Objective: To assess the effect of Medical Cannabis (MC) on patients with dystonia.

Background: MC has been suggested to treat involuntary contractions of muscles in patients with dystonia and alleviate related pain, in a few case reports and case series. The suggested mechanism is activation of cannabinoid receptors in the basal ganglia, enhancing the release of γ-aminobutyric acid (GABA). MC is approved by the Israeli Ministry of Health (MOH) since 2013 for symptomatic treatment in patients with movement disorders accompanied by pain.

Method: Patients with dystonia of all types (primary and secondary, focal, segmental, generalized) with an MOH approved MC license were interviewed via phone regarding treatment efficacy and side effect profile from chronic MC consumption. Global efficacy was rated on a Likert scale of 1-5.

Results: Twelve patients with dystonia (6 females, mean age 54.6) were interviewed for this study. Three patients suffered from focal dystonia, seven patients from generalized dystonia and two patients from hemi-dystonia. 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 5 possible points. Efficacy for pain was 3.67 out of 5. Nine out of twelve patients reported improvement in sleep. 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.

Conclusion: MC seems to mitigate dystonic muscle activity and related pain. Psychiatric side effects of MC treatment have to be monitored especially following treatment initiation. Larger cohort should be further investigated to determine MC efficacy, mechanism of action, optimal doses and the best THC/CBD ratio for the treatment of dystonia.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-real-life-study-of-medical-cannabis-effect-on-adults-with-dystonia/