Tel Aviv, Israel: Medical Cannabis and Dystonia Study

A real-life study showed that consumption of medical cannabis (MC) may mitigate dystonic muscle activity and related pain. Although the researchers suggest that there is a need for monitoring the psychiatric side effects of MC treatment, especially after treatment initiation. The findings of the study were presented at the International Congress of Parkinson's Disease and Movement Disorders Society (MDS) Virtual Congress 2021, held from September 17 to 22, 2021.

Few case reports and case series have suggested the utility of MC for treating involuntary contractions of muscles in dystonia patients and alleviating related pain. It could be through the activation of cannabinoid receptors in the basal ganglia that enhances the release of γ-aminobutyric acid (GABA). A team of researchers from Israel, led by T. Gurevich aimed to assess the effect of Medical Cannabis on patients with dystonia.

For this purpose, the researchers interviewed dystonia patients of all types (primary and secondary, focal, segmental, generalized) with a MOH-approved MC license via phone. They were queried regarding the treatment efficacy and side effect profile from chronic MC consumption. Global efficacy was rated on a Likert scale of 1-5.

Out of twelve patients with dystonia (6 females, mean age 54.6) interviewed for the study, three patients suffered from focal dystonia, seven patients from generalized dystonia, and two patients from hemi-dystonia.

Key Findings

• The etiology of the dystonia was known in 5 patients (DYT1, DYT6, and three patients with Parkinson's disease).
• Duration of MC use (years) was 2.80±0.79, average dose of MC (grams/month) was 34.29±5.68, %THC 11.63±2.12, %CBD 9.44±1.47, mode of administration: cigarettes/vapor (42%), oil (42%), both (16%), frequency of use 4.73±1.54 (per day), number of puffs/drops for each use 6.60±1.88.
• The total global impression efficacy score for dystonia was 3.16 out of a total of 5 possible points. Efficacy for pain was 3.67 out of 5.
• Nine out of twelve patients reported improvement in sleep. The most common side effects were dry mouth (75%) and fatigue (50%).
• Five patients (42%) suffered from psychiatric side effects: three suffered from anxiety (one with hallucinations) while two suffered from mood worsening (one with suicidal thinking) soon after treatment initiation.
• Side effects resolved in 4 patients after treatment modification and only one patient had to stop treatment.
• One patient stopped treatment due to inefficacy.

"There is a need for further investigating larger cohort to determine MC efficacy, mechanism of action, optimal doses, and the best THC/CBD ratio for the treatment of dystonia," wrote the authors.

Reference

S. Anis, A. Faust-Socher, D. Sverdlov, N. Hezi, N. Giladi, T. Gurevich. A real-life study of Medical Cannabis effect on adults with dystonia [abstract]. Mov Disord. 2021; 36 (suppl 1). https://www.mdsabstracts.org/abstract/a-real-life-study-of-medical-cannabis-effect-on-adults-with-dystonia/. Accessed December 24, 2021.