Randomized controlled trials on the use of cannabis-based medicines in movement disorders: a systematic review.

Oikonomou et al. ·Journal of neural transmission (Vienna, Austria Impact 3.0

Mixed GRADE High 15 citations

Samplek = 2 Studien

Durationunclear

ControlPlacebo

EndpointMotor symptoms / movement…

Blindingunklar

DesignSystematic Review

Key finding

Cannabinoids show mixed results in RCTs on movement disorders: improvements in quality of life, anxiety and tics in some studies, but no consistent improvements in motor symptoms in Parkinson's or dystonia.

Summary

Systematic review of RCTs on cannabinoids in movement disorders; k=2 RCTs on Tourette syndrome showed improvement in tics. Abstract does not report numerical effect sizes for the Tourette subgroup; general conclusion: small, inhomogeneous RCTs do not allow reliable statements.

PopulationAdults with movement disorders (Parkinson's, Tourette syndrome, Huntington's disease, dystonia), pooled from 15 RCTs

InterventionCannabis-based medicines (various cannabinoids incl. nabilone, cannabidiol, various formulations)

ControlPlacebo (in the included RCTs)

OutcomeHeterogeneous results: no motor improvement in Parkinson's; reduction of levodopa-induced dyskinesias in only one RCT (nabilone); improvement in tics in both Tourette RCTs; mixed findings in Huntington's; no reduction in dystonia

Confidence in the evidence

High

The highest of four GRADE levels, the effect estimate is very reliable.

Quality profile

Sample size ★★★★★

Blinding —

Effect size Mixed

Citations / year ★★★★★

Authors

Oikonomou P, Jost WH

DOI 10.1007/s00702-022-02529-x↗

Design: Systematic Review

Abstract

Anecdotal references, preclinical, and non-randomized studies support the therapeutic potential of cannabinoids for movement disorders (MD). To create an evidenced-based point of view for patients and physicians, we performed a systematic review of randomized controlled trials (RCT) on the use of cannabinoids in MD. The seven RCTs found on PD used different cannabis formulations. No improvement of motor symptoms was shown in any of the two RCTs with this as primary outcome (PO), but in the nabilone group, an improvement in quality of life was documented. Of the three RCTs having levodopa-induced dyskinesia as PO, only one using nabilone showed a reduction. Anxiety and anxiety-induced tremor could be reduced in the cannabidiol group as well as anxiety and sleeping problems in the nabilone group in another RCT. In two RCTs with Tourette syndrome, an improvement in tics was revealed. From three RCTs on Huntington's disease only one found symptoms relief using nabilone. No reduction of dystonia could be shown in the two included RCTs. The limited number of available but small and inhomogeneous RCTs precludes reliable conclusions. Therefore, more and smartly designed RCTs are urgently needed.

The impediment to action advances action. — Marcus Aurelius