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.
Similar content being viewed by others
References
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
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
Billakota S, Devinsky O, Marsh E (2019) Cannabinoid therapy in epilepsy. Curr Opin Neurol 32:220–226. https://doi.org/10.1097/WCO.0000000000000660
Müller-Vahl KR (2013) Treatment of Tourette syndrome with cannabinoids. Behav Neurol 27:119–124. https://doi.org/10.3233/BEN-120276
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
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
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
Marsden CD (1981) Treatment of torsion dystonia. In: Barbeau A (ed) Disorders of movement, current status of modern therapy. Lippincott, Philadelphia, pp 81–104
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
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
Gauter B, Rukwied R, Konrad C (2004) Cannabinoid agonists in the treatment of blepharospasm – a case report study. Neuro Endocrinol Lett 25:45–48
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Author information
Authors and Affiliations
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.
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10072-019-04196-5