We are conducting studies now on the chemicals dopamine and serotonin in the
brain of
people with TS.

I attach answers to frequently asked questions.
We are including people from around the country. We reimburse the travel, room,
and
board of the participants.

For your information, I attach the general description that I have prepared for
people.

I attach answers to some of the common questions people have about the study.

There are two studies to look at chemicals in the brain. One study examines
dopamine. All
studies include one magnetic resonance imaging (MRI) scan of the head. All
studies
include two to four positron emission tomography scans of the head. The dopamine
study
involves four PET scans, two on one day and two approximately a week later. The
other
study examines serotonin. The serotonin study involves two PET scans on one day.

> The screening procedures take 6 to 12 hours. The initial assessments include
detailed
medical history, physical examination, neurological examination, psychiatric
assessment,
and psychological evaluations. In particular there will be specializes
evaluations of
movements, obsessions, and compulsions. They can be done over several days.

The face mask construction takes an hour and the MRI takes an hour. For the MRI
(
magnetic resonance imaging) a strong magnetic field will pass through your head.
It will
not hurt you. However, the machine makes a loud noise like a jackhammer. You
will use
ear plugs for the MRI to deaden the noise. One you enter the MRI machine, the
MRI lasts
about 15 minutes.

On of the procedures is your being interviewed and examined by Dr. Harvey
Singer, a
pediatric neurologist who has decades of experience in the diagnosis and
treatment of TS.
Dr. Singer will answer your questions about your condition. Dr. Singer will
inform you
about diagnostic and treatment options for you and other members of your family.
Dr.
Singer will tell you about evidence that TS may run in families. Dr. Singer will
provide your
physician with information about his recommendations for the treatment of TS.
Your
physician may continue to call Dr. Singer to ask for consultation about your
treatment.

In order to learn about the diagnosis and treatment of people with TS, I would
like to be
present when you are interviewed and examined by Dr. Singer.

Additionally we ask people to complete detailed questionnaire about TS and other
related
conditions that affect some people with TS. It may take 2 to 10 hours to
complete the
questionnaires. The person may take the forms home to complete at their
convenience.

At the start of each PET scan you will receive an injection of an experimental
radiotracer.
The radioactivity will wear out of your body after a few hours. You will not
feel the
radioactivity. The radioactivity will have no physical or psychological effects
on you.

Each PET scan lasts about 90 minutes. In addition there is a period of
adjustment of your
head on the PET table and a check of the functioning of the equipment so you
will be on
the PET table for around 2 hours for each PET scan. Usually the PET scans are
performed in
pairs. There is a short break of 10 minutes between PET scans for you to go to
the rest
room before returning for the next scan.

Generally there are two scans performed in the morning at 8:30 am and 10:45 am
or two
in the afternoon at 1 pm and at 3:15 pm. For morning scans you arrive at 6 am
and are
finished shortly after lunchtime. For afternoon scans you arrive in the
midmorning and
leave after dinner time.

When you arrive for the PET scans a line is placed in the artery of one arm to
permit the
technologists to rapidly sample blood for radioactivity during the scan. Then a
line is
placed in the vein in the other arm for the injection of the radioatracers. The
lines are
removed at the end of the day when the scans are over.

The study of serotonin involves the injection of two experimental radiotracers.
They have
no physical or psychological effects. You receive no active drugs for the
serotonin study.
Usually the two scans of the serotonin study are performed on one day.

The study of dopamine involves the injection of two different experimental
radiotracers.
The radiotracers have no physical or psychological effects. For the study of
dopamine you
will receive active drugs on both days. On the first day you will receive a
drug,
amphetamine, to increase dopamine, and on the second day you will receive an
active
drug, raclopride, to decrease dopamine. You are likely to experience temporary
psychological and physical effects of both of these substances. On the first day
of PET
scans of the dopamine study, after receiving amphetamine, you may experience a
temporary increase in blood pressure and heart rate and unusual psychological
effects,
including seeing things that are not present and hearing voices that are not
there. These
are temporary effects that go away in minutes or hours. On the second day of PET
scans of
the dopamine study after receiving raclopride, you may experience restlessness
and the
urge to move as well as muscles contraction, spasms, and cramps, like you have
never had
before. These effects are temporary and subside in minutes or hours.

The day after receiving the active drugs, you will be back to your regular self.
There are
medications available to immediately relieve the side effects of the active
drugs if they
bother you a lot.

After receiving active drugs your judgment and coordination may be impaired
temporarily
so you may not drive a car or operate dangerous machinery that day.

We recommend that you rest the day of the PET scans.

All the procedures take place at Johns Hopkins Hospital. Currently we arrange
for people
to stay at a room near the hospital or at a hotel on the Inner Harbor. We plan
to arrange
for people to stay at the General Clinical Research Center at Johns Hopkins
Hospital in the
future. People are given a stipend for meals. They are reimbursed for travel and
hotel
expenses. They are compensated for the hours of participation in the study.

We have studied people with TS of various levels of severity, from mild to
severe. We
studied some people last summer with severe TS with constant tics.

The serotonin study takes at least one day during the week if the PET and MRI
scans can
be scheduled on the same day. It is preferable and much more comfortable for all
of us, to
have the person here for 3 to 4 days for the serotonin study.

The dopamine study requires two scans and then two scans a week later. If they
can be
scheduled, the first two scans can be done on Monday and the last two scans on
Friday so
the person can come on one weekend and leave on the following weekend for the
dopamine study.

It is preferable and more comfortable to have a few additional days; however, a
full week is
the minimal time for the dopamine study.

One the day of the PET scans the scans are completed in about 7 hours if
everything is one
schedule. However, it is exhausting for the person. Therefore, the person ought
to plan to
rest overnight in the hotel after the PET scans to recover from the PET scans.

If someone wants to take part in both studies, the person may do one now and the
other a
year or more later. The person must wait at least twelve months between studies.

People who currently use recreational, street, illegal, or nonprescribed
substances are not
eligible. Then a line is placed for any of these studies of Tourette syndrome.
People must
not use any substance of abuse for at least 30 days before the study. A test for
toxicology
will be performed to check for any evidence of substances of abuse. If there is
evidence
that you have taken substances of abuse, then you will be removed from
participation in
the study, you will not be compensated for your participation, and your expenses
will not
be reimbursed.

Please let me know what other questions you may have. You may call me at 410 955
8354. Please leave a message if I am out. I am often busy interviewing and
examining
people and conducting the scans. I shall call you back in a day or. I can also
be contacted
by email at brasic@...


Generally people need to come for Baltimore for a few days for the serotonin
study and for
7 to 10 days for the dopamine study. Since the PET Center is open only Monday
through
Friday, you must be here at least on one day during the week for the serotonin
study.
However, it is less rushed and more comfortable if you are here longer.

Scans may be scheduled up to six months ahead. Please schedule your studies now.
If
your plans change, then you may cancel the scans. Please give us at least 48
hour notice if
you cancel scans.

Johns Hopkins Hospital is open on several holidays, including Columbus Day,
Lincoln's
Birthday, Washington's Birthday, President's Day, Veteran's Day, and Election
Day, so you
may want to include these holidays in your visit.

Since the scans are typically scheduled months in advance, your preferences for
scan dates
can be honored best if you schedule early. When you determine convenient times
for you
to come to Baltimore for the study, you can contact me to find out if scanning
times are
available then.

I am attaching an electronic copy of an article about an earlier version of the
dopamine
study conducted in the 1990s. I also attach an article about neuroimaging
procedures for
TS and other conditions. Please share these published documents with all.

I have additional articles on TS, brain imaging, and related topics in paper
only. If you
provide me your mailing address, then I'll be glad to mail them to you.

In order to determine the appropriate study for you, please send me the names
and doses
of all medications that you take currently.


We are grateful for your interest in our study.



Thanks.

James Brasic