Cannabinoids and dystonia: an issue yet to be defined

Abstract

Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements and postures. Besides motor manifestations, patients with dystonia also display non-motor signs and symptoms including psychiatric and sensory disturbances. Symptomatic treatment of motor signs in dystonia largely relies on intramuscular botulinum toxin injections and, in selected cases, on deep brain stimulation. Oral medications and physical therapy offer a few benefits only in a minority of patients. Cannabinoids have been shown to be a complementary treatment in several neurological disorders but their usefulness in dystonia have not been systematically assessed. Given recent policy changes in favor of cannabis use in clinical practice and the request for alternative treatments, it is important to understand how cannabinoids may impact people with dystonia. Reviewing the evidence so far available and our own experience, cannabinoids seem to be effective in single cases but further studies are required to improve our understanding on their role as complementary treatment in dystonia.

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References

  1. 1.

    Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, Rahman R, Murnion B, Farrell M, Weier M, Degenhardt L (2018) Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain 159:1932–1954. https://doi.org/10.1097/j.pain.0000000000001293

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Wright S, Yadav V, Bever C Jr, Bowen J, Bowling A, Weinstock-Guttman B, Cameron M, Bourdette D, Gronseth GS, Narayanaswami P (2014) Summary of evidence-based guideline: complementary and alternative medicine in multiple sclerosis: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 83:1484–1486. https://doi.org/10.1212/01.wnl.0000455935.13606.91

    Article  PubMed  Google Scholar 

  3. 3.

    Billakota S, Devinsky O, Marsh E (2019) Cannabinoid therapy in epilepsy. Curr Opin Neurol 32:220–226. https://doi.org/10.1097/WCO.0000000000000660

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Müller-Vahl KR (2013) Treatment of Tourette syndrome with cannabinoids. Behav Neurol 27:119–124. https://doi.org/10.3233/BEN-120276

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Baron EP (2015) Comprehensive review of medicinal marijuana, cannabinoids, and therapeutic implications in medicine and headache: what a long strange trip it’s been …. Headache 55:885–916. https://doi.org/10.1111/head.12570

    Article  PubMed  Google Scholar 

  6. 6.

    Consky ES, Lang AE (1994) Clinical assessments of patients with cervical dystonia. In: Jankovic J, Hallett M (eds) Therapy with botulinum toxin, 1st edn. Marcel Dekker, New York, pp 211–238

    Google Scholar 

  7. 7.

    Comella CL, Stebbins GT, Goetz CG, Chmura TA, Bressman SB, Lang AE (1997) Teaching tape for the motor section of the Toronto Western Spasmodic Torticollis Scale. Mov Disord 12:570–575. https://doi.org/10.1002/mds.870120414

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Marsden CD (1981) Treatment of torsion dystonia. In: Barbeau A (ed) Disorders of movement, current status of modern therapy. Lippincott, Philadelphia, pp 81–104

    Google Scholar 

  9. 9.

    Chatterjee A, Almahrezi A, Ware M, Fitzcharles MA (2002) A dramatic response to inhaled cannabis in a woman with central thalamic pain and dystonia. J Pain Symptom Manag 24:4–6. https://doi.org/10.1016/S0885-3924(02)00426-8

    Article  Google Scholar 

  10. 10.

    Uribe Roca MC, Micheli F, Viotti R (2005) Cannabis sativa and dystonia secondary to Wilson’s disease. Mov Disord 20:113–115. https://doi.org/10.1002/mds.20268

    Article  PubMed  Google Scholar 

  11. 11.

    Gauter B, Rukwied R, Konrad C (2004) Cannabinoid agonists in the treatment of blepharospasm – a case report study. Neuro Endocrinol Lett 25:45–48

    PubMed  Google Scholar 

  12. 12.

    Radke PM, Mokhtarzadeh A, Lee MS, Harrison AR (2017) Medical cannabis, a beneficial high in treatment of blepharospasm? An early observation. Neuroophthalmology 41:253–258. https://doi.org/10.1080/01658107.2017.1318150

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Consroe P, Sandyk R, Snider SR (1986) Open label evaluation of cannabidiol in dystonic movement disorders. Int J Neurosci 30:277–282. https://doi.org/10.3109/00207458608985678

    CAS  Article  PubMed  Google Scholar 

  14. 14.

    Fox SH, Kellett M, Moore AP, Crossman AR, Brotchie JM (2002) Randomised, double-blind, placebo -controlled trial to assess the potential of cannabinoid receptor stimulation in the treatment of dystonia. Mov Disord 17:145–149. https://doi.org/10.1002/mds.1280

    Article  PubMed  Google Scholar 

  15. 15.

    Zadikoff C, Wadia PM, Miyasaki J, Chen R, Lang AE, So J, Fox SH (2011) Cannabinoid, CB1 agonists in cervical dystonia: failure in a phase IIa randomized controlled trial. Basal Ganglia 1:91–95. https://doi.org/10.1016/j.baga.2011.04.002

    Article  Google Scholar 

  16. 16.

    Jabusch HC, Schneider U, Altenmüller E (2004) Delta9-tetrahydrocannabinol improves motor control in a patient with musician’s dystonia. Mov Disord 19:990–991. https://doi.org/10.1002/mds.20214

    Article  PubMed  Google Scholar 

  17. 17.

    Jabusch HC, Vauth H, Altenmüller E (2004) Quantification of focal dystonia in pianists using scale analysis. Mov Disord 19:171–180. https://doi.org/10.1002/mds.10671

    Article  PubMed  Google Scholar 

  18. 18.

    Hallett M (2016) Functional (psychogenic) movement disorders – clinical presentations. Parkinsonism Relat Disord 22:S149–S152. https://doi.org/10.1016/j.parkreldis.2015.08.036

    Article  PubMed  Google Scholar 

  19. 19.

    Albanese A, Bhatia K, Bressman SB, DeLong MR, Fahn S, Fung VS, Hallett M, Joseph J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK (2013) Phenomenology and classification of dystonia: a consensus update. Mov Disord 28:863–873. https://doi.org/10.1002/mds.25475

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Tinazzi M, Squintani G, Berardelli A (2009) Does neurophysiological testing provide information we need to improve the clinical management of primary dystonia? Clin Neurophysiol 120:1424–1432. https://doi.org/10.1016/j.clinph.2009.06.015

    Article  PubMed  Google Scholar 

  21. 21.

    Schmerler DA, Espay AJ (2016) Functional dystonia. Handb Clin Neurol 139:235–245. https://doi.org/10.1016/B978-0-12-801772-2.00020-5

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Mainka T, Erro R, Rothwell J, Kühn AA, Bhatia KP, Ganos C (2019) Remission in dystonia - systematic review of the literature and meta-analysis. Parkinsonism Relat Disord. https://doi.org/10.1016/j.parkreldis.2019.02.020

  23. 23.

    Le Boisselier R, Alexandre J, Lelong-Boulouard V, Debruyne D (2017) Focus on cannabinoids and synthetic cannabinoids. Clin Clin Pharmacol Ther 101:220–229. https://doi.org/10.1002/cpt.563

    Article  PubMed  Google Scholar 

  24. 24.

    García C, Palomo-Garo C, Gómez-Gálvez Y, Fernández-Ruiz J (2016) Cannabinoid-dopamine interactions in the physiology and physiopathology of the basal ganglia. Br J Pharmacol 173:2069–2079. https://doi.org/10.1111/bph.13215

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Sañudo-Peña MC, Tsou K, Walker JM (1999) Motor actions of cannabinoids in the basal ganglia output nuclei. Life Sci 65:703–713. https://doi.org/10.1016/S0024-3205(99)00293-3

    Article  PubMed  Google Scholar 

  26. 26.

    Pertwee RG, Howlett AC, Abood ME, Alexander SP, Di Marzo V, Elphick MR, Greasley PJ, Hansen HS, Kunos G, Mackie K, Mechoulam R, Ross RA (2010) International Union of Basic and Clinical Pharmacology. LXXIX. Cannabinoid receptors and their ligands: beyond CB1 and CB2. Pharmacol Rev 62:588–631. https://doi.org/10.1124/pr.110.003004

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Starowicz K, Finn DP (2017) Cannabinoids and pain: sites and mechanisms of action. Adv Pharmacol 80:437–475. https://doi.org/10.1016/bs.apha.2017.05.003

    CAS  Article  PubMed  Google Scholar 

  28. 28.

    Pertwee RG (2015) Endocannabinoids and their pharmacological actions. Handb Exp Pharmacol 231:1–37. https://doi.org/10.1007/978-3-319-20825-1_1

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Friedman D, French JA, Maccarrone M (2019) Safety, efficacy, and mechanisms of action of cannabinoids in neurological disorders. Lancet Neurol 18:504–512. https://doi.org/10.1016/S1474-4422(19)30032-8

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Maccarrone M, Bab I, Bíró T, Cabral GA, Dey SK, Di Marzo V, Konje JC, Kunos G, Mechoulam R, Pacher P, Sharkey KA, Zimmer A (2015) Endocannabinoid signaling at the periphery: 50 years after THC. Trends Pharmacol Sci 36:277–296. https://doi.org/10.1016/j.tips.2015.02.008

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Albanese A, Sorbo FD, Comella C, Jinnah HA, Mink JW, Post B, Vidailhet M, Volkmann J, Warner TT, Leentjens AF, Martinez-Martin P, Stebbins GT, Goetz CG, Schrag A (2013) Dystonia rating scales: critique and recommendations. Mov Disord 28:874–883. https://doi.org/10.1002/mds.25579

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Defazio G, Hallett M, Jinnah HA, Stebbins GT, Gigante AF, Ferrazzano G, Conte A, Fabbrini G, Berardelli A (2015) Development and validation of a clinical scale for rating the severity of blepharospasm. Mov Disord 30:525–530. https://doi.org/10.1002/mds.26156

    Article  PubMed  PubMed Central  Google Scholar 

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Contributions

M.M. Mascia: conceptualization, literature search, writing the first draft

D. Carmagnini: revision and critique

G. Defazio: revision and critique

All the authors read and approved the final manuscript.

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Correspondence to Marcello Mario Mascia.

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Mascia, M.M., Carmagnini, D. & Defazio, G. Cannabinoids and dystonia: an issue yet to be defined. Neurol Sci 41, 783–787 (2020). https://doi.org/10.1007/s10072-019-04196-5

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Keywords

  • Dystonia
  • Cannabinoids