Archive for the ‘dystonia’ Category

Pain, spasticity, tremor, spasms, poor sleep quality, and bladder and bowel dysfunction, among other symptoms, contribute significantly to the disability and impaired quality of life of many patients with multiple sclerosis (MS). Motor symptoms referable to the basal ganglia, especially paroxysmal dystonia, occur rarely and contribute to the experience of distress. A substantial percentage of patients with MS report subjective benefit from what is often illicit abuse of extracts of the Cannabis sativa plant; the main cannabinoids include delta-9-tetrahydrocannabinol (delta9-THC) and cannabidiol. Clinical trials of cannabis plant extracts and synthetic delta9-THC provide support for therapeutic benefit on at least some patient self-report measures. An illustrative case is presented of a 52-year-old woman with MS, paroxysmal dystonia, complex vocal tics, and marijuana dependence. The patient was started on an empirical trial of dronabinol, an encapsulated form of synthetic delta9-THC that is usually prescribed as an adjunctive medication for patients undergoing cancer chemotherapy. The patient reported a dramatic reduction of craving and illicit use; she did not experience the “high” on the prescribed medication. She also reported an improvement in the quality of her sleep with diminished awakenings during the night, decreased vocalizations, and the tension associated with their emission, decreased anxiety and a decreased frequency of paroxysmal dystonia.

8 patients – children or adolescents aged 3 to 14 years – have been treated with Ä9-THC, dosages ranged from 0.04 mg/kg body weight to 0.14 mg/kg body weight.
In an 8 year-old-boy with NCL Jansky-Bielschowsky spasticity was diminished, he became more alert and his mood improved.
In a 12 year-old-girl, who had suffered from severe hypoxia during birth, mood improved, awareness was increased and focal seizures (presenting as nystagmus and versive movement) but not tonic-clonic seizures were reduced.
A 12 year-old-girl with PDHC-deficiency became more interested in her surroundings and society. Nodding spasms and tonic seizures decreased.
In a 14 year-old-girl with marked dystonia due to NCL Spielmeyer-Vogt a reduction of abnormal movement patterns was observed. In addition the girl had more initiative.
In a 13 year-old-boy presenting with spasticity, athetosis, myoclonic movements and epileptic seizures of unknown cause interest in his surroundings was improved, myoclonic movements were less intense but of similar frequency. Frequency and duration of his focal and generalized seizures were not influenced.
In an 11 year-old-girl with a traumatic paraplegia a significant improvement of symptoms of a posttraumatic reaction presenting as an eating disorder and negative behaviour was observed. Taking higher doses the girl started to develop side effects including inappropriate language (concerning sexual content) and very associative thinking. Therapy was discontinued without signs of withdrawal.
In a 3 10/12 year-old-boy with a traumatic paraplegia a significant improvement in his behaviour and eating disorder was observed.
In a 14 year-old-boy suffering from intractable epilepsy and severe mental retardation appetite and mood improved. Frequency of seizures seemed not to be influenced, but clear assessment was not possible because antiepileptic drugs were changed.
Conclusion: In severly disabled children and adolescents Ä9-THC-medication can have positive psychotropic effects, influences the degree of spasticity and dystonia and-occasionally-seems to have an anticonvulsant action.