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AVANCES EN EL TRATAMIENTO DEL SINDROME DE TOURETTE
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AVANCES EN EL TRATAMIENTO DEL SINDROME DE TOURETTE

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En esta revisión se resumen todos los informes de casos y los ensayos controlados disponibles que investigaron el efecto de diferentes canabinoides en el tratamiento de los tics. También se tuvieron en cuenta las limitaciones y los efectos adversos del tratamiento con estos fármacos.
mullervahl9.jpg Autor:
Kirsten R. Müller-vahl
Columnista Experto de SIIC

Institución:
Department of Clinical Psychiatry, Medical School Hannover


Artículos publicados por Kirsten R. Müller-vahl
Recepción del artículo
24 de Noviembre, 2005
Aprobación
29 de Diciembre, 2005
Primera edición
30 de Mayo, 2006
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
Los tics son el sello distintivo del síndrome de Tourette (ST). Los antagonistas dopaminérgicos constituyen el tratamiento de elección aunque los neurolépticos frecuentemente presentan efectos colaterales poco satisfactorios. Por tanto, existe un creciente interés en obtener nuevos enfoques terapéuticos. Algunos informes anecdóticos han sugerido que Cannabis sativa podría disminuir los tics. Dos estudios controlados en un número pequeño de pacientes demostraron que el delta-9-tetrahidrocannabinol (THC) -el ingrediente más psicoactivo del cannabis- fue efectivo para controlar los tics sin inducir efectos adversos serios. Además, no se observaron alteraciones del desempeño neuropsicológico. Por lo tanto, el THC debiera incorporarse al listado de fármacos útiles para el tratamiento de los tics. Nosotros recomendamos la utilización de esta molécula en los pacientes con ST que no respondieron al tratamiento con las drogas de referencia o presentaron efectos adversos significativos. Hasta el momento, no queda claro si la planta de cannabis, los agonistas naturales o sintéticos de los receptores cannabinoides o los agentes que interfieren con la inactivación de los endocannabinoides poseen el mejor perfil de efectos adversos en el tratamiento de los tics. Los datos disponibles sugieren que el sistema del receptor cannabinoide central endógeno CB1 podría regular la actividad motora de los ganglios de la base. Por lo tanto, se puede especular que este sistema de receptores podría estar relacionado con la fisiopatología del ST.

Palabras clave
síndrome de Tourette, tics, cannabinoides, marihuana, THC, cannabis


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Abstract
Tics are the hallmarks of a Tourette syndrome (TS). Dopamine receptor antagonists are the approved treatment, although neuroleptic treatment is often unsatisfactory due to side effects. Therefore, there is expanding interest in new therapeutic strategies. From anecdotal reports it has been suggested that Cannabis sativa L. might reduce tics. Two controlled studies in a small number of TS patients demonstrated that delta-9-tetrahydrocannabinol (THC), the most psychoactive ingredient of cannabis, is effective in the treatment of tics without causing serious adverse effects. In addition, no impairment in neuropsychological performance was observed. Therefore, THC should be added to the list of those drugs that are suitable to reduce tics. We recommend THC treatment in TS patients who did not respond to well-established drugs or develop significant side effects. So far, it is unclear, whether herbal cannabis, other natural or synthetic cannabinoid receptor agonists, or agents that interfere with the inactivation of endocannabinoids may have the best adverse effect profile in the treatment of tics. Available data suggest that the endogenous central cannabinoid CB1 receptor system might regulate motor activity in the basal ganglia. It, therefore, can be speculated that the CB1 receptor system might be involved in the pathophysiology of TS.

Key words
Tourette syndrome, tics, cannabinoids, marijuana, THC, cannabis


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Especialidades
Principal: Neurología, Salud Mental
Relacionadas: Farmacología, Medicina Familiar, Medicina Farmacéutica, Medicina Interna, Neurocirugía, Pediatría



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Kirsten R. Müller-Vahl, Department of Clinical Psychiatry, Medical School Hannover, D-30625, Carl-Neuberg-Str. 1, Hannover, Alemania
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