A role for cannabinoids in the treatment of myotonia Report of compassionate use in a small cohort of patients.
The symptomatic treatment of myotonia and myalgia in patients with dystrophic and non-dystrophic myotonias is often not satisfactory. Some patients anecdotally report symptoms relief through consumption of cannabis. A combination of cannabidiol and tetrahydrocannabinol (CBDTHC) was prescribed as compassionate use to six patients (four patients with myotonic dystrophy types 1 and 2, and 2 patients with CLCN1-myotonia) with therapy-resistant myotonia and myalgia. CBDTHC oil was administered on a low dose in the first 2 weeks and adjusted to a higher dose in the following 2 weeks. Myotonia behaviour scale (MBS), hand-opening time, visual analogue scales (VAS) for myalgia and myotonia, and fatigue and daytime sleepiness severity scale (FSS, ESS) were performed weekly to monitor treatment response. All patients reported an improvement of myotonia especially in weeks 3 and 4 of treatment MBS improved of at least 2 points in all patients, the hand-opening time variously improved in 5 out of 6 patients. Chronic myalgia was reported by both DM2 patients at baseline, one of them experienced a significant improvement of myalgia under treatment. Some gastrointestinal complaints, as abdominal pain and diarrhoea, improved in 3 patients however, 4 out of 6 patients reported new-onset constipation. No other relevant side effect was noticed. These first empirical results suggest a potentially beneficial role of CBDTHC in alleviating myotonia and should encourage further research in this field including a randomized-controlled trial on larger cohorts.