHD leading to severe physical and psychosocial impairment.


RESULTS
Administration of Delta 9-THC improved tics considerably without adverse effects, allowing parallel stimulant treatment of comorbid ADHD. Along with the Delta 9-THC treatment, intracortical inhibition was increased, reflected in the enhanced short-interval intracortical inhibition and the prolongation of the cortical silent period.


CONCLUSIONS
Our observation suggests that Delta 9-THC might be a successful alternative in patients with severe TS refractory to classic treatment. Particularly in the case of stimulant-induced exacerbation of tics, Delta 9-THC might enable successful treatment of comorbid ADHD. The enhancement of intracortical inhibition might be mediated by modulating release of several neurotransmitters including dopamine and gamma-aminobutyric acid. Further studies are needed to substantiate our findings.
Hasan
Alkomiet
A
Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, Göttingen, Germany.
Rothenberger
Aribert
A
Münchau
Alexander
A
Wobrock
Thomas
T
Falkai
Peter
P
Roessner
Veit
V
D000284:Administration, Oral; D000293:Adolescent; D002540:Cerebral Cortex / Q000187:drug effects* / Q000502:physiology; D013759:Dronabinol / Q000008:administration & dosage* / Q000097:blood; D006801:Humans; D008297:Male; D009433:Neural Inhibition / Q000187:drug effects* / Q000502:physiology; D005879:Tourette Syndrome / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D050781:Transcranial Magnetic Stimulation / Q000379:methods
D013759:Dronabinol