Müller-Vahl K R, Schneider U, Koblenz A, Jöbges M, Kolbe H, Daldrup T, Emrich H M
Department of Clinical Psychiatry and Psychotherapy, Hanover Medical School, Germany.
Pharmacopsychiatry. 2002 Mar;35(2):57-61. doi: 10.1055/s-2002-25028.
Anecdotal reports in Tourette's syndrome (TS) have suggested that marijuana (cannabis sativa) and delta-9-tetrahydrocannabinol (Delta(9)-THC), the major psychoactive ingredient of marijuana, reduce tics and associated behavioral disorders. We performed a randomized double-blind placebo-controlled crossover single-dose trial of Delta(9)-THC (5.0, 7.5 or 10.0 mg) in 12 adult TS patients. Tic severity was assessed using a self-rating scale (Tourette's syndrome Symptom List, TSSL) and examiner ratings (Shapiro Tourette's syndrome Severity Scale, Yale Global Tic Severity Scale, Tourette's syndrome Global Scale). Using the TSSL, patients also rated the severity of associated behavioral disorders. Clinical changes were correlated to maximum plasma levels of THC and its metabolites 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC) and 11-nor-Delta(9)-tetrahydrocannabinol-9-carboxylic acid (THC-COOH). Using the TSSL, there was a significant improvement of tics (p=0.015) and obsessive-compulsive behavior (OCB) (p = 0.041) after treatment with Delta(9)-THC compared to placebo. Examiner ratings demonstrated a significant difference for the subscore "complex motor tics" (p = 0.015) and a trend towards a significant improvement for the subscores "motor tics" (p = 0.065), "simple motor tics" (p = 0.093), and "vocal tics" (p = 0.093). No serious adverse reactions occurred. Five patients experienced mild, transient side effects. There was a significant correlation between tic improvement and maximum 11-OH-THC plasma concentration. Results obtained from this pilot study suggest that a single-dose treatment with Delta(9)-THC is effective and safe in treating tics and OCB in TS. It can be speculated that clinical effects may be caused by 11-OH-THC. A more long-term study is required to confirm these results.
抽动秽语综合征（TS）的轶事报告表明，大麻（大麻）及其主要精神活性成分Δ9-四氢大麻酚（Δ9-THC）可减轻抽动症状及相关行为障碍。我们对12例成年TS患者进行了一项随机双盲安慰剂对照交叉单剂量试验，给予Δ9-THC（5.0、7.5或10.0毫克）。使用自评量表（抽动秽语综合征症状清单，TSSL）和检查者评分（夏皮罗拉布雷斯综合征严重程度量表、耶鲁全球抽动严重程度量表、抽动秽语综合征全球量表）评估抽动严重程度。患者还使用TSSL对相关行为障碍的严重程度进行评分。临床变化与THC及其代谢物11-羟基-Δ9-四氢大麻酚（11-OH-THC）和11-去甲-Δ9-四氢大麻酚-9-羧酸（THC-COOH）的最大血浆水平相关。使用TSSL，与安慰剂相比，Δ9-THC治疗后抽动症状（p = 0.015）和强迫行为（OCB）（p = 0.041）有显著改善。检查者评分显示，“复杂运动抽动”子评分有显著差异（p = 0.015），“运动抽动”（p = 0.065）、“简单运动抽动”（p = 0.093）和“发声抽动”（p = 0.093）子评分有显著改善趋势。未发生严重不良反应。5例患者出现轻度、短暂的副作用。抽动改善与11-OH-THC最大血浆浓度之间存在显著相关性。这项初步研究的结果表明，单剂量Δ9-THC治疗TS的抽动和OCB有效且安全。可以推测，临床效果可能由11-OH-THC引起。需要进行更长期的研究来证实这些结果。
