Tourette Syndrome Association Celebrates the Senate Passage of
Genetic Nondiscrimination Legislation
Long-Awaited Legislation Will Protect Against Healthcare and
Employment Discrimination


BAYSIDE, NY -- (MARKET WIRE) -- 10/14/2003 -- The national Tourette
Syndrome Association (TSA), a membership driven, non-profit
organization dedicated to serving all people with Tourette Syndrome
(TS), hails the vote in the United States Senate approving
comprehensive legislation to ban genetic discrimination in health
insurance and employment.

"For almost a decade, TSA has been vigorously advocating for this
legislation," said Judit Ungar, TSA President. "Our members, and all
those with inherited conditions, will benefit enormously in terms of
discrimination in both healthcare coverage and privacy issues."

S. 1053, the Genetic Information Nondiscrimination Act, would
prevent health insurers and employers from using an individual's
genetic predisposition to a disease as a basis for denying them
health coverage or a job. Health insurers would be prohibited from
using predictive genetic information to deny, change, refuse or
renew, or change the terms, premiums or conditions of coverage.
Employers would be barred from using this genetic information in
making employment-related decisions, such as those related to
hiring, firing, promotions, or other job-related issues.

With Senate action completed, the focus now shifts to the House of
Representatives. While two House committee held hearings on genetic
discrimination in 2001, no action has occurred since that time.

"We are optimistic that the House will act swiftly now that the
Senate has realized the importance and necessity of this
legislation," said Ungar.

In the House, TSA has endorsed H.R. 1910, Genetic Information
Nondiscrimination in Health Insurance and Employment Act. Sponsored
by Rep. Louise Slaughter (D-NY), this legislation has been endorsed
by over 300 organizations. It also has strong bipartisan backing,
with almost 50 Republican signing on and key GOP leaders, such as
Committee on House Administration Chairman Bob Ney, signaling their
support.

"Representative Slaughter and her staff are to be keenly appreciated
by the public for their crucial role in championing this
legislation," Ungar said.

"Tourette Syndrome is a genetically based disorder and our members
are concerned about being denied insurance or employment, without
any reference to their actual condition, their ability to perform in
a job, or the cost of their medical care, simply because there may
be a history of TS in their family. Without protections on the
disclosure and use of genetic information people will be reluctant
to participate in critical research, undertake certain types of
therapies, or give a full family medical history to treating
physicians."

The Tourette Syndrome Association is joining dozens of others in
calling upon the House of Representatives leadership to schedule a
vote on S. 1053 as quickly as possible. Passage of this initiative
is crucial to ensuring the future of genetic research and the
ability of all Americans to take advantage of genetic tests without
fearing the information they obtain will be used against them.

Marked by involuntary twitching and vocal tics, TS is an inherited,
neurobiological disorder frequently misunderstood and misdiagnosed,
affecting more than 200,000 Americans. TSA is a national voluntary
organization that directs a network of 50 chapters and more than 300
support groups across the country.

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Tracy Colletti-Flynn
718-224-2999, ext. 236

Tourette Updates

New drug, tested by local doctor, offers hope for Tourette's
patients
By ELIZABETH SIMPSON, The Virginian-Pilot
© October 6, 2003

At first, the 7-year-old's problems in school seemed minor.
A few fights with his classmates. Trouble sitting still. Falling
behind in classwork.
  But there also were the odd mannerisms. Touching the ground with
his hand every so often. Knocking his knees together. Excessively
blinking his eyes.
Classmates were starting to tease him. ``I annoyed them,'' said the
boy, now 12, who lives in Suffolk but asked that his name not be
used.
Over time, the mannerisms waxed and waned, but the boy's problems in
school and social circles worsened.

At age 10 came a diagnosis that helped identify his problem:
attention deficit-hyperactivity disorder. And then a year later came
another diagnosis that completed the picture: Your son also has
Tourette's syndrome, a neurologist told his parents. That disorder
is characterized by involuntary movements called tics.
Alone, either Tourette's or attention deficit disorder can be a
challenge. Together, which is the case for nearly half of the
children with Tourette's, they are misery makers. While there are
stimulants to treat those with attention disorders, doctors say they
sometimes exacerbate the tics that can cause children with
Tourette's to feel like outcasts.
But a nonstimulant drug called atomoxetine, used to treat attention
disorders, has improved the outlook for the boy and others.
Last year, the boy became one of 148 children to participate in a
clinical trial of one version of the medication developed by Eli
Lilly & Co.
Dr. Donald Lewis, a pediatric neurologist at Children's Hospital of
The King's Daughters in Norfolk, presented preliminary results of
the trial at a national conference last week in Miami. The study
also is being published in the Annals of Neurology.
Lewis, who helped coordinate the trial, said the drug not only
didn't worsen the patients' tics, but in many cases, made them
better.
That was the case for the Suffolk boy.
``Before, I was all hyper and jumpy,'' he said. ``I was always
talking and jumping and running around. Now I can concentrate more.
I feel calmer.''
He credits the medication for enabling him to move from special-
education classes -- where he spent the last two years -- into a
regular seventh-grade class.
Sue Levi-Pearl, vice president of medical and scientific programs
for the National Tourette Syndrome Association, said that early
results of the drug's studies look encouraging, but she wants to see
more study. She said a major difficulty of treating children with
Tourette's who need medication is finding one that works.
``There is a host of different drugs that seem to work for only some
of the people some of the time,'' Levi-Pearl said in an e-mail
response.
Not all children with Tourette's or attention disorders need
medication, Lewis said, but in some cases, medication can help a
child cope better with the symptoms.
Parents of local children with Tourette's hope the study will not
only help those children already diagnosed with the syndrome, but
also will raise awareness for parents and doctors of children who
have not been diagnosed.
Symptoms of Tourette's syndrome -- which an estimated 100,000 people
in the country have -- usually appear before age 18. Men and boys
are more likely to have the syndrome than women and girls. The tics
can change from one movement to another and also vary in severity
over time, so they may not be recognized as signs of Tourette's for
years.
About a third of the children who have tics outgrow them, another
third continue to have mild variants and another third continue to
have them at the same level into adulthood.
Many children spend years being made fun of in class and struggling
with poor grades because their tics distract both them and their
classmates. Their behavioral problems -- like angry outbursts --
often land them in counselors' offices. Teachers tend to view them
as troublemakers; students think of them as too weird to befriend.
A familiar story among Lewis' patients is how long it took them to
get a diagnosis of Tourette's.
The mother of another boy with Tourette's said her son, who is now
11, started exhibiting unusual behavior when he was about 8. He
sniffed and cleared his throat a lot even when he didn't have a
cold.
The boy -- who lives in Chesapeake and also didn't want his name
used -- was referred to an allergist, who could find no allergies.
Then, he was sent to an ear, nose and throat doctor, who gave him
the all-clear as well.
At the same time, the boy was having behavioral problems. One minute
he would be calm and happy, and the next moment, a minor incident
would cause a burst of anger.
Finally, a pediatrician friend suggested the boy's mother take him
to see a neurologist.
She went to see Lewis, who quickly noticed the boy had tics. The boy
now has been diagnosed with Tourette's and an attention disorder.
He is not one of the children who were part of the atomoxetine
study, but he does take the medication.
The Chesapeake mother said a combination of medication and coping
techniques have helped her son during the past year. For a while, he
carried balls in his pockets that he squeezed when he felt a burst
of energy coming on.
``There's so much that can be done once there's a diagnosis,'' the
mother of the Chesapeake boy said. ``But if they're not diagnosed,
they're labeled as problem children or bad kids.''
Reach Elizabeth Simpson at 446-2635 or
elizabeth.simpson@...
Linked from:

http://home.hamptonroads.com/stories/story.cfm?story=60638&ran=100813

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Personal Interests Story For Girls and Daughters


Chuck Best passes his gymnastic skills on to 3 generations

Sun, Oct 5, 2003
By Leanne Phillips
Truth Regional Reporter


ELKHART -- Walking into his high school homeroom one day in 1945,
something happened to Chuck Best he'll never forget. It was unusual
for a guy at the time, but he was selected to be a cheerleader.
Best was on the gymnastics team in high school in Cambridge, Ohio,
and was a national champion in tumbling, but never dreamed of
cheerleading. Before he knew it, he, along with another male and two
females from the gymnastics team, made up the school's first co-ed
cheerleading squad.

"We started a practice together and didn't know a thing about
cheers," he said, smiling. "We did the normal sis-boom-rah."
Best said the boys did the foot pitches to hold the girls up, and
the foursome did back handsprings for every point the team scored.
He said back then it was easy to get the crowd going since mostly
students came to the games and not many adults.

"There was a lot of noise being made at that time," he said.
Best moved to Elkhart in 1949 at age 21. It wasn't long before he
started the first girl's gymnastics team in town at the old YMCA on
Franklin Street, where he began his career as a volunteer tumbling
coach. He was later asked to be head physical education director,
and coached a number of champions, both girls and boys.
Best, along with friend John Hamilton, started the first
cheerleading classes at the Y in the 1960s.

"There has been tremendous growth in cheerleading since back then,"
Best said. And he would know, considering he passed along the
cheerleading gene to his daughter and granddaughters.
The Y was a second home to the Best children, Susie, Gary, Larry and
Chuck.

"I hung out at the Y all the time because of dad," Susie said. "He
always coached us. He was just a major coach all our life."
Susie quickly became interested in cheerleading, while her brothers
took up the trampoline. The family had a trampoline act they
performed at fairgrounds and churches.

Susie cheered throughout junior high and four years at Elkhart
Central High School, where she graduated in 1981. "I was always
interested in it," she said, adding she planned to cheer in college,
but got married instead.

Best and his wife, Bonnie, have seven grandchildren, but Susie's two
daughters, Jena and Kaley, were the first to express any interest in
carrying on the family's cheerleading tradition.
Just like her father coached her, Susie coaches her daughters at
home and at Elkhart Elite, where she is an all-star cheerleading
coach.

Jena, 16, despite a diagnosis at age 5 of Tourette's syndrome,
started gymnastics when she was 9 at Elkhart Elite. "It (Tourette's)
started getting pretty bad around fifth grade and it was affecting
her self-esteem," her mom said.

One of the side effects of Tourette's is incessant movements such as
jerking of the head and kicking. But that hasn't stopped Jena, who
began taking medication around the same time she started gymnastics.
"Being in a sport helped her concentrate on other things as opposed
to that problem," Susie said. "It completely helped her self-esteem."

Jena said, "When I was at practice at Elkhart Elite, I always
watched the cheerleaders." She got on the all-star cheerleading team
when she turned 11 and went to nationals her first year, where the
team placed third.

Best said, "I think through her gymnastics and her acceptance of her
condition, and also through her cheerleading, it has been a great
outlet for her. Several times she has been asked to speak to groups
about her affliction, which has helped her self-confidence. I am
really proud of her from that standpoint. Her involvement in
cheerleading and other activities shows the courage to overcome that
kind of affliction." Jena said, "My grandpa was the one who taught
me my first back handspring." As the story goes, grandpa Chuck got a
little teary when Jena did that first back handspring.

Jena has given a number of speeches about her condition at Concord
High School, where today she is on the varsity cheerleading squad.
Not long ago, a parent from the school gymnastics team had a child
diagnosed with Tourette's syndrome and Jena encouraged the family
not to panic, telling them their child could achieve whatever they
wanted.

In addition to cheerleading, Jena has taken an interest in dance and
is involved in choreographing at Elkhart Elite and at Concord.
She has been an encouragement and inspiration to many people,
including her little sister, Kaley.

The 10-year-old started out at the age of 2 in gymnastics and did
her first back handspring when she was 3 years old.
"Within five minutes, she learned a back handspring on the
trampoline," her mom said.

Kaley progressively moved into higher levels of gymnastics, and
transitioned to cheerleading at Elkhart Elite at age 6. She tied for
second place in individual cheering and dance at Jam Fest National
in 2001. Her team has gone to the national program every year for
five straight years. Kaley hopes to continue her cheerleading career
throughout junior high, high school and college.

The cheerleading teams at Elkhart Elite are co-ed, with the
organization the first in this area to go co-ed three years ago.
"Having the guys there has been a lot of fun for the girls," Susie
said. "We realized a huge need for it if these girls are interested
in going on to cheer at the college level."

The idea of co-ed squads was not foreign to someone whose father was
a cheerleader.

Linked From:
http://www.elkharttruth.com/news/279689993029612.bsp

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http://www.tourettes-disorder.com we are always adding and updating
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Johns Hopkins Tourette Syndrome Research  PET Scan Study

People with TS age 18-70 years old are needed to participate in Neuro
Imaging studies sponsored by the TSA.  It is hoped that this
research will
teach us more about the role of two key brain chemicals suspected of
playing
a role in causing this condition.  Participants will be asked to
take part
in 1) Comprehensive physical, psychological and neurological
examinations,
2) a PET Scan (Positive Emission Tomography), and 3) a MRI Scan
(Magnetic
Resonance Imaging) of the brain.

Subjects will have their expenses paid and receive a modest
compensation for
their important contributions to this scientific investigation.

Copies of the clinical assessments will be provided to the
participants and
their physicians.

TO LEARN MORE AND HAVE YOUR QUESTIONS ANSWERED
CONTACT: JAMES BRASIC, MD, MPH  410-955-8354
EMAIL: brasic@...

FOR INFORMATION ON ADDITIONAL STUDIES
CONTACT DANA BRIDGES,RN, MS, CFNP 410-614-4869
EMAIL: dfreema7@...

Dana D. Bridges, RN, MS, CFNP
Tourette's Syndrome Clinical Research Coordinator
Certified Family Nurse Practitioner
Phone: 410-614-4869
Fax: 410-614-2297
Email: dfreema7@...

OCD may be associated with a chemical imbalance in the brain and is
thought by many experts to be inherited.

"Everyone who has OCD does not have a chemical imbalance, and
parents who have OCD do not necessarily pass it on to their
children," said CDR Chris Kowalsky, NNMC Adult Behavioral Health
department head. Nothing is black and white in the mental health
field."

OCD can start at any time from preschool age to adulthood. OCF
statistics say that nearly one million children and teens in the
United States suffer from OCD. OCD is more common than many other
childhood illnesses. Approximately one in every two hundred children
may have the disorder.

Researchers have found that children with OCD and or tic disorders
or Tourette's syndrome, experience worsening symptoms following
bouts of "strep throat" infections and scarlet fever. Step
infections have also been proven to be the primary catalyst in many
children with OCD and tic disorders or Tourette syndrome. This
phenomenon is known as PANDAS, an abbreviation for Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal
Infections.

Following a strep throat infection, children will have a
dramatic, "overnight" onset of symptoms, including obsessions,
compulsions, and motor or vocal tics. In addition to these symptoms,
children may also become moody, irritable or show concerns about
separating from parents or loved ones.

Experts believe that PANDAS effects the Basal Ganglia portion of the
brain, which controls movement and behavior, and produces OCD and/or
tics.

General OCD symptoms in children and adults tend to wax and wane
over time.

Most people with OCD find their thoughts and actions to be excessive
and senseless, but are unable to control them. When someone with OCD
does not recognize their beliefs and actions are unreasonable, this
is termed "OCD with poor insight."

"Generally, it can take a while for OCD patients to come to us,"
said Kowalsky. "They have slipped into a learned helplessness, and
are so protective of their own anxiety that they need a good friend
or family member to step in and encourage them to get help."

The first step in treating OCD is educating the patient and family
about OCD and its treatment. Doctors use two effective treatments
for OCD, usually in combination: cognitive-behavioral psychotherapy
(CBT) and medication with a serotonin selective reuptake inhibitor
(SSRI), which increases the concentration of serotonin, a chemical
messenger in the brain.

"In my experience, response exposure prevention or REP, a form of
cognitive or behaviorally-oriented therapy, works the best," said
Ulissi. "I let my patients know that some of the therapy will be
uncomfortable because it makes them respond to their fears without
escaping them. The medication is helpful because it helps reduce
some anxiety and allows the person to relax. In OCD therapy, when
doctors use REP and medication together, the success rate is 80
percent or higher."

Whether doctors are treating child or adult OCD patients, it is
challenging on both sides.

"I remain humble when treating children with OCD," said
Ulissi. "Children are constantly developing and changing. They are
literally 'moving targets.' They are not the best informants. I
often rely on parents and teachers to report their patterns of
behavior.

Teenage OCD patients are also challenging because they are already
at a tumultuous point in their lives. I am careful when I
distinguish between normal teenage emotions and OCD tendencies."

Old habits die hard. According to Kowalsky, that is where the
challenge lies with treating adult OCD patients.

"Studies have also found that it takes an average of 10 to 12 years
from the time OCD begins for people to seek treatment," said
Kowalsky. "When the patient finally comes to the us, they are going
to have deeply entrenched thinking patterns and habits that are
going to be extremely difficult to modify."

Treatment for OCD is not a quick fix. According to the OCF, people
with OCD see three to four doctors and spend over nine years seeking
treatment before they receive a correct diagnosis. People with OCD
may be secretive about their symptoms and doctors are sometimes
unfamiliar with the different sides of the disorder.

Part of a patient's recovery is the realization that there is no
miracle cure for his or her condition.

"The obsessions can come back and sometimes the compulsions to carry
them out will come back as well, usually within six to eight months
after a patient has recovered," said Ulissi. "The relapse rate for
most recovered OCD cases is about 80 percent.

"A patient came back and to me said, 'the speaker is still on, but
the volume is much lower now,' meaning he still sometimes has
obsessions, but they no longer consume his life. And then that
patient honestly admitted that he still wanted to adjust the fringe
on the rug, but no longer feels compelled to do it. These are signs
that the patient has dramatically improved."

There are disorders that closely resemble OCD. Obsessive Compulsive
Personality Disorder (OCPD), despite its similar name, does not
involve obsessions and compulsions. Rather, OCPD is a personality
pattern that involves a preoccupation with rules, schedules, lists,
perfectionism, excessive devotion to work, rigidity and
inflexibility.

However, when people have both OCPD and OCD, the successful
treatment of the OCD often causes a favorable change in the
patient's personality.

"OCPD is not entirely bad," explained Kowalsky. "The condition can
be ego-syntonic, meaning it fits well into the person's lifestyle.
If the person is a pilot, or works with highly sensitive
information, it would behoove them to be a bit perfectionistic. When
the condition disturbs the person's lifestyle, it's known as ego-
dystonic. People with OCPD are hard to live with and hard to work
for, but through therapy they can filter their energy into something
productive and it can become positive."

Individuals with OCD might experience bouts of depression and stress
in dealing with their disorder. They develop substance-abuse
problems, sometimes as a result of attempts to self-medicate.

"People will go with what they know first," said Kowalsky. "They
might pick up a bottle or use drugs and think that might temporarily
make their problems go away.

"The good news is that in this information age there are many great
resources available on OCD. Over the years therapy has improved and
changed many lives. As medicine continues to evolve, the road to
recovery for OCD patients will hopefully shorten as well."

Individuals with questions pertaining to OCD should contact their
primary care provider or a mental health professional.

Chronic Tics A Potential Red Flag
Nervous Habit May Be Sign Of Bigger Problem

Reported By the thebakersfieldchannel.com
http://www.thebakersfieldchannel.com/health/2508176/detail.html

Does your child blink a lot? It may not be a vision problem.

If your child has what looks like nothing more than a nervous habit,
you may want to take it more seriously. A new study shows that
chronic tics are more common than once thought and they may be a red
flag for a bigger problem.

Frankie Baliva loves playing video games.


His brother, Santino, would much rather play street hockey.

But the two have one thing in common, Tourette's syndrome, a
disorder noted for its tics.

Both boys were diagnosed around age 6.

"In the beginning I would go into a store and they would be swearing
at me and I'd have 50 people looking at me like 'why am I not doing
anything,'" recalled their father, Chris Baliva.

Dr. Donna Palumbo explained that "the swearing tic is called
coprolalia, so it really is a true tic."

The swearing tic is rare, but according to new research by Palumbo
at the University of Rochester, NY, tics in general are grossly
underdiagnosed.

"In our epidemiologic study we found rates of almost 19 percent of
kids in a school-age population who had tics in a regular classroom
setting," Palumbo said.

That's important for parents and teachers to know. Fifty percent of
the time, kids with chronic tics also have attention deficit
disorder (ADHD) or obsessive-compulsive disorder (OCD).

"All three of those things can significantly impact school
functioning," Palumbo said.

Life hasn't been easy for the Balivas. The boys take medications to
suppress their tics and treat the associating ADHD and OCD.

"I have found with my kids that it just wasn't medication, it was
behavioral therapy also to cope," Baliva said. "Because there is no
magic pill. With the doctors and the medications that they've had, I
think that they're going to do ok."

Eye blinking and throat clearing are two of the more common tics.
Others include nose twitching, head jerks, sniffing, humming, and
shoulder shrugs. The swearing tic that involves the shouting of
obscenities accounts for 5 percent of Tourette tics.

Reported By the thebakersfieldchannel.com
http://www.thebakersfieldchannel.com/health/2508176/detail.html


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Comments or Questions:
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http://www.tourettes-disorder.com we are always adding and updating
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Sertraline May Be Helpful for Major Depressive Disorder in Children
CME

News Author: Laurie Barclay, MD
CME Author: Hien T. Nghiem, MD



Aug. 26, 2003 — Sertraline may be helpful in treating children with
major depressive disorder (MDD), according to the results of two
randomized, placebo-controlled trials published in the Aug. 27 issue
of The Journal of the American Medical Association. The editorialist
reviews the recent history of use of selective serotonin reuptake
inhibitors (SSRIs) for MDD in children and reminds clinicians not to
initiate treatment with paroxetine. He suggests that fluoxetine and
sertraline may be preferable.

"The efficacy, safety, and tolerability of SSRIs in the treatment of
adults with MDD are well established," write Karen D. Wagner, MD,
PhD, and colleagues from the Sertraline Pediatric Depression Study
Group. "Comparatively few data are available on the effects of SSRIs
in depressed children and adolescents."

Between December 1999 and May 2001, 376 children and adolescents
aged 6 to 17 years were enrolled in two double-blind trials
conducted at 53 centers in North America, India, Costa Rica, and
Mexico. All subjects had at least moderate severity MDD based on DSM-
IV criteria. For 10 weeks, subjects received a flexible dosage (50-
200 mg/day) of sertraline or matching placebo.

At week 10, overall mean improvement in the Children's Depression
Rating Scale-Revised (CDRS-R) was -22.84 in the sertraline group
and -20.19 in the placebo group (P = .007). Treatment response,
defined as a 40% decrease in the adjusted CDRS-R total score at
study end, occurred in 69% of the sertraline group and in 59% of the
placebo group (P = .05).

Although sertraline treatment was generally well tolerated, 17
patients receiving sertraline (9%) and five patients receiving
placebo (3%) withdrew from the study because of adverse events,
which included diarrhea, vomiting, anorexia, and agitation.

Study limitations include use of subjective rating scales, short
duration of treatment, unclear applicability of the CDRS-R to
younger patients, and treatment of most patients with doses lower
than the maximum allowed.

"Sertraline is an effective and well-tolerated short-term treatment
for children and adolescents with MDD," the authors write. "Whether
lower initial dosages in children would improve tolerability or long-
term sertraline treatment in children and adolescents would result
in maintenance of effect and an improvement of quality of life
deserves study."

Pfizer funded and supervised this study and has financial
arrangements with several of its investigators. Several authors
report additional financial arrangements with various other
pharmaceutical companies.

In an accompanying editorial, Christopher K. Varley, MD, from the
University of Washington in Seattle, agrees with the warning from
regulatory agencies not to use paroxetine in children and
adolescents.

"Prudent practice in the treatment of depressive illnesses in
children and adolescents must include careful attention to the
decision to treat a child or adolescent with medication for MDD;
clinical expertise with mental health assessment, consideration of
varied treatment modes including cognitive behavioral or
interpersonal psychotherapy, partnership with patients and their
parents, and careful attention to symptom course, particularly
emotional lability and the assessment of suicidal ideation in youth
who are treated with antidepressant medications," he writes.

JAMA. 2003;290:1033-1041, 1091-1093

Learning Objectives
Upon completion of this activity, participants will be able to:
Review the prevalence and significance of depression in children and
adolescents.
Recognize the role of SSRIs in general and the efficacy of
sertraline in particular in treating major depressive disorder in
children and adolescents.
Clinical Context
Major depressive disorder (MDD) affects 3% to 8% of children and
adolescents, according to the authors of this study. Depression may
facilitate feelings of worthlessness, low self-esteem, poor
concentration, and thoughts of suicide. Suicide is the leading cause
of death in adolescents; hence, it poses as a major healthcare
concern. Depression is one of the major risk factors associated with
suicide. Therefore, appropriate therapies, especially
psychopharmacologic treatments, are needed to combat MDD in children
and adolescents.

Although many psychotropic medications have been proven to be safe
and effective in the treatment of MDD in adults, the studies have
not yielded the same results in children and adolescents. In recent
studies, SSRIs, particularly fluoxetine and sertraline, have been
shown to be effective and safe in treating depression in children
and adolescents. Fluoxetine has already received U.S. Food and Drug
Administration (FDA) approval for the treatment of MDD in children
and adolescents. However, paroxetine, another SSRI, is not
recommended for children and adolescents due to the possibility of
increased risk of suicidal thinking and suicide attempts. Not only
is the need for appropriate medications in the treatment of MDD in
children and adolescents essential, but also careful monitoring must
be provided to ensure efficacy of the medication.

In this report, Wagner and colleagues evaluated two identically
designed, concurrently conducted 10-week international, multicenter,
randomized, double-blind, placebo-controlled trials of sertraline
vs. placebo in children and adolescents with MDD.

Study Highlights
Two trials were identically designed and concurrently conducted at
53 hospitals, general practices, and academic centers in the U.S.,
India, Canada, Costa Rica, and Mexico. Participants were aged 6 to
17 years and had met diagnostic criteria for MDD, as defined in the
Diagnostic and Statistical Manual of Mental Disorders, Fourth
Edition (DSM-IV) and by the Kiddie Schedule for Affective Disorders
and Schizophrenia for School-Age Children-Present and Lifetime
Version (K-SADS-PL). Also, for eligibility, their current episode of
major depression had to be at least 6 weeks' duration.
The trials began with a 2-week pretreatment screening period. In
addition to meeting the criteria of MDD, patients were required to
have a Children's Depression Rating Scale-Revised (CDRS-R) score of
at least 45 and a Clinical Global Impression of Severity of Illness
(CGI-S) rating of at least 4; each indicating at least moderate
severity of depression.

At the third screening visit (baseline), 376 eligible patients were
randomly assigned to double-blind treatment with sertraline (n =
189) or placebo (n = 187) for 10 weeks. Treatment was initiated at a
dosage of 25 mg/day and titrated upward to a maximum of 200 mg/day
until a satisfactory clinical response was achieved.
Primary efficacy rating scale was the CDRS-R, a 17-item, clinician-
rated instrument that measures the severity of a patient's
depression symptoms. Secondary efficacy measures included the
proportion of CDRS-R responders, defined as patients who had at
least a 40% decrease in the adjusted CDRS-R total score; scores on
the CGI-S and the Clinical Global Impression of Improvement (CGI-I).
All three scales were measured at the end of weeks 1, 2, 3, 4, 6, 8,
and 10.

Data from both studies were pooled in a combined analysis.
Sertraline-treated patients exhibited significantly greater
improvement over the course of the study than those receiving
placebo on the CDRS-R (mean change in total scores of -30.24 vs. -
25.83, respectively; P = .001), as well as on the CGI-S and CGI-I.
Significant differences in favor of sertraline were evident as early
as week 1 on the CGI-I and week 3 on the CDRS-R and the CGI-S (P
< .05).

Statistically significant improvement was noted with the sertraline-
treated patients in 5 of the 17 items of the CDRS-R: irritability,
low self-esteem, excessive weeping, listless speech, and
hypoactivity.

No statistically significant difference was noted between treatment
groups and placebo for suicidal ideation (P = .78).
There was a 10% difference in response rates observed between
sertraline and placebo groups in the CDRS-R (69% vs. 59%,
respectively), as well as in the CGI-I scores. This result indicated
that the number needed to treat to expect a difference in response
between sertraline and placebo would be 10.
Sertraline was generally well tolerated. 17 patients receiving
sertraline (9%) and five patients receiving placebo (3%)
discontinued the study due to adverse events, such as diarrhea,
vomiting, anorexia, or agitation. However, major adverse events,
including suicide attempts, were similar between the sertraline and
placebo groups.

The results from these studies support sertraline as an effective
short-term treatment for children and adolescents with MDD.
Limitations to this study include the subjectivity of the rating
scales and the relatively short duration of treatment exposure.

Pearls for Practice

MDD is a major healthcare concern in children and adolescents.
Particularly in adolescents, MDD is one of the major risk factors
for suicide.
Sertraline is effective and safe for the treatment of MDD in
children and adolescents.

----------------------------------------------------------------


Tim Piccirillo doesn't have to search very far to find an example of
the impact teachers can have on a young person's life.
All he has to do is look in the mirror.
The 43-year-old motivational speaker from Ridgway addressed the
employees of the New Castle Area School District during an in-
service day yesterday at Cascade Park.
Piccirillo was born with Tourette's syndrome, which manifests itself
through jerking of the limbs, involuntarily facial tics and self-
abusive behavior. Piccirillo's symptoms are controlled by medication.
His illness didn't stop him from reaching his goal of being a
professional magician. That is due in no small part, he said, to
three staff members at Ridgway High School.
One was his ninth-grade typing teacher, John Lovell, who showed him
a magic trick one day in class when he pulled a half-dollar from a
typewriter. After that, Piccirillo made almost daily trips to
Lovell's house over the next two years to learn magic.
"He gave this kid something to reach out and grab onto when I had
nothing else," Piccirillo said.
He gave his first professional magic show when he was 15 and was
paid $10.
"I was overpaid," he said. "I was terrible, but I kept going."
Piccirillo's medical condition forced him to receive homeschooling
or one-on-one instruction during his junior and senior years. A
guidance counselor, Fran Grandinetti, suggested he join the touring
theater class.
Class members built sets and rehearsed plays, which they performed
at various elementary schools in the area. It was the only in-school
class Piccirillo could take.
The teacher, Bill Connelly, had him perform an opening magic act
before the curtain went up on the production.
To Piccirillo, Lovell, who remains his close friend; Grandinetti,
who is superintendent of schools and is about to retire; and
Connelly, who is now the high school principal, are what teachers
are all about.
"These guys believed in me," he said. "These guys made a difference
in my life.
"I haven't overcome anything. I've learned to deal one day at a time
because of people like you. You have the power to impact the world.
You are the most important people in the world as far as I'm
concerned."
Piccirillo went on to graduate from Clarion University in 1984 with
a bachelor of science degree in habilitative science. He worked his
way up the ladder in the mental health/mental retardation field
before becoming executive director of a center for independent
living in 1989.
Still, his goal since he was 15 years old was to become a
professional magician. In 1992, he decided to pursue that dream, and
he has gone on to work with various national stars and celebrities
in his career.
Piccirillo became a motivational speaker in 1995. He sprinkles magic
tricks throughout his presentation.
To succeed, he said, fear cannot be allowed to take control.
"Fear holds us back. As long as you continue to grow, as long as you
stretch past your comfort zone, you're going to have fear."
He advised the crowd to develop its own barometer to measure success.
"Success is a personal thing. Henry Ford had a great quote: 'Whether
you think you can or whether you think you can't, you're right.'
It's perception.
"If you have a kid like me, what are you going to do? Focus on the
kid's ability, not his disabilities. Focus on positives, not
liabilities. Focus on what you can do, not what you can't do."

(Rick Elia can be contacted at relia@n... or by calling
(724) 654-6651, extension 618.)
©New Castle News 2003

----------------------------------------------------------------

Dutch Approve Cannabis as Prescription Drug

Mon September 1, 2003 07:17 AM ET
By Paul Gallagher

AMSTERDAM (Reuters) - The Netherlands Monday became the world's
first country to make cannabis available as a prescription drug in
pharmacies to treat cancer, HIV and multiple sclerosis patients, the
Health Ministry said.
The Netherlands is making the drug widely available to chronically
ill patients amid pressure on countries like Britain, Canada,
Australia and the United States to relax restrictions on its supply
as a medicine.
Dutch doctors will be allowed to prescribe it to treat chronic pain,
nausea and loss of appetite in cancer and HIV patients, to alleviate
MS sufferers' spasm pains and reduce physical or verbal tics in
people suffering Tourette's syndrome.
"From September 1, 2003 pharmacies can provide medicinal cannabis to
patients with a prescription from a doctor. Cannabis has a
beneficial effect for many patients," the Health Ministry said.
The Netherlands, where prostitution and the sale of cannabis in
coffee shops are regulated by the government, has a history of
pioneering social reforms. It was also the first country to legalize
euthanasia.
Two companies in the Netherlands have been given licenses to grow
special strains of cannabis in laboratory-style conditions to sell
to the Health Ministry, which in turn packages and labels the drug
in small tubs to supply to pharmacies.
As well as pharmacies, 80 hospitals and 400 doctors will be allowed
to dispense five-gram doses of SIMM18 medical marijuana for 44 euros
($48) a tub and more potent Bedrocan at 50 euros.
The Health Ministry recommends patients dilute the cannabis -- which
will be in the form of dried marijuana flowers from the hemp plant
rather than its hashish resin -- in tea or turn it into a spray.
HIV SUFFERERS WELCOME MOVE
A British drug firm pioneering cannabis spray medicine to give pain
relief for multiple sclerosis patients is hoping to launch the
product in Britain later this year.
The association of HIV patients in the Netherlands welcomed the
government's move to make cannabis available in high-street
pharmacies.
"We are glad the government recognizes that for some people it can
improve the quality of life," said Robert Witlox, managing director
of HIV Vereniging. The association has called on health insurers to
cover the cost of the drug like any other.
The government, which recognized many chronically ill people were
already buying cannabis from coffee shops, said it should only be
prescribed by doctors when conventional treatments had been
exhausted or if other drugs had side-effects.
The government said it would start distributing to pharmacies
Monday. The Health Ministry's Office of Medicinal Cannabis has a
monopoly on wholesale distribution of the drug, grown in laboratory-
style conditions to ensure medicinal purity.
The ministry estimates up to 7,000 people in the Netherlands have
used cannabis for medical reasons, buying it in coffee shops. It
said this could more than double once it was available from
pharmacies in pure medicinal form.
Cannabis has a long history of medicinal use. It was used as a
Chinese herbal remedy around 5,000 years ago, while Britain's Queen
Victoria is said to have taken cannabis tincture for menstrual
pains.
But it fell out of favor because of a lack of standardized
preparations and the development of more potent synthetic drugs.
Critics argue that it has not passed sufficient scientific scrutiny
at a time when researchers are trying to determine if it confers the
medical benefits many users claim. Some doctors say it increases the
risk of depression and schizophrenia. ($1=.9145 Euro)
http://reuters.com/newsArticle.jhtml?type=healthNews&storyID=3367251

Medicinal cannabis - which will be sold in the form of dried
marijuana flowers from the hemp plant - is being grown to order by
two official suppliers, it added, and rigorously tested for
impurities.
It will be prescribed as a painkiller for people suffering from
cancer, Aids, multiple sclerosis or Tourette's syndrome, but only if
more conventional drugs have failed or caused unwanted side effects.

----------------------------------------------------------------

Human Interest Article

"It is OK to be me," high schooler with Tourette's
Carolyn Bower
Post-Dispatch
09/06/2003


Marc Elliot greeted classmates at Clayton High School with the
confidence of a high school senior whose school feels like home.

Dazzling smile. Firm handshake. A genuine "How was your summer?"
And then Marc barked.

Seniors and teachers seemed not to notice.

Since transferring to Clayton High School his sophomore year from
Parkway Central High School, Marc, 18, has made a name for himself.
Students elected him head of the Clayton student government. He
landed a lead role in the school play. He has given speeches to
students, teachers and assistant superintendents across the region.

He has worked in hospitals, raised money for children's hospitals,
served as a counselor at a camp for children with cancer, worked at
Clayton's Shaw Park pool concession stand and helped start a car-
detailing business.

He keeps a 4.0 grade-point average and takes Advanced Placement
chemistry, Advanced Placement European history, Advanced Placement
calculus, honors physics and advanced composition. He has applied to
attend Washington University and wants to become a pediatric
surgeon.

On this day Marc quickly did what he often does when he boards an
airplane, enters a new classroom or talks with strangers.

"I'm OK," Marc told the rest of the auditorium - about 200
freshmen. "Don't worry about me. I have Tourette's syndrome."

Tourette's is a neurological disorder with symptoms such as head-
shaking, blinking, sniffing, body gestures or vocal sounds. Fewer
than 15 percent of people with Tourette's use inappropriate
language.

Just using curse words around Marc, who is among that 15 percent,
plants the suggestion deep in his brain. After hearing such words,
he often winds up using those words, over and over again.

"I don't have a lot of control over it," Marc said.

Doctors confirmed the condition when Marc was 9 years old, but he
had had symptoms since he was 5.

Marc already had had his fill of doctor's offices and hospitals. He
was born with Hirschsprung's disease, an intestinal disorder. He
spent the first six months of his life in hospitals. By the age of 4
he had had seven operations, leaving him with no large intestine and
only a small portion of a small intestine.

Iris Elliot, his mother, credits surgeries by Dr. Jessie Ternberg at
St. Louis Children's Hospital with turning Marc into a miracle
child, a poster child for a telethon to raise money for children's
hospitals.

"He never acted like a sick baby," Iris Elliot said. "We never
treated him as a person with a medical condition that needed to be
coddled. He was strong-willed and hard to discipline. We didn't want
to destroy that because that was what got him through."

Marc's doctor took to calling him "one tough bird" and gave him toy
penguins as a tribute to his resilience and charisma.

More than 100 penguins, from small crystal ones to 6-foot blow-ups,
decorate his bedroom. They come from all parts of the world,
replicas of animals who survive ice, wind and storms.

Speaking out

After 5-year-old Marc started kindergarten at Green Trails
Elementary School in the Parkway School District, he became one of
the school's fastest runners. He played Little League baseball and
soccer. He had to go to the bathroom frequently, because, he
said, "I eat and it goes out fast."

He had a quick mind, and if he had trouble focusing or deciphering
letters, he learned to solve his problem. He attended classes for
gifted students.

Marc's Tourette's symptoms, or "tics," became more apparent as he
moved into middle school and high school. Occasions of importance
such as his brother's bar mitzvah, or stress and the onset of
adolescence increased the tics and repetitive speech such as "Love
you, love you, love you."

The family tried all kinds of remedies. Hypnotism. Biofeedback.
Medication. Botox injections. Those injections, in his neck and
throat, began a year ago and seem to lessen the painful head-shaking
and shoulder-jerking.

By the time he reached Parkway Central High School and then Clayton
High, concern about how to handle Tourette's overshadowed his other
health issues.

Marc found that if he talked with teachers or other students, they
seemed to understand.

Sometimes.

Before football games, Marc would tell the opposing team that he had
Tourette's and that he made inappropriate comments.

"I can't help it more than someone who sneezes or coughs," he
said. "It bothers me more than you. I'm not trying to offend you."

Mike Musick, associate principal at Clayton and a football coach,
said: "Marc's greatest strength is he is an excellent communicator.
He doesn't let his tics get in the way."

Musick said the players, many of whom were African-American, said
fine, let's play football. Then Marc said a racial slur maybe 200
times.

The coach said other players seemed to accept Marc's condition. But
after a game, Musick heard Marc say, "I wish I wouldn't do it."

Marc fared less well on a Greyhound bus in Indianapolis. He had
boarded the bus to ride home to St. Louis from a summer camp about a
year ago. He blurted out a racial slur. The bus driver called
authorities after a passenger complained. When Marc got off the bus
to plead his case to police, he was not allowed back on the bus. The
more they asked him to stop using the language, the more agitated he
became the more obscenities spilled out. Eventually a friend drove
him home.

The episode left Marc angry, ashamed and vulnerable. It shattered
his belief that the world holds tolerance and understanding.

As days passed, Marc decided to speak out about Tourette's, his
experiences and his hope for the way things should be.

"All of us have challenges"

At a back-to-school training session for teachers in Parkway several
weeks ago, Marc talked about Tourette's syndrome, his symptoms and
the obsessive-compulsive disorder that accompanies it.

He told them things that make his mother blanch, how he was driven
sometimes to take risks, how he stuck his hand down a garbage
disposal as a child.

He told them how important it is for people to speak up for
themselves and to recognize that everyone has problems. Some people
have anxiety. Some have depression. Some have learning disabilities.
Some struggle with concern about parents getting a divorce or
relatives who are ill.

"All of us have challenges," Marc said. "Sometimes kids keep things
bottled inside. Not everybody has to go out and speak like I do, but
they should confide in someone."

Marc told the teachers how stress makes his symptoms worse. He told
them that at school he takes standardized tests outside his
classroom, not so much for him but to allow other students to
concentrate.

When Marc made inappropriate outbursts at a Home Depot two years
ago, a man tapped him on the shoulder and asked him if he had
Tourette's. When Marc replied that he did, the man said he had a
friend whose belief in Jesus had saved and cured the friend. Marc
said, "Great, I'm Jewish."

The man asked if he could pray for Marc, and Marc said sure. The man
put his hand on Marc's shoulder and prayed for him.

"I think it's great that a man I did not know would want to pray for
me," Marc said.

Marc told the teachers that he has overcome challenges with support
from his mother; his father, Bill Elliot, a financial adviser; his
brother, Brian, 22; and his brother, Justin, 10.

Marc said he admires Brian's courage in going public as a high
school sophomore about being gay. Marc also looks up to Dr.
Ternberg, someone he says saved his life and inspired him to touch
other lives.

In addition to relatives, teachers, principals, neighbors and
doctors, Marc's sense that he had to beat the odds has carried him
through.

"I had to prove that it is OK to be me," Marc said. "If I am mocked
and jeered at, I simply laugh, turn around and continue with my
life. I have just learned to let go. Life is too precious. I cannot
give up in the face of adversity. I would feel if I did, I would
have lost in some way."

"I am not crazy"

At school a few students have told teachers they are embarrassed by
Marc's outbursts, but students who know Marc seem to accept him as
one of the crowd.

Pia Luchini, 17, a senior, said: "Marc gives out positive vibes, and
people want to be with him. The effort he puts into life and giving
back to the community is a lot more than anyone else, and people
admire him for that."

At a recent dinner with Marc in the Central West End, Pia noticed
two women listening to Marc and snickering.

"I thought it was mean," Pia said.

Marc said he has experienced so much more than what his friends see.

When he made several inappropriate outbursts recently as he stood in
line to order food at McDonald's, a man in front of him turned
around and said, "What are you, retarded?"

Marc said he sometimes wonders how it would feel to be able to walk
into a movie theater or restaurant without people noticing him.

"The day I don't have to explain the Tourette's will be a special
day," he said.

A friend asked recently how Marc made it through an airport without
saying "bomb." That conversation stuck in Marc's head.

As Marc prepared to board an airplane to St. Louis recently after
visiting his brother in San Francisco, he said the "B" word. An
agent pulled Marc aside. He told her he had Tourette's. She
replied, "Don't worry, honey, I am crazy, too."

Marc said, "Ma'am, I am not crazy. I have Tourette's syndrome."

Reporter Carolyn Bower:
E-mail: cbower@p...
Phone: 314-209-1246

http://www.stltoday.com/stltoday/news/stories.nsf/News/Education/EF78
47CB34DE263A86256D990032E587?OpenDocument&Headline=%
22It+is+OK+to+be+me,%22+high+schooler+with+Tourette's

----------------------------------------------------------------

Taking on twitching

Montreal clinic provides free treatment to reverse tics as part of
long-term study

AARON DERFEL

The Gazette
Sunday, September 07, 2003

The young computer manager couldn't stop blinking his eyes
frantically. He'd sit in a meeting and blink hundreds of times a
minute, scrunching the muscles around his eyes.
At home, he blinked while watching TV. On the road, he blinked
behind the wheel of his car. He blinked so much talking to his
girlfriend she threatened to dump him if he didn't seek treatment.
That's when the 29-year-old Montrealer sought the help of clinical
psychologist Kieron O'Connor at the Louis-H. Lafontaine Hospital.
"He has this idea that he had to invest a lot more effort into
seeing things than was normally required," O'Connor recounted. "In
his mind, he didn't want to miss anything and so he ended up
blinking that way."

Excessive eye blinking is one of many types of tics that affect as
many as half a million Quebecers. Chronic tic disorders can include
head jerks, cheek twitches, tongue clacking - even barking and
growling. In severe cases, people will scratch their faces
compulsively (a habit known as scabiomania), or pull out their hair
(trichotillomania). People suffering from bruxism will grind their
teeth to the point where they have to see a dentist.
"Chronic tics tend to be the things that the person really cannot
control at all," O'Connor explained. "If somebody has a facial tic,
it can be very distressing. They are often discriminated against in
getting jobs. They can have problems going out during social
occasions or sports activities."

Fortunately, a Montreal clinic is now providing treatment free of
charge to reverse tics as part of a long-term study. The service is
also being offered to people with Gilles de la Tourette's syndrome,
which is characterized by multiple tics and repetitive movements as
well as involuntary barking or swearing.

A common misconception about tics is that they are nervous in
nature. In a study of 90 people, O'Connor and his colleagues found
anxiety and nervousness were not sources of tics. Rather,
frustration appeared to be the cause.

"People with chronic tics and habits do seem to have a low
frustration threshold. They have problems planning activities. They
sometimes have perfectionist beliefs about the way things should be
done, which makes them adopt a kind of frustrating and tension-
producing action."

Ironically, in seeking to release that tension, they will resort to
tics, which in turn, produce more tension. With habit disorders like
severe nail biting (oncychophagia), depression can also play a role.
Psychiatrists initially hypothesized tics represented repressed
hostility - a psychoanalytic theory that has since been discredited.
Neuorleptic drugs - essentially, tranquilizers - have been used to
treat people with tics, but O'Connor recommends behaviour therapy.
First, the therapist will videotape the patient in the throes of the
tics or habit, the latter involving more destructive self-inflicted
behaviour. The patient is then shown the videotape to raise self-
awareness.

The patient is also encouraged to keep a tic diary to help pinpoint
the situations in which the behaviour is common. There are some
times of the day when the individual doesn't have tics, and at other
moments, the tics are incessant.

Finally, the therapist teaches the patient relaxation exercises to
ease tension and prevent tics. In his study, O'Connor noted
significant improvement in 65 per cent of the patients who underwent
behaviour treatment. At a two-year follow-up, 52 per cent were able
to control their tics or habits most of the time.
As for the computer manager, his frenetic eye blinking vanished
after 12 weeks of therapy. "He felt much better and was more able to
cope," O'Connor said.

O'Connor is recruiting for a second study people with chronic tic
and habit disorders as well as Tourette's syndrome. The treatment is
being offered at the Fernand-Séguin Research Centre, affiliated with
Louis-H Lafontaine Hospital.

Those interested in treatment and taking part in the study can
contact France Quevillon at (514) 251-4015, Local 3585.

aderfel@t...

© Copyright  2003 Montreal Gazette

http://www.canada.com/montreal/news/story.asp?id=97FD3F3D-1DD6-4707-
BF5E-479D42B0B057

----------------------------------------------------------------

UNDERSTANDING Tourette Syndrome - Doctor's Guide (press release)

http://www.docguide.com/gpc.nsf/doc?
CreateDocument=&n=27&l=PE&u=/news/content.nsf/webcast/01535A591EAAA68
885256D8E005687E8?OpenDocument&c=Neurologic%20Other&count=10

Note* you will have to cut and past the above link into a new
browser for it to work.

This text-based teaching module reviews the diagnostic criteria for
Tourette
syndrome, and frequently associated behavioural disorders. ...
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
----------------------------------------------------------------
Credits
----------------------------------------------------------------

Paul Marshall PhD***
Tourette – Updates Moderator
http://groups.yahoo.com/group/Tourette-Updates

To receive these updates in your personal mail box send a blank e-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@t...

For more information on Tourette Syndrome you may visit my site at:
http://www.tourettes-disorder.com we are always adding and updating
files.

***Permission is granted for posting this message in other groups
and
forums when including everything from the credits lines in your post
for our service at Tourette – Updates.

----------------------------------------------------------------
End
----------------------------------------------------------------

Tourette Updates

Reported August 18, 2003
Drug Benefits OCD and Binge Eating
By Shanida Smith, Ivanhoe Health Correspondent
GAINESVILLE, Fla. (Ivanhoe Newswire) -- Researchers from the
University of Florida are studying the drug topiramate for obsessive-
compulsive disorder and binge eating. Topiramate is an
anticonvulsant medication that is FDA-approved for epilepsy and
related disorders.
Investigators want to determine if the addition of topiramate to
typical treatment for OCD would help patients who have had only a
partial response to standard therapy. In an interview with Ivanhoe,
lead researcher Nathan Shapira, M.D., Ph.D., says, "About 40 to 50
percent [of patients] get almost no benefit from current treatments
and the other half typically get partial benefit, so there's a
significant room for improvement in terms of treatment."
In the current trial, half of the patients are given topiramate with
the standard treatment and the other half of patients are receiving
a placebo with medications they are already taking. The study is
being conducted at several sites across the country and
investigators hope to finish by next year.
Earlier studies using topiramate for binge eating disorder shows the
average starting binges were between four and a half to five times a
week for all patients. The patients on placebo went down to about
three binges a week while the patients on the treatment went down to
about 0.3 binges a week. Participants also experienced significant
weight loss. Dr. Shapira says, "Somewhere over 80 percent of
patients were to the point where they had no binge eating."
Phase III trials are beginning now at 20 sites around the United
States and researchers hope to enroll about 360 patients. Some
patients will receive topiramate and some patients will receive a
placebo. Currently, there are no FDA-approved treatments for binge
eating disorder.
This article was reported by Ivanhoe.com, who offers Medical Alerts
by e-mail every day of the week. To subscribe, go to:
http://www.ivanhoe.com/newsalert/.
SOURCE: Interview with Nathan Shapira, M.D., Ph.D., Aug. 10, 2003
----------------------------------------------------------------
Addressing Adult ADHD
CHAPEL HILL, N.C. (Ivanhoe Newswire) -- If you had attention-deficit-
disorder or attention deficit-hyperactivity-disorder as a child,
there's a good chance you may still suffer its effects. Here's a
treatment that works for the adult population.
Susan Paris works in a school, but her own schooling brings back
painful memories. "I mostly remember it in junior high, having a lot
of "D's" on my report card," she tells Ivanhoe. No one knew she had
ADHD. "I was on a cloud all by myself," she says, "And didn't really
seem to be tuned into what the rest of the group was doing."
As an adult, Paris still struggles. "It takes me longer to do things
than other people, and so I end up taking work home with me."
Psychiatrist Richard Weisler, M.D., of University of North Carolina
at Chapel Hill, says it's an increasingly common story because many
doctors were never taught to look for ADHD in adults. "The good news
now is that we have treatments available to help people, that can
really change their lives in a very positive way."
Dr. Weisler led a study in which adults with ADHD were treated with
an extended-release amphetamine. Patients showed an average 44-
percent decrease in symptoms. "Patients really saw an improvement in
their ability to accomplish more, both at home and at work, feeling
better about themselves, being more in control, less agitated," he
says.
For Paris, it was the diagnoses that really healed the pain of
shame. She says, "There's a happier ending to this story than I
imagined years ago."
As many as 70 percent of children diagnosed with ADD or ADHD may
still experience symptoms as adults.
This article was reported by Ivanhoe.com, who offers Medical Alerts
by e-mail every day of the week. To subscribe, go to:
http://www.ivanhoe.com/newsalert/.
If you would like more information, please contact:
Crystal Hinson-Miller
Director of Public Relations
University of North Carolina at Chapel Hill
(919) 966-9115
----------------------------------------------------------------

Human Interest Article
Marco youngster, family deals with Tourette's Syndrome
Wednesday, July 30, 2003
By Tiffany St. Martin, Staff Writer
When he is playing baseball — when he is in his element — no one has
any indication 12-year-old Nicholas Macchiarolo has a life-altering
disorder.
He may jump unexpectedly before he reaches the batter's box, but as
soon as he takes his stance he is focused and poised. Once he hits
the ball, he resumes twitching as he runs toward first base.

Nicholas, who will enter sixth grade at Marco Island Charter Middle
School in the fall, has Tourette's Syndrome, an inherited
neurological disorder that causes repeated involuntary body
movements and vocal sounds, or tics.
"It's not a mental thing, it's behavioral," said his mother, Toni,
who, along with husband Nick, owns Dry & Clean Carpet Cleaning. "He
has no control over it."
Doctors diagnosed Nicholas about four years ago, shortly after the
family moved to Marco Island from New York.
He underwent a series of tests, including an EKG and a CAT scan,
before they discovered Tourette's was causing his erratic behaviors,
which are similar to the urge to sneeze.
Nicholas experiences both motor and vocal tics, which can include
obsessive throat clearing, blinking, and neck and arm twitching. He
sometimes throws dishes, remote controls or whatever he may be
holding at the time of an attack into the air, but he always catches
them.
When Nicholas has severe tics, he hits himself in the face over and
over again. His friends or teachers may ask him what he is doing,
and he tells them he has no way of restraining himself.
So many of his peers questioned his behavior last year he eventually
stood up in front of the classroom and spoke openly to his fellow
students, telling them to overlook his actions.
"It's like me telling you not to blink," he said to them.
He occasionally can hold his tics in during school or in public, but
once he gets into a comfortable environment — such as his home — he
releases them in full force.
Nicholas' tics always are sudden. They begin and end at different
times, can last for days or months at a time and are different types
of tics.
"We never know when it's going to start, and we never know what's
going to come out," Toni said. "We just take it one day at a time."
He now is going through a "waxing and waning" period, meaning his
symptoms are not severe.
Although there is no cure for Tourette's Syndrome, treatments are
available. Nicholas takes Risperdal, which decreases his tics, and
Zoloft, which helps control his obsessive compulsive behavior. As
his tics increase, the amount of medicine he takes increases.
In the past the family has tried homeopathic, or natural, remedies
as well as acupuncture, which hurt Nicholas because his tics would
not allow him to keep still.
He has visited psychiatrists, neurologists and pediatricians, and he
sees a chiropractor for neck problems he sustains from his neck
twitches.
Most people accept Nicholas' behavior, but the family knows not
everyone understands the disorder. They were having dinner at a
local restaurant a few weeks ago when another customer said Toni
should learn to "control her child."
Toni said she and her husband treat and discipline Nicholas the same
way they do their other son, 7-year-old Anthony.
"Kids with Tourette's have to be treated like they're any other
child," Toni said. "They're not acting out, they're not misbehaving
or looking for attention.
They still can be successful."
Toni constantly tells both her children they can do or be whatever
they want.
The Macchiarolos do not know who in their family carried the
dominant gene. Toni said she often teases her husband, saying it was
his family.
He taunts back, saying it was her family.
Anthony has not yet shown any of the symptoms, but it still is hard
for him. Toni said he has returned home from school distraught
because kids were calling his older brother names.
The family belongs to a Tourette's Syndrome support group, which
helps them realize they are not alone in dealing with the disorder.
"It's good for us parents to vent to one another, so we don't
think, 'Am I the only one going through this?'" Toni said.
The Southwest Florida group is part of the Tourette Syndrome
Association, or TSA, and it will hold the Southwest Golf Fest in
Fort Myers on Oct. 11.
The charity golf tournament will feature former Florida Marlins
first baseman and outfielder Jim Eisenreich, who has triumphed over
his own struggles with Tourette's.
Local children with Tourette's, including Nicholas, will wear shirts
that read, "Ask me what makes me tic."
The object of the tournament is to raise money for Tourette's
Syndrome research and increase overall awareness of the disorder.
http://www.marcoeagle.com/03/07/marco/d951083a.htm
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Tourette Updates July Editors Question and Answers

Comments on Mecamylamine


Hi,
I am on your mailing list, and look forward reading it each time I
receive it. I feel compelled to write to you in reference to this
article on the Mecamylamine studies at USF. I have three children
with TS and BP. Though my children have not been part of the
studies, their physician is associated with USF. My children, twins
ages 13 and a daughter 8, have all been have been prescribed
Mecamylamine for TS and BP over the last three years. It has changed
our lives. I personally believe this to be a miracle drug. Also, my
one son had some side effects from the Inversine, so instead he uses
a Nicotine Patch. The patch also amazingly has the same results.
There is no doubt in My mind that inhibiting nicotinic receptors in
the brain is a major key to treating both TS and BP.
Knowing the changes this has brought into our lives I don't
understand why there isn't more articles written on the Mecamylamine
studies.

Just wanted to thank you for your newsletter.
Alison

#############################


Hi Paul.  In reading about mecamylamine I have a question you may be
able to help me with.  It says they believe this drug may help
because it blocks actylcholine to the brain (or something of the
sort).  I recently have been looking into supplementing with choline
or lecithin because of all the benefits it is suppose to have on
mood, the brain, behavior, and possibel movement disorders
etc...This is opposite of what this says- correct?? Am I correct in
it is saying actylcholine is an excitatory substance in the brain?
Thanks for any help.  Laura


Hello Laura,

Thank you for contacting me.  This is the best I can answer you at
the moment, as I am on my way out, however I would say that your
assumption is not accurate in context that you are looking for it
in.  The following information will help you understand.
Acetylcholine is a neurotransmitter and the supplementing with
choline or lecithin is not opposite or as I understand your
questions apposing acetylcholine.  See Below.

###########

acetylcholine


(esetelko´len) , a small organic molecule liberated at nerve endings
as a neurotransmitter . It is particularly important in the
stimulation of muscle tissue. The transmission of an impulse to the
end of the nerve causes it to release neurotransmitter molecules
onto the surface of the next cell, stimulating it. After such
release, the acetylcholine is quickly broken into acetate and
choline, which pass back to the first cell to be recycled into
acetylcholine again. The poison curare acts by blocking the
transmission of acetylcholine. Some nerve gases operate by
preventing the breakdown of acetylcholine causing continual
stimulation of the receptor cells, which leads to intense spasms of
the muscles, including the heart. Acetylcholine is often abbreviated
as Ach. See nervous system.

###########

In depth information about:
ACETYLCHOLINE & ACETYLCHOLINE RECEPTORS (AChRs)

http://www.neuro.wustl.edu/neuromuscular/mother/acetylcholine.htm


http://www.neurosci.pharm.utoledo.edu/MBC3320/acetylcholine.htm
The first neurotransmitter system to be covered will be the
cholinergic system. Acetylcholine was one of the first
neurotransmitters to be discovered, (originally
called "vagusschtuff" because it was found to be the substance
released by stimulation of the vagus nerve that altered heart muscle
contractions).

Acetylcholine is produced by the synthetic enzyme choline
acetyltransferase which uses acetyl coenzyme A and choline as
substrates for the formation of acetylcholine. Dietary choline and
phosphatidylcholine serve as the sources of free choline for
acetylcholine synthesis. Upon release, acetylcholine is metabolized
into choline and acetate by acetylcholinesterase, and other
nonspecific esterases. Acetylcholine release can be excitatory or
inhibitory depending on the type of tissue and the nature of the
receptor with which it interacts.
Cholinergic receptors can be divided into two types, muscarinic and
nicotinic, based on the pharmacological action of various agonists
and antagonists. Muscarinic receptors originally were distinguished
from nicotinic receptors by the selectivity of the agonists
muscarine and nicotine respectively. Muscarinic receptors will be
discussed in detail later, while nicotinic receptors will be
discussed in the next section.
Nicotinic cholinergic receptors
Nicotinic receptors produce pharmacologically and physiologically
distinct responses from muscarinic receptors, although acetylcholine
(and other agonists such as carbamylcholine) stimulates each type of
response. Nicotinic responses are of fast onset, short duration and
excitatory in nature. The pharmacology of nicotinic receptors has
been studied in great detail and our understanding of how ion
channel-coupled neurotransmitter receptors work is based largely on
the study of this class of proteins.
Nicotinic receptors are found in a variety of tissues, including the
autonomic nervous system, the neuromuscular junction and the brain
in vertebrates. They also are found in high quantities in the
electric organs of various electric eels and rays. The high
quantities of receptors in these tissues and the use of neurotoxins
from snake venom (e.g., cobra venom) that bind specifically to the
nicotinic receptor aided the purification of the receptor protein.
Agonists such as acetylcholine, carbamylcholine and nicotine produce
the physiological responses associated with nicotinic cholinergic
activation. Acetylcholine produces an influx of sodium through a
ligand-gated ion channel. Acetylcholine and carbamylcholine also
stimulate muscarinic receptors and therefore should be considered
mixed cholinergic agonists.
The amino acid sequence for the nicotinic receptor was determined
after solubilization of the receptor from the electric organ of
Torpedo californica using anionic detergents such as sodium dodecyl
sulfate, passing the receptor through an affinity column containing
 bungarotoxin (from snake venom) and washing the receptor from the =

column. Subsequently, molecular biological techniques were used to
clone additional receptor subunits. The nicotinic receptor consists
of five polypeptide subunits. The amino acid sequence for the 
subunits consists of a glycolipid region (which contains the ACh
binding site and a sulfhydryl groups) with four hydrophobic regions
that span the membrane. Nine  subunits have been cloned, along with=

four  subunits. In the neuromuscular junction,  and &#61543=
; subunits
also have been identified. The  subunit is replaced by an  =
subunit
in the adult muscle.

-Bungarotoxin binds to the  and  subunits and proba=
bly blocks
both the channel and the ACh binding site. Local anesthetics and
other compounds such as phencyclidine bind to the receptor,
apparantly at the site of the sodium channel and modulate the
binding of acetylcholine to the active site. Local anesthetics also
prevent ion conductance through a direct action at the channel. The
sodium channel and the channel for the nicotinic cholinergic
receptor have some similar properties (in both structure and
sensitivity to drug action) and may have a common genetic origin.
In general terms, acetylcholine binds to the -subunits of the
receptor making the membrane more permeable to cations and causing a
local depolarization. The local depolarization spreads to an action
potential or leads to muscle contraction when summed with the action
of other receptors. Nicotinic receptors possess a relatively low
affinity for acetylcholine at rest. The affinity for acetylcholine
is increased during activation (through an allosteric mechanism
which increases the likelihood of another molecule of acetylcholine
binding to the other  subunit). At high concentrations of
acetylcholine, the affinity for acetylcholine becomes higher and the
receptor subsequently becomes desensitized. The ionophore (ion
channel) is open during the active state and local anesthetics may
bind to the open channel.
The subunit composition of nicotinic receptors differs in skeletal
muscle, autonomic ganglia and brain. The table below lists some of
the properties of receptors found in different tissues. Note that
multiple subunit compositions are possible, which may permit the
development of compounds selective for a particular combination.
Within the CNS, the 42 combination predominates.

Nicotinic antagonists
Antagonists for nicotinic receptors include such diverse compounds
as curare, -bungarotoxin and gallamine. Nicotinic receptors found
at the neuromuscular junction differ from the receptors found in
autonomic ganglia and can be distinguished both pharmacologically
and biochemically.
Gallamine (a mixed muscarinic and nicotinic antagonist) and
decamethonium are more effective antagonists at the neuromuscular
junction than at the autonomic ganglia. The spacing of the charged
nitrogens seems to be of critical importance in the selectivity of
the drugs. Gallamine and succinylcholine are used during surgery to
block nmj receptors and produce paralysis. Succinylcholine is used
more often because it can be metabolized by acetylcholinesterase to
produce inactive compounds. Note the structural similarity to
acetylcholine. Decamethonium is another nicotinic antagonist with
some selectivity for the neuromuscular junction
Ganglionic blockers include the quaternary compounds hexamethonium
and tetraethylammonium as well as the tertiary and secondary amines
mecamylamine and pempidine. While quaternary amines competitively
inhibit cholinergic responses in autonomic ganglia, tertiary and
secondary amines also have a noncompetitive component.
Ganglionic blockers are used to treat hypertension in some cases.
Because they block both sympathetic and parasympathetic responses,
their use is restricted to emergency situations or circumstances
where the patient can be monitored (orthostatic hypotension is one
of the common side effects).
Succinylcholine and decamethonium are both depolarizing blockers of
nicotinic receptors, in that they initially mimic the action of
acetylcholine. Following the initial depolarization, the
depolarizing blockers exert a long-acting blockade of the receptor,
thereby preventing further activation by acetylcholine. The
trimethylammonium group seems to be important for action as a
depolarizing blocker since compounds with a triethylammonium group
do not cause the depolarization but do block the action of
acetylcholine (see gallamine for instance).

Nicotinic agonists
Over the past several years, a variety of research groups have
focused on the development of selective nicotinic agonists.
Nicotinic agonists could be useful in the treatment of a variety of
neurological disorders including Alzheimer's disease, Parkinson's
disease and chronic pain. Epibatidine is a nicotinic agonist
isolated from the skin of an Ecuadoran frog Epipedobates tricolor
that displays potent analgesic properties.
Another nicotinic agonist, ABT-418, exhibits some cognition
enhancing properties. Note its similarity to nicotine, with an
ixoxazole moiety replacing the pyridyl group of nicotine.
Epiboxidine is a structural analogue that combines elements of both
epibatidine and ABT-418. It also is a potent nicotinic agonist.
Two other derivatives are worth noting. The azetidine analogue of
epibatidine, ABT-594, is a potent analgesic with significantly fewer
side effects than epibatidine. SIB-1508 is another nicotinic agonist
with potential utility in the treatment of Parkinson's disease.

Muscarinic receptors
Acetylcholine and carbamylcholine can bind to both muscarinic and
nicotinic receptors, yet the responses elicited by activating each
receptor differ in several ways. Muscarinic responses are slower,
may produce excitation or inhibition and involve second messenger
systems, rather than the direct opening of an ion channel.
Muscarinic receptors are G protein-coupled receptors and mediate
their responses by activating a cascade of intracellular pathways.
Muscarine is the prototypical muscarinic agonist and derives from
the fly agaric mushroom Amanita muscaria. Like acetylcholine,
muscarine contains a quaternary nitrogen important for action at the
anionic site of the receptor (an aspartate residue in transmembrane
domain III). Most muscarinic agonists obey the "rule of five" atoms
from the quateranry ammonium moiety to the terminal atom.
Muscarinic receptors are found in the parasympathetic nervous
system. Muscarinic receptors in smooth muscle regulate cardiac
contractions, gut motility and bronchial constriction. Muscarinic
receptors in exocrine glands stimulate gastric acid secretion,
salivation and lacrimation. Muscarinic receptors also are found in
the superior cervical ganglion where they can produce at least two
physiologically distinct responses. In addition, muscarinic
receptors are found throughout the brain, including the cerebral
cortex, the striatum, the hippocampus, thalamus and brainstem.
In general the classical muscarinic antagonists such as atropine
recognize a single class of binding sites as determined in binding
assays. In the 1980's, several selective muscarinic antagonists were
identified. Pirenzepine was very useful in the characterization of
M1 muscarinic receptors, while AF-DX 116 was used to identify M2
receptors in the heart. M3 receptors are found in smooth muscle and
in both exocrine glands (e.g., lacrimal glands) and endocrine glands
(e.g., pancreas). Muscarinic agonists bind heterogeneously to
receptors in both the brain and peripheral nervous system.
In the late 1980's, molecular cloning techniques identified five
different subtypes of muscarinic receptors. Each receptor shares
common features including specificity of binding for the agonists
acetylcholine and carbamylcholine and the classical antagonists
atropine and quinuclidinyl benzilate. Each receptor subtype couples
to a second messenger system through an intervening G-protein. M1,
M3 and M5 receptors stimulate phosphoinositide metabolism while M2
and M4 receptors inhibit adenylate cyclase. The tissue distribution
differs for each subtype. M1 receptors are found in the forebrain,
especially in the hippocampus and cerebral cortex. M2 receptors are
found in the heart and brainstem while M3 receptors are found in
smooth muscle, exocrine glands and the cerebral cortex. M4 receptors
are found in the neostriatum and M5 receptor mRNA is found in the
substantia nigra, usggesting that M5 receptors may regulate dopamine
release at terminals within the striatum. The structural
requirements for activation of each subtype remain to be elucidated.
Muscarinic antagonists
Muscarinic antagonists such as scopolamine and atropine are among
the oldest known molecules, originally derived from natural sources.
They are both alkaloids (natural, nitrogenous organic bases, usually
containing tertiary amines) from the nightshade plant Atropa
belladonna. The presence of an N-methyl group on atropine or
scopolamine changes the activity of the ligand, possibly by
preventing a close interaction between the ligand and the membrane
or lipophilic sites on the receptor. The methyl group also prevents
the penetration into the brain.
The potent anticholinergics are used to control the secretion of
saliva and gastric acid, slow gut motility, and prevent vomiting.
They also have a limited therapeutic use for the treatment of
Parkinson's disease. In large doses however, the muscarinic
antagonists with tertiary amines have severe central effects,
including hallucinations and memory disturbances.
In recent years, the quaternary muscarinic antagonist ipratroprium
has been used in the treatment of chronically obstructed pulmonary
disorder as an adjunct to 2 agonist therapy. M3 muscarinic
receptors mediate bronchoconstriction in the airways. Muscarinic
antagonists such as ipratropium and the long-lasting tiotropium are
effective bronchodilators.
The possible use of presynaptic antagonists to increase
acetylcholine levels has attracted some attention recently.
Muscarinic autoreceptors resemble pharmacologically the M2 receptor
found in the heart. M2 antagonists enhance acetylcholine release by
blocking the feedback inhibition produced by the action of
acetylcholine on presynaptic terminals.
Muscarinic agonists
The ability for the quaternary ammonium group to fit into an anionic
site on muscarinic receptors may be an important factor for the
binding of a ligand to muscarinic receptors. For an example of the
requirement of the quaternary amine moiety, condsider that
dimethylaminoethylacetate (the tertiary form of acetylcholine) is
1000-fold less than acetylcholine, in part due to a lower affinity
for the receptor.
The molecule of acetylcholine is flexible and may form an infinite
number of conformations from the extended to the quasi-ring
structure. The three-membered ring of acetoxycyclopropyl-
trimethylammonium iodide demonstrates the concept that the extended
form of acetylcholine contains the highest intrinsic activity. The
trans isomer has much higher activity than the cis isomer which
orients the ester and the quaternary amine together.

While the quaterany nitrogen is essential for eliciting full
muscarinic responses with muscarinic agonists, there are a few
potent muscarinic agents which contain tertiary amines (e.g.,
arecoline, oxotremorine and pilocarpine). They are potent both
peripherally and centrally although they are of limited therapeutic
value because of the wide range of cholinergic responses that they
elicit. Oxotremorine is of interest because of its ability to
produce tremors, thereby providing an early model for Parkinson's
disease.
Simple tertiary amines do not show considerable potency for the
receptor, but this can be counteracted if the rest of the molecule
binds potently to the receptor (e.g., through an ester bioisostere).
Oxotremorine fills this role with an amide group in a pyrrolidone
ring as the nitrogen replaces oxygen in a hydrogen bond acceptor
role. Arecoline (isolated originally from the betel nut) has a
reversed ester acetylcholine profile, while pilocarpine has its
ester in the cyclic form of a lactam ring, which may help increase
the binding interaction. In general, it is important to have two
sites for hydrogen bond acceptance in the ester isostere. The
orientation of the ester isostere may be important for selective
action as well.

The events associated with G protein-coupled receptor activation are
as follows.
1. Agonist binds to the receptor, which has a high affinity for
agonists at rest.
2. The binding of the agonist stabilizes a receptor
conformation promotes receptor/ G protein coupling and allows GTP to
exchange for GDP on the G protein  subunit.
3. The binding of GTP leads to the dissociation of the G
protein from the receptor, thereby lowering agonist affinity. The
agonist then dissociates from the activated receptor.
4. The G protein consists of three subunits (, , and &#6154=
3;) which
also dissociate. The  subunit activates the appropriate second
messenger system (e.g., phospholipase C for M1 receptors). The  and=

 subunits can exert independent actions.
5. The  subunit is inactivated by the hydrolysis of GTP to
form GDP by a GTPase intrinsic to the G protein (GTPase activity may
be activated by other intracellular proteins called GTPase
activating proteins [GAPs]).
6. The  subunit (with GDP bound) can then recombine with the &#6153=
8;
and  subunits. The receptor is then in a high affinity state and
ready for the binding of another agonist.

Alzheimer's disease
Alzheimer's disease is characterized by amyloid plaques and
neurofibrillary tangles. Amyloid plaques contain deposits of -
amyloid, which is a 40-42 amino acid peptide derived from amyloid
precursor protein. Neurofibrillary tangles contain a
hyperphosphorylated  protein, which forms paired helical filaments.=

Alzheimer's disease is associated with a loss of cholinergic neurons
which project from the basal forebrain to the cerebral cortex and
the hippocampus. The loss of cholinergic neurons is progressive and
results in profound memory disturbances and irreversible impairment
of cognitive function.
The cause of Alzheimer's disease is unknown, yet several genes and
gene products (proteins) have been implicated.
• Mutations in APP (a small percentage of all Alzheimer's
patients
• Presenillin mutations (may promote the formation of -
amyloid)
• Apolipoprotein E allele (E4 is associated with an increased
risk of Alzheimer's disease)

Drug development
Recent efforts have focused on the development of centrally active
muscarinic receptor agonists for the treatment of Alzheimer's
disease. The rationale for therapy involves replacement of
acetylcholine, which is depleted in Alzheimer's patients as the
basal forebrain neurons degenerate. An ideal candidate for a drug
would have several features including high CNS penetrance, high
efficacy and selectivity for forebrain receptors and a low incidence
of side effects.
The muscarinic agonist xanomeline is an arecoline derivative with
very high affinity and selectivity for M1 muscarinic receptors. It
contains a 1,2,5-thiadiazole ring, which is more stable than the
ester found in arecoline. In CDD-0102 a 1,2,4-oxadiazole moiety
serves as a suitable ester isostere.
Reference:
http://www.neurosci.pharm.utoledo.edu/MBC3320/acetylcholine.htm


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Tourette Updates

Mecamylamine Relieves Depression in Children With Tourette's Syndrome
Source: University of South Florida College of Medicine
A well-tolerated drug that blocks nicotine receptors in the brain
appears to relieve depression and mood instability in children and
adolescents with Tourette's syndrome, a preliminary study by
University of South Florida College of Medicine researchers has
found.

The multicenter, placebo-controlled study of the drug mecamylamine
is published in the latest issue of the journal Depression and
Anxiety.

"These preliminary findings are consistent with anecdotal
observations that mecamylamine stabilizes mood," said lead author
Douglas Shytle, PhD, assistant professor in the USF Departments of
Neurosurgery and Psychiatry. "In addition, this is the first
clinical evidence supporting the hypothesis that many
antidepressants function, in part, by inhibiting nicotinic
receptors."

Dr. Shytle emphasized that larger clinical studies are needed to
determine if nicotine antagonists like mecamylamine would provide a
new avenue for treating depression and other mood disorders.

In a 1998 study, the USF researchers reported that small doses of
mecamylamine (trade name Inversine(TM)), a drug originally used to
treat hypertension, seemed to reduce the rage reactions and
irritability that many children with Tourette's experience.

In this national randomized study, the researchers examined the
effect of mecamylamine on symptom improvement in a group of 50
children and adolescents co-diagnosed with Tourette's syndrome and
at least one of several mood disorders. The mood disorders were
major depression, attention deficit hyperactivity disorder (ADHD),
oppositional defiance disorder, obsessive compulsive disorder, and
hypomania.

Of the 50 participants, 38 completed the full 8-week trial -- 17 on
mecamylamine and 21 receiving a placebo pill.

The four Tourette's patients co-diagnosed with major depression
showed the greatest mecamylamine-related improvements in behavioral
and emotional symptoms, including significant decreases in sudden
mood changes, irritability, demanding attention, inattention,
restlessness, anxiety and impulsiveness. The medication's most
beneficial effect appeared to be stabilizing mood.

The depressed patients treated with the placebo showed no benefit.

In a report published this summer in the journal Molecular
Psychiatry, the USF researchers suggest that many newer, more
selective antidepressants such as Prozac work, in part, by
inactivating nicotine receptors in the brain. These receptors appear
to be overstimulated by the biochemical messenger acetylcholine in
patients who are depressed.

The most common current explanation for how antidepressants work is
by boosting levels of serotonin, a brain biochemical that is low in
people with depression.

"Our preliminary findings with mecamylamine suggest that another way
antidepressants may improve depressed moods is by blocking
acetylcholine's excess activation of nicotine receptors," said
investigator Paul R. Sanberg, PhD, DSc, professor and director of
the USF Neuroscience Program.

"It allows us to explore a new class of drugs for neuropsychiatric
disorders," said investigator Archie Silver, MD, director of the USF
Center for Infant and Child Development.

The USF research team recently started a controlled study of
mecamylamine in children and adolescents with bipolar disorder, also
known as manic depression. This latest study is funded in part by
the Stanley Medical Research Institute.

Other authors of study in Depression and Anxiety were Kathy Sheehan,
PhD; and David Sheehan, MD.

The study was supported in part by a grant from the USF High-Tech
Corridor Project. The researchers got mecamylamine through Layton
BioScience, Inc., a California biotechnology firm that owned rights
to the medication at the time of the study.

Mecamylamine (Inversine(TM)) is now owned and marketed by Targacept,
a Salem, NC pharmaceutical company that licenses USF's patent
covering the use of nicotine antagonists for the treatment of
neuropsychiatric disorders."

Reference:

Shytle RD, Silver AA, Sheehan KH, Sheehan DV, Sanberg PR. Neuronal
nicotinic receptor inhibition for treating mood disorders:
preliminary controlled evidence with mecamylamine. Depression and
Anxiety, 2002;16(3):89-92


Copyright © 2002 Acurian Inc. All Rights Reserved.

##########################################



Reported July 21, 2003
Depression Risk in the Genes
(Ivanhoe Newswire) -- Why do some people become depressed after a
stressful event while others don't? New research suggests it could
be a specific version of a gene.
Researchers from Wisconsin and London followed more than 800
participants from birth into adulthood. Seventeen percent of the
participants carried two copies of a short version of the serotonin
transporter gene, about 30 percent carried two copies of a long
version of the gene, and about 50 percent carried one copy of each
version of the gene.
Results of the study show more than 40 percent of the participants
carrying two short genes suffered from depression following a
traumatic life event. Less than 20 percent of those with long genes
developed depression after a stressful event. Researchers define
a "stressful event" as losing a job, having a loved-one die, being
diagnosed with a serious illness, or experiencing a break-up or
divorce.
Terrie Moffitt, Ph.D., from the University of Wisconsin and King's
College in London, says, "We found the connection [between the gene
version and depression] because we looked at the study members'
stress history."
Everyone inherits two copies of the serotonin transporter gene, one
copy from each parent. Each version of the gene functions
differently. The short version makes less protein, resulting in
increased levels of serotonin. Researchers say this may be why it
appears less efficient at stopping unwanted messages.
Participants with the short genes who had experienced four or more
life stresses accounted for nearly one quarter of the cases of
depression. Among those with four or more life stresses who
developed depression, more than 40 percent had two copies of the
short gene compared to 17 percent with two copies of the long
version of the gene.
Researchers say more research is needed to confirm their findings.
This article was reported by Ivanhoe.com, who offers Medical Alerts
by e-mail every day of the week. To subscribe, go to:
http://www.ivanhoe.com/newsalert/.
SOURCE: Science, 2003;301:386-389
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=6626

##########################################

Neuroscience researchers

  Neuroscience researchers at Washington University School of
Medicine in St. Louis are studying the brains of patients with
Tourette Syndrome (TS) to see whether they can use sophisticated
imaging techniques to identify differences in the dopamine system of
people with the tics that characterize TS. A team of researchers,
led by Kevin J. Black, M.D., assistant professor of psychiatry,
neurology and radiology at Washington University School of Medicine,
is using PET imaging to see what the brain does in response to
levodopa, a natural amino acid that has been used for many years to
treat movement disorders, such as Parkinson's disease. With PET
imaging, the researchers can measure the boost in the brain's
dopamine levels in response to the drug both in people with Tourette
Syndrome and in those who do not have tics. By identifying
differences, they hope to isolate the causes of tics and to help
people with TS control or eliminate them.
http://news-info.wustl.edu/tips/page/normal/294.html

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This is an adult subject and may not be suitable for all readers.
It is provided for the many sexual problems and function in relation
to Tourette Syndrome and is for informational purposes only.  If you
are not sure what this means, then STOP READING HERE AND GO ASK YOUR
PARENTS BEFORE CONTINUING ANY FARTHER.
`
`
`
`
`
`
Because the neurotransmitters such as acetylcholine, dopamine and
serotonin are involved in the provided information I thought it
might shed some light on those that have sent in questions regarding
Masturbation and Tourette Syndrome.

Fatal Consequences of Excessive Masturbation

Frequent masturbation and ejaculation stimulate
acetylcholine/parasympathetic nervous functions excessive can result
in over production of sex hormones and neurotransmitters such as
acetylcholine, dopamine and serotonin. Abundant and unusually amount
of these hormones and neurotransmitters can cause the brain and
adrenal glands to perform excessive dopamine-norepinephrine-
epinephrine conversion and turn the brain and body functions to be
extremely sympathetic. Other words, there is a big change of body
chemistry when one excessively masturbation.

The side effects of such changes to the body include:

Fatigue. Feeling tired all the time
Lower back pain
Stress / Anxiety
Thinning hair / Hair Loss
Soft / Weak Erection
Premature Ejaculation
Eye floaters or fuzzy vision
Groin / Testicular Pain
Pain or cramp in the pelvic cavity or/and tail bone

If above symptoms are experienced, you need to restore the balance
of brain's acetylcholine / parasympathetic ratio, reduces the level
of sex hormones in the body, and sedates sympathetic nervous
function, or the symptoms would become worsen.

**
Over-masturbaters would experience problems with concentration and
memory. This is a dangerous side effect of over-masturbation and
signals that the brain is being over drained of acetycholine. Over-
masturbating can also drain the motor nerves, neuro-muscular
endings, and tissues of acetycholine and replace it with too much
stress adrenalin which is where absentmindedness, memory loss, lack
of concentration, and eye floaters come from. To fight these
symptoms, the chemical levels in your body needs to be balanced.

Notice a pattern yet? The plethora of problems associated with over-
masturbation come from the fact that your body is drained of
important nutrients and hormones.
Mitchell McNiff, M.D.
Dr. Mitchell McNiff, M.D. is a board certified urologist who
received his specialized fellowship training in Male Reproductive
Medicine and Surgery and Male Erectile Dysfunction at UCLA Medical
Center. He is also the Medical Director of C.A.Z.T. Laboratories, a
laboratory that specializes in Fertility Testing and Sperm Banking.
http://www.herbolove.com/experts/drMitchell.asp

Editors Comments
----------------------------
      To understand why this is relevant information, you need to
refer to your information on the effects of Neurotransmitters and
Tourette Syndrome.  In shot if there is a shortage of these then one
could see why there may be an increase or excessiveness of
masturbation or other sexual side effects in those dealing with
Tourette Syndorme.
There is good information about Tourette Syndrome and
Neurotransmitters in several books including
Tourette Syndrome and Human Behavior by Dr. David E. Comings
http://www.hopepress.com
Here is a site with some relevant online information about
Neurotransmiters and Tourette Syndrome.
http://au.geocities.com/jones_kacm/chem.htm

Paul Marshall PhD
Editor
http://www.tourettes-disorder.com


References
http://www.herbolove.com/library/resource/overmas/fatal.asp


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The Boston Globe, June 28, 2003

MENTAL AILMENTS IN CHILDREN BEING LINKED TO STREP

By Carey Goldberg, Globe Staff

KENNEBUNKPORT, Maine - Sammy Jelin, math whiz and natural comedian,
sailed through fifth grade, a school enthusiast eager for the bus
each morning. By the start of sixth grade last fall, he could barely
make it to school at all: In just weeks, his world had turned into a
minefield of germ phobias, invisible walls, and constant tics -
hallmarks of obsessive compulsive disorder and Tourette's syndrome.

By this May, Sammy's mother, Beth Jelin, was nearing her wits' end.
Then an acquaintance mentioned that her son had contracted similar
mental ailments through a streptococcus infection. The idea sounded
wild, especially because Sammy had never had strep throat. But a
prompt blood test did turn up unusually high levels of strep, and
Sammy went on antibiotics.

Within days, Sammy got so much better that Beth Jelin is
convinced that undiagnosed strep was the culprit, and a growing body
of research, though still controversial, suggests she might be right.

It could be that at least one child in every 1,000 suffers from
obsessive compulsive disorder linked to strep, say federally
financed researchers who have been exploring the connection for
several years.

Garden-variety strep, bacteria best known for attacking the throat,
is far more common than that; virtually every child catches it once
or twice a winter. And strep sometimes infects a child without
bringing noticeable symptoms.

In contrast to strep, a child has only a small chance of developing
strep-related obsessive compulsive disorder, or OCD.

But among children who do have OCD, up to one-half of those cases
could be strep-related, said one specialist, Dr. Tanya Murphy of the
University of Florida.

Skeptics say strep is so common in schoolchildren that simple chance
could dictate that it would sometimes coincide with the onset of OCD
or Tourette's.

But evidence is accumulating. Researchers in Rochester, N.Y.,
reported last year that over four years in one pediatric practice,
they had linked 25 cases of children with OCD and tics to strep.

And when those children at Elmwood Pediatric Group were quickly
given antibiotics, both the strep and the psychiatric symptoms went
away, Drs. Michael Pichichero and Marie Lynd Murphy reported at
conferences and in the Archives of Pediatrics & Adolescent Medicine.

While no one advocates prescribing antibiotics more broadly as a
precaution against OCD, some specialists say the link is now
established enough that pediatricians should order a strep test when
a child comes in with sudden-onset OCD or tics.

The connection remains little known among pediatricians, even though
it is recognized enough to have a name: PANDAS, for Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal
Infection. And dozens of studies have focused on it recently.

Several points about PANDAS are already quite clear, said Dr. Susan
Swedo, who helped discover the syndrome in the early 1990s and now
leads the National Institute of Mental Health PANDAS research team.

There is no question, she said, that a there is a group of children
with a "fairly unique clinical presentation": abrupt onset of OCD or
tics along with other unusual behaviors, from frequent urination to
high separation anxiety.

Normally, OCD develops gradually, often over years; but with sudden
onset, parents often say their child seemed to get ill overnight, or
can name the date when the symptoms started. Typical OCD involves
obsessions, often with cleanliness or fears about safety, and can
include compulsions, like repeated hand-washing.

With PANDAS, Swedo said, it is also clear that the children's
psychiatric symptoms get worse with subsequent strep infections but
fade when the strep does.

Also, she and others said, this is not the first time that
infections have been connected to psychiatric disorders. In its
advanced stages, syphilis can lead to insanity. Lyme disease has
been known to bring on psychiatric problems, and some researchers
have reported that strep may also be connected to anorexia.

There is broad agreement, Swedo said, on a possible mechanism for
PANDAS: It could be that in some children, strep triggers antibodies
that mistakenly attack the basal ganglia, a part of the brain that
helps control movement, much as antibodies mistakenly attack the
heart in rheumatic fever.

But researchers have a ways to go before they really understand what
happens, and why it happens only in certain children, Swedo said.

There seems to be a genetic element involved as well, she noted;
PANDAS children seem to have immune systems predisposed to the
disorder.

Other researchers are working to try to find biological markers or
highly objective measures to distinguish PANDAS children from those
with garden-variety OCD or Tourette's. Still others are focusing on
how best to prevent and fight PANDAS using antibiotics.

If specialists' estimates are correct, tens of thousands of children
between the toddler years and puberty may be affected.

For the past month, Jelin has been doing a great deal of research on
PANDAS and using the information to try to help Sammy. Most
recently, she has been looking into the best ways to fight strep,
and found a new study favoring amoxicillin.

"We're approaching this like a military operation," she said in an e-
mail describing the antibiotics her son is now taking. "First, we
dropped massive amounts of penicillin. Next we're sending in the
ground troops - Keflex and amoxicillin."

Before his improvement, Sammy had suffered through a wide range of
OCD and Tourette's symptoms.

He developed bruises on his arms and legs from using them, rather
than his fingers, to flick light switches. He felt compelled to hop
and clear his throat at the same time. At one point, he needed to
eat with his eyes closed.

This month, Beth Jelin said, many of those behaviors have faded,
though some remain in a less pronounced and less frequent form.

During a 20-minute conversation last week at his kitchen table,
Sammy seemed just slightly more squirmy than the average boy and was
quietly hilarious as he discussed his surfeit of self-confidence and
his economic suggestions for President Bush.

He did not want to talk about his OCD and recent improvement, but
his mother said he recently told her, "Mom, I'm a boy full of hope."

She is left wondering, she said, "How many children are there out
there with mental health diagnoses where we're not really looking
for the physical cause?"

Swedo cautions parents of children diagnosed with OCD not to get
their hopes up. She has heard from many parents who were crushed
when their children's strep tests turned up nothing.

Still, she said, if a child fits the PANDAS profile, "it's really
worth it to look for an asymptomatic strep infection." Prompt
antibiotic treatment, she said, "can cause a pretty dramatic
improvement in the symptoms. It's not very often, but it is worth
it."

Or as Sammy put it when asked what he would tell other children who
run into problems like his: "It's very good to test this kind of
thing out because, frankly, it's not very fun to have."

"It's exhausting," he said. "Something you have to keep in mind is,
don't worry, it's not just you." Carey Goldberg can be reached at
goldberg@....

http://www.boston.com

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http://www.boston.com
goldberg@....

Paul Marshall PhD***
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My son has Tourette's syndrome.  My husband and I are
very curious as to where and how he came down with this terrible
syndrome.  They
say its hereditary but as far as we can tell, there are no signs of
Tourette's
in either side of our family.  Is their a way for my husband and I
to be
tested to see if there is a link somewhere?  If Tourette's is
genetic, could this
affect my sons' children and are their ways to have him tested also?
   I know their is so much more to learn about this disorder but if
they are
testing  this chromosome 7 and see some kind of link to it, why
aren't parents
being made aware of this and given the option to have their children
tested for
this?  Thanks so much for all of your e-mails, they have been very
helpful.
I hope you can help me with this one!

                                                            Thank you,
                                                             L…..


This is the most common question asked of me about Tourette
Syndrome.  I am posting this so that these links are easily
accessible here in response to several recent requests.

You may be able to find some clinical studies that are doing gene
research in your area to see or you may have to travel.  I suppose
there may be a way to pay for this type of testing to be done,
however it would probably be completely voluntary and of your own
expense if you find a Dr. able and willing.

As far as what it would mean for your children and your children's,
children, here are a couple of links with some info you can look at.

The testing and gene studies have been around a while, however they
are not at a point where they are able to be solid and concrete and
there are still a lot of unknowns.  Plus insurances may not want it
to be readily available because it probably is very expensive and
not cost effective from their point of view.

Also being it is a fairly new study it takes time for parents to be
given the information to become aware of it.  That has been one of
my goals to get the information out there and available for parents
to have.

My step mother had no information available when we were children
and wish there would have been at least as much information that
there is now available.

Will my children have Tourette...the most common question asked.
http://www.geocities.com/mrindianajonesprm/will_child_hv_ts.htm

http://au.geocities.com/jones_kacm/chance.htm

http://au.geocities.com/jones_kacm/chance.htm#table

http://au.geocities.com/jones_kacm/contents.htm


Paul Marshall PhD
http://paul.tourette.info

--- In Tourette-Updates@yahoogroups.com, "Paul Marshall" <paul@t...>
wrote:
> June 10, 2003: CAUTION: If your child is on Paxil (marketed as
> Seroxat in Europe), be advised that the UK has banned its use in
> children under the age of 18 due to safety concerns of increased
self-
> harm in children taking that medication. The U.S. FDA is also
> reviewing the situation. Contact your prescribing physician or
> pharmacist about the matter. When the FDA issues a statement, it
will
> be noted at

http://www.tourettesyndrome.net

June 20, 2003 Update: Although the FDA has not completed its
evaluation of the new safety data, the FDA is recommending that
Paxil not be used in children and adolescents for the treatment of
Major Depressive Disorder. There is currently no evidence that Paxil
is effective in children or adolescents with MDD, and Paxil is not
currently approved for use in children and adolescents. Other
approved treatment options are available for depression in children.
You can find additional information on the

FDA's site.
http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01230.html

Gene linked to Tourette's syndrome
DNA defect may cause involuntary physical and verbal tics.
23 June 2003
JOHN WHITFIELD
Researchers have found a gene mutation that seems to lead to the
mental disorder Tourette's syndrome. The gene is normally switched
on in nerve cells; its disruption might make them hyperactive.
The gene has been detected in only one family so far. Studies of
more people with Tourette's syndrome are needed to confirm its
involvement in the condition.
"This gene might be involved in some people with Tourette's
syndrome, but it won't be in all of them," says the leader of the
team that found it, Ben Oostra, of Erasmus University, Rotterdam,
the Netherlands.
Tourette's syndrome affects about 1 in every 2,000 people. Sufferers
have involuntary physical and verbal tics that can include outbursts
of swearing. They often also have obsessive-compulsive disorder,
engaging in repetitive, ritualized behaviour.
In 1885, Gilles de la Tourette noticed that the condition now
bearing his name runs in families. Now genetic make-up is thought to
be a risk factor that combines with the environment to produce the
disorder.
Oostra's team studied a Californian family. The father has obsessive-
compulsive disorder, two of his children have this, plus tics and
other mental and physical problems. Tourette's syndrome is an
extreme version of obsessive-compulsive disorder, Oostra believes.
In all three people, a chunk of chromosome 2 is transplanted into
chromosome 7, the researchers found. This insertion breaks up a gene
on chromosome 7, called CNTNAP2, which helps to control the firing
of nerve cells.
"Some features of this gene are quite exciting," says child
psychiatrist James Leckman of Yale University, New Haven,
Connecticut. Other experiments have hinted that nerve cells in the
brains of those sufferering from Tourette's fire too easily. "This
suggests a mechanism by which the transmission of messages between
nerve cells might be juiced up," says Leckman.
Others doubt that this genetic abnormality has anything to do with
Tourette's syndrome. The number of people studied is too small to
draw strong conclusions, warns psychiatrist David Curtis of the
Royal London Hospital, UK.
Also, CNTNAP2 is not in a region of the genome previously suspected
of harbouring genes linked to Tourette's. "It might turn out to be
something, but it's a bit of a long shot," he says.
The children also have three copies of a small section of chromosome
2. It's this, rather than the single damaged gene, that probably
causes their more general mental and physical problems, says Oostra.
The team is testing other Tourette's sufferers to see whether they
have the same genetic change, and are studying the behaviour of a
mouse that lacks the gene. The gene does not point to any obvious
treatments, says Oostra.
References
Verkerk, A. et al. CNTNAP2 is disrupted in a family with Gilles de
la Tourette syndrome and obsessive compulsive disorder. Genomics,
82, 1 - 9, (2003). |Article|
© Nature News Service / Macmillan Magazines Ltd 2003
http://www.nature.com/nsu/030616/030616-23.html

Family's Genetic Abnormality Linked to Tourette's Syndrome
http://www.betterhumans.com/News/news.aspx?articleID=2003-06-25-2
Gabe Romain
Betterhumans Staff
Wednesday, June 25, 2003, 11:53:43 AM CT



A family with obsessive-compulsive disorder has led researchers to a
gene that may be involved in Tourette's syndrome.
The finding, by researchers from
http://web.eur.nl/english/
Erasmus University  in Rotterdam, Netherlands, is reported in the
journalGenomics(readbstract)
Although they have only detected the gene in one family so far, the
researchers are hopeful that they're on to something.
"This gene might be involved in some people with Tourette's
syndrome, but it won't be in all of them," lead researcher Ben
Oostra told Nature News Service.
Tourette's syndrome
Tourette's syndrome is an inherited neurobehavioral disorder
characterized by sudden involuntary repetitive muscle movements and
vocalizations.
The disorder is named after Gilles de la Tourette, a neurologist who
described the syndrome in 1885.
Many people with Tourette's syndrome develop behavioral problems
such as obsessions and compulsions, inattention, hyperactivity and
impulsivity.
Symptom onset typically occurs during childhood or early
adolescence.
About one in every 2,000 people is affected.
Chromosomal abnormality
Oostra believes that Tourette's syndrome is an extreme version of
obsessive-compulsive disorder.
His team studied a California family in which the father and two
children suffer from OCD and the children additionally suffer from
tics and general mental and physical problems.
In all three family members, an abnormality involving chromosome 2
and chromosome 7 was found.
The abnormality is characterized by a portion of chromosome 2
interfering with a gene called CNTNAP2 that encodes for a membrane
protein that mediates cell-cell interactions in the nervous system.
CNTNAP2 resides on chromosome 7 and is involved in controlling the
firing of nerve cells.
Recent experiments show that nerve cells in the brain of people with
Tourette's syndrome fire too easily, suggesting the transmission of
messages between nerve cells might be working on overdrive.
The sample size for the current study relating a mutation in CNTNAP2
to such problems is small, however, and further studies are
necessary to validate the findings.
To this end, the researchers plan to continue tests on both people
with Tourette's syndrome and animal models.
Abstract
Cntnap2 is disrupted in a family with gilles de la tourette syndrome
and obsessive compulsive disorder
1 Annemieke J. M. H. Verkerka, Carol A. Mathewsb, Marijke Joossea,
Bert H. J. Eussena, Peter Heutinka, Ben A. Oostra ,  and the
Tourette Syndrome Association International Consortium for Geneticsa

a Department of Clinical Genetics, Erasmus MC, P.O. Box 1738, 3000
DR, Rotterdam, The Netherlands
b Neuropsychiatric Genetics Group, Department of Psychiatry,
University of California at San Diego, La Jolla, CA 92093-0810, USA

Received 19 September 2002;  accepted 26 March 2003. ; Available
online 13 May 2003.

Abstract
Gilles de la Tourette syndrome (GTS) is a sporadic or inherited
complex neuropsychiatric disorder characterized by involuntary motor
and vocal tics. There is comorbidity with disorders like obsessive
compulsive disorder and attention deficit hyperactivity disorder.
Until now linkage analysis has pointed to a number of chromosomal
locations, but has failed to identify a clear candidate gene(s). We
have investigated a GTS family with a complex chromosomal
insertion/translocation involving chromosomes 2 and 7. The affected
father [46,XY,inv(2) (p23q22),ins(7;2) (q35–q36;p21p23)] and two
affected children [46,XX,der(7)ins(7;2)(q35–q36;p21p23) and 46,XY,der
(7)ins(7;2)(q35–q36;p213p23)] share a chromosome 2p21–p23 insertion
on chromosome 7q35–q36, thereby interrupting the contactin-
associated protein 2 gene (CNTNAP2). This gene encodes a membrane
protein located in a specific compartment at the nodes of Ranvier of
axons. We hypothesize that disruption or decreased expression of
CNTNAP2 could lead to a disturbed distribution of the K+ channels in
the nervous system, thereby influencing conduction and/or
repolarization of action potentials, causing unwanted actions or
movements in GTS.
Author Keywords: Gilles de la Tourette syndrome; Contactin-
associated protein; Potassium channel; Node of Ranvier;
Translocation
Corresponding author. Fax: +31 10 4089489.
complete list of members can be found under Acknowledgments in Am.
J. Hum. Genet. 65 (1999) 1428–1436.
Full article in PDF  Must cut and past entire link below into your
browser.  Unfortunately there is a fee to join the service and I can
not post the entire abstract here as I don't subscribe to the
service at the moment myself and don't have permissions.  Sorry.
http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6WG1-
48KF9H9-2-B&_cdi=6809&_orig=search&_coverDate=07%2F31%
2F2003&_qd=1&_sk=999179998&view=c&wchp=dGLbVzb-
lSztA&_acct=C000050221&_version=1&_userid=10&md5=dcecf34026b258ead978
18b22b8d3921&ie=f.pdf
----------------------------------------------------------------


http://mp.medscape.com/cgi-bin1/DM/y/hcUj0GAQDt0Dyr0FcV50A8


Behavioral Therapy Helpful in Trichotillomania  CME
News Author: Laurie Barclay, MD
CME Author: Bernard M. Sklar, MD, MS
Release Date: June 6, 2003; Valid for credit through June 6, 2004
Physicians - up to 0.25 AMA PRA category 1 credit(s)


  June 6, 2003 — Behavioral therapy (BT) is more effective than
fluoxetine for the short-term treatment of trichotillomania,
according to the results of a randomized trial published in the May
issue of the Archives of General Psychiatry.
"Both [BT] and serotonin reuptake inhibitors have been reported
effective in the treatment of trichotillomania," write Agnes Van
Minnen, PhD, and colleagues from the University of Nijmegen in the
Netherlands. "Powerful randomized controlled studies comparing the
efficacy of BT and pharmacotherapy in the treatment of
trichotillomania are still lacking."
In this 12-week study, 43 patients with trichotillomania were
randomized to BT, treatment with 60 mg/d fluoxetine hydrochloride,
or a control group awaiting treatment. Of the 43 patients, 40
completed the trial, including 14 in the BT group, 11 in the
fluoxetine group, and 15 in the control group.
BT was superior to the other two groups in reducing the symptoms of
trichotillomania measured by effect sizes on the Massachusetts
General Hospital Hairpulling Scale (3.80 for BT; fluoxetine, 0.42;
and 1.09 for the control group). The percentage of patients who
experienced clinically significant improvements was 64% in the BT
group, 9% in the fluoxetine group, and 20% in the control group.
Patients in the BT group also fared better in terms of severity of
hair loss as rated by independent assessors. General
psychopathologic and depressive symptoms did not differ
significantly between groups.
Study limitations include self-reporting of severity of
trichotillomania symptoms, concerns regarding video ratings of hair
loss, a relatively small sample of self-referred patients, and
failure to address long-term outcomes.
"Behavioral therapy is highly effective for reducing symptoms of
trichotillomania in the short term, whereas fluoxetine is not," the
authors write. "Whether the superior treatment effects for BT will
be maintained in the long term is unknown. Follow-up studies are
essential to provide information about the stability of symptom
reduction."
Eli Lilly supported this study.
Arch Gen Psychiatry. 2003;60:517-522
Learning Objectives
Upon completion of this activity, participants will be able to:
Discuss the signs, symptoms, and treatment of trichotillomania.
Describe the results of a clinical trial comparing BT, fluoxetine,
and placement on a waiting list in the treatment of
trichotillomania.
Clinical Context
According to the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, trichotillomania is the recurrent pulling
out of one's hair resulting in noticeable hair loss. Sites of hair
pulling may include any region of the body in which hair may grow
(including axillary, pubic, and other regions), with the most common
sites being the scalp, eyebrows, and eyelids. Hair pulling may occur
in brief episodes scattered throughout the day or in less frequent
more sustained periods that can continue for hours.
Stressful circumstances frequently increase hair-pulling behavior,
but increased hair pulling also occurs in states of relaxation and
distraction (eg, when reading a book or watching television). An
increasing sense of tension is present immediately before pulling
out the hair. For some hair-pullers, tension does not necessarily
precede the act but is associated with attempts to resist the urge.
There is gratification, pleasure, or a sense of relief when pulling
out the hair.
Some individuals experience an "itchlike" sensation in the scalp
that is eased by the act of pulling hair. The diagnosis is not given
if the hair pulling is accounted for by another mental disorder (eg,
in response to a delusion or a hallucination) or is due to a general
medical condition (eg, inflammation of the skin or other
dermatologic condition). The disturbance causes significant
impairment in social, occupational, or other important areas of
functioning.
According to the authors of the current study, trichotillomania is
considered part of the spectrum of obsessive-compulsive disorders
because of its phenomenologic, epidemiologic, and neurobiologic
characteristics.
Several open-trial studies indicate that BT techniques are
successful in reducing or stopping hair pulling. Most of these
studies report the effectiveness of habit reversal, a BT program
that consists of self-monitoring, awareness training, training of an
incompatible response, preventive interruption of the habit,
overcorrection, and relaxation training.
In some studies, serotonergic medication was found to be effective
for trichotillomania. In several open-trial studies, clomipramine
and fluoxetine proved effective. Controlled studies, however,
yielded conflicting results. In one such study, clomipramine was
found to be more effective than desipramine. In another study, both
clomipramine and fluoxetine were shown to be more effective than
placebo treatment. However, two other controlled studies failed to
demonstrate a superior treatment effect for fluoxetine compared with
placebo treatment.
Thus far, only one randomized controlled study has compared BT with
psychopharmacological treatment. Ninan and colleagues, writing in
the January 2000 issue of the Journal of Clinical Psychiatry,
compared the treatment effects of cognitive BT, clomipramine
treatment (250 mg/d), and placebo in a sample of 16 patients with
trichotillomania. Cognitive BT proved more effective than
clomipramine, and clomipramine was found to be more effective than
placebo.
The present study compares BT with fluoxetine and placement on a
waiting list in the treatment of trichotillomania.
Study Highlights
Forty-three patients with trichotillomania entered a 12-week
randomized, waiting-list-controlled study of BT and fluoxetine (60
mg/d). Forty patients (14 in the BT group, 11 in the fluoxetine
group, and 15 in the waiting-list group) completed the trial.
Treatment effects were evaluated using the Massachusetts General
Hospital Hairpulling Scale, and severity of hair loss was rated by
independent assessors. In addition, general symptoms of
psychopathologic abnormalities and depression were measured.
Patients in the BT group showed a significantly greater reduction in
trichotillomania symptoms, higher effect sizes, and more clinically
significant changes than patients in the fluoxetine and waiting-list
groups. For severity of hair loss, a similar trend was also found in
favor of the BT group.
No significant differences between groups were established for
general psychopathologic and depressive symptoms.
Pearls for Practice
BT is highly effective for reducing symptoms of trichotillomania in
the short term, whereas fluoxetine is not.
Follow-up studies are essential to determine whether the superior
treatment effects for BT will be maintained in the long term.
Authors and Disclosures

This article may discuss investigational products or unapproved uses
of products regulated by the U.S. Food and Drug Administration.
News Author
Laurie Barclay, MD
Writer for Medscape Medical News
Disclosure: Dr. Barclay has reported no significant financial
interests.
CME Author
Bernard M. Sklar, MD, MS
Writer for Medscape Medical News
Disclosure: Dr. Sklar has disclosed that he has served as a
consultant for Schering-Plough.
News CME Staff
Deborah Flapan
Medscape Medical News Coordinator
Disclosure: Ms. Flapan has reported no significant financial
interests.
Elliott Silverman
News CME Manager
Disclosure: Mr. Silverman has reported no significant financial
interests.
Gary Vogin, MD
Clinical Reviewer and Senior Medical Editor, Medscape
Disclosure: Dr. Vogin has reported no significant financial
interests.
----------------------------------------------------------------



http://www.medscape.com/viewarticle/456666_3

Journal of Child Psychology and Psychiatry
May 2003 (Volume 44, Number 4)
The Psychosocial Functioning of Children and Spouses of Adults With
ADHD
Minde K, Eakin L, Hechtman L, et al.
Journal of Child Psychology and Psychiatry. 2003;44(4):637-646
The authors of this study sought to examine the psychosocial
functioning of families with attention-deficit/hyperactivity
disorder (ADHD) caretakers. They sought to (1) assess the prevalence
of ADHD in offspring of adults diagnosed with ADHD, (2) assess risk
for psychopathology and maladjustment in these offspring, (3) assess
the mental health and marital relationship of the spouse of the ADHD
adult parent.
Participants in the study included 33 adults with ADHD, 23 spouses,
and 63 children. The control group included 26 non-ADHD adults, 20
spouses, and 40 children. The adults with ADHD were selected from a
large study looking at the psychosocial functioning of 191 clinic-
referred adults with ADHD. Inclusion for the second study required
the presence of children between 4 and 17 years of age. The
comparison group was recruited through advertisements in the
community newspaper.
Results were as follows: 43% of children with ADHD parents met
criteria for ADHD vs 2% of comparison children. One family had 2
parents with ADHD and 3 offspring with ADHD. There was no
intergenerational continuity for subtype. ADHD mothers had more boys
with ADHD (4 of 11). ADHD fathers had more boys with ADHD (15 of
16). In terms of comorbidity, 70% of ADHD adults had other disorders
vs 15% of the comparison adults. Spouses of adults with ADHD had
more psychiatric disorders but not of a statistically significant
increase. Male spouses of ADHD women were more symptomatic than
comparison males with non-ADHD wives. Marital adjustment was much
poorer in families of ADHD adults, regardless of gender of the
parent; 58% of these parents reported maladjustment (vs 25% of
comparison group). However, spouses of the ADHD parent did not
always rate the marriage as poorly. Divorce rates were not
significantly different in the 2 groups. Assessment of the children
showed that those offspring diagnosed with ADHD had more anxiety and
oppositional defiant disorder than controls. The children with ADHD
also had poor psychosocial functioning, an effect not significantly
influenced by the presence of at least 1 healthy adult. However,
children without ADHD had improved functioning when at least 1
parent was healthy.
In their discussion, the authors noted that only 40% of ADHD adults
lived with a partner and only 31% had children. Average age was 32.5
years for ADHD males and 34.7 for ADHD females. Higher rates of
marriage and children had been expected. ADHD-related emotional
immaturity might have contributed to their delays in marriage and
entry into family life. It was hypothesized that children with an
ADHD parent would have more psychiatric disorders. The presence of
ADHD predicted comorbidity (73%) not presence of an ADHD parent. The
authors also had hypothesized that family and marital functioning
would be compromised by an adult with ADHD. It seemed that men
married to ADHD women were quite distressed and critical of their
wives but that women married to ADHD men were more supportive and
willing to compensate for the husband's impairments. Another
hypothesis was that parental psychopathology, marital discord, and
child psychopathology would be correlated. It seems that the
presence of ADHD in a child did not influence parental mental health
and that non-ADHD children seemed protected from impaired
functioning when at least 1 parent was mentally well. On the other
hand, almost half of the children with an ADHD parent had current
psychiatric disorder and 25% of spouses met criteria. These findings
underscore the importance of assessing family members when treating
an ADHD adult.


http://www.medscape.com/viewarticle/456666_2

Archives of General Psychiatry
May 2003 (Volume 60, Number 5)
Parent-Child Conflict and the Comorbidity Among Childhood
Externalizing Disorders
Burt SA, Krueger RF, McGue M, Iacono W
Archives of General Psychiatry. 2003;60(5):505-513
The authors of this study used data from the Minnesota Twin Family
Study (MTFS) to determine genetic and environmental factors
associated with the development of externalizing disorders in youth
exposed to parent-child conflicts. They entered parent-child
conflict, attention-deficit/hyperactivity disorder (ADHD),
oppositional defiant disorder (ODD), and conduct disorder (CD) into
a multivariate biometrics model to define the role of conflict as
part of a shared environmental factor common to ADHD, ODD, and CD.
Average age during the intake visit was 11 years. The cohort
included 753 same sex, reared-together monozygotic and dizygotic
twins (373 male pairs and 380 female pairs). The authors augmented
the sample with twins born between 1989 and 1991 to bring in 55
additional 11-year cohort pairs of twins. The total sample involved
1616 participants. They assessed parent-child relationships as well
as lifetime ADHD, ODD, and CD incidence.
Results were as follows. First, parent-child conflict appeared to
act as a common vulnerability that increased the risk for multiple
childhood disorders. The authors looked at other correlations
between psychosocial measures and ADHD, ODD, and CD in male and
female children. Conflict was the most highly correlated for all 3
externalizing disorders in both male and females. Low parental
involvement, low twin regard for parent, and low parent regard for
twin were separate variables associated with this factor. Second,
the genes common to ADHD, CD, and ODD may be the same genes that
influence conflict. The models showed that the genetic and nonshared
environmental disorder-specific paths were all significant. Third,
the shared environmental factor that influences conflicts accounted
for roughly a quarter of the shared environmental effects common to
ADHD, CD, and ODD. Although the study and its design have
limitations, the results have important implications. These results
include the probability that the source of psychiatric comorbidity
may lie in broad latent factors such as parent-child conflict and
family environment.

----------------------------------------------------------------


Prestwick Labs raises $15M round
Prestwick's lead drug, Xenazine, Used to Treat Tourette Syndrome
by Tyson Freeman
Prestwick Laboratories Inc., a biotechnology startup with an unusual
approach to drug discovery, announced Thursday, June 19, that it has
raised $15 million in a first-round financing.

The round was co-led by BioAsia Investments LLC of Palo Alto,
Calif., and Sofinnova Ventures of San Francisco, with investments
from Atlas Venture of Boston and BA Venture Partners of Foster City,
Calif.
Cooley Godward LLP represented Prestwick, while investor counsel was
Wilson Sonsini Goodrich & Rosati.
"Prestwick's late-stage product portfolio is one of the best we have
seen in a first-round venture financing," said Edgar Engleman,
general partner of BioAsia Investments. "Dr. [Kathleen] Clarence-
Smith clearly has demonstrated the ability to identify and bring in
promising therapeutic opportunities in the area."
"It is truly remarkable for a company at this stage to have a late-
stage development pipeline that will yield multiple approved drugs
within a reasonably short period of time," said Jim Healy, a general
partner at Sofinnova Ventures, in a statement.
Unlike many other biotechnology companies, Prestwick does no so-
called "basic research" of compounds. Instead of starting from
scratch to search for treatments, Prestwick searches for drugs
already under development at universities or at non-U.S.
pharmaceutical companies.
Prestwick finds opportunities in academia or from European companies
and takes the drugs through Phase II and Phase III trials in the
U.S., said Clarence-Smith, the company's founder, president and
chief scientific officer. "Our favorite opportunities are compounds
that have already been given to humans and have shown good results,"
she added.
That approach has been viewed with favor by investors searching for
a less risky, later-stage investment. "Investors always welcome risk
mitigated on someone else's money," said David Weaver, an analyst at
Bloomfield Hills, Mich.-based consulting firm Aimattech Consulting
LLC. He said that because Prestwick's lead drug has already been
accepted in the European market, it would be an easier sale to the
U.S. Food and Drug Administration (news - web sites) after clinical
trials in the U.S. "It cuts the timeframe and expense down," Weaver
said.
Weaver noted that with drugs already in use in Europe, Prestwick
could better predict the market potential for the U.S.
Prestwick's lead drug, Xenazine, has been shown effective in
multiple published clinical studies and has been approved for use in
Europe, Canada and Australia, but has not yet been approved in the
U.S., except under specific dispensing permits granted by the FDA.
The drug treats hyperkinetic movement disorders, such as
Huntington's disease, tardive dyskinesia and Tourette's syndrome.
Hyperkinesias, also known as chorea, are characterized by excessive,
involuntary purposeless and repetitive movements, which may involve
the face, limbs or the entire body.
While on the market as a schizophrenia treatment, it was given to
people with chorea and was effective. Clarence-Smith said that
nearly 100 million doses to 2,500 patients have been administered in
Europe with at least 80% of the patients showing improvement.
The drug has been registered in Europe with Cambridge Laboratories
of the U.K., said Clarence-Smith, but the company "saw going through
the FDA's process in the U.S. from Europe as a fairly daunting
prospect. So it sat on the shelf."
The market for the drug is not big enough for large pharmaceutical
companies, which puts its commercialization in a type of no-man's
land, said Frank Kung, managing partner at BioAsia Investments. "The
FDA approval process is expensive," he said, "so there is limited
incentive for large pharmaceuticals to undertake the effort and
smaller companies have not had the expertise or the willingness to
take it to the U.S."
The drug is distributed in limited doses by Dr. Joseph Jankovic of
Houston who has Investigation New Drug certification from the FDA.
Jankovic will be one of Prestwick's investigators in the clinical
trial planned to demonstrate the drug's performance.
Clarence-Smith said that the first patients will begin trials next
week and, eventually, the trial will encompass 16 locations in the
U.S. with between 70 and 90 patients.
Most of the proceeds will be used to finish Phase III studies of
Xenazine, and Clarence-Smith expects the drug to be on the market by
the third quarter of 2004.

Other drug candidates in Prestwick's portfolio include drugs for the
treatment of sleep apnea, Parkinson's, Alzheimer's and autism
----------------------------------------------------------------

Melbourne animator shows his feat of clay
June 15 2003

Harvie Krumpet follows the misfortunes of Harvie's life, dealing
with his case of Tourette's syndrome, the loss of a testicle and, of
course, love. The film was shot over 15 months between October 2001
and January 2003. Geoffrey Rush stars as the narrator.
Born in Melbourne, Elliot grew up on a prawn farm in South
Australia, as the son of an acrobatic clown and a tap-dancing mother.
As a child he was constantly creating things with egg cartons and
pipe cleaners, activity that his parents encouraged. "I was always
making things," he says.
He attended the VCA's film and television school, studying all forms
of filmmaking but when his hands touched a lump of plasticine,
Elliot was hooked.
A bookcase in his Windsor home is littered with statues of Harvey.
Tucked behind them are four AFI trophies, just a few of more than 50
awards he has won for his work.
Elliot says more films are in the pipeline and he's keen to get
stuck back into lumps of plasticine, creating more characters for
audiences to enjoy.
There's no tension on the set, Elliot insists, because his
stars, "are easy to work with and never talk back".
Harvie Krumpet will screen at the upcoming Melbourne International
Film Festival.


----------------------------------------------------------------

***Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
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Credits
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Paul Marshall PhD***
Tourette – Updates Moderator
http://groups.yahoo.com/group/Tourette-Updates

To receive these updates in your personal mail box send a blank e-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
Paul@...

For more information on Tourette Syndrome you may visit my site at:
http://paul.tourette.info we are always adding and updating files.

***Permission is granted for posting this message in other groups
and
forums when including everything from the credits lines in your post
for our service at Tourette – Updates.

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Dear Members and Friends:



This alert is going to be the first of several different alerts that
will be sent to you in the next couple of months.  All of the alerts
will be requesting you to take action, but in different ways, so
please respond.  By taking action on one of the alerts does not
preclude you from taking action on all.



SUMMARY:



On June 12, 2003, after months of negotiations, the Senate Health,
Education, Labor and Pensions Committee introduced a bipartisan
special education bill, S. 1248, Individuals with Disabilities
Education Improvement Act of 2003.



The Tourette Syndrome Association applauds the Senate for developing
bipartisan legislation that attempts to find compromises in many
complex educational issues.  S.1248 is a drastic improvement over
the House passed bill, H.R. 1350.



Many of the concerns that TSA had with H.R. 1350 were addressed in
S. 1248.  For example, including convening a manifestation
determination hearing after a student has been removed (H.R. 1350
removed this provision), the bill takes proactive steps to assist
individual students to receive the supports they need to manage
their behavior (H.R. 1350 eliminated positive behavioral supports),
the bill successfully addresses the need for states to do more
around alternative assessments (H.R. 1350 did not), and S. 1248
continues the annual IEP process (H.R. 1350 proposed an optional
three-year IEP).



Although S. 1248 is a marked improvement over the bill passed by the
House and it addresses many of TSA's concerns—there are still
some
provisions that need to be fixed, namely, eliminating functional
behavioral assessments, short-term objectives and full mandatory
funding.



ACTION:



As promised, the Senate Health, Education, Labor and Pensions
Committee is conducting bipartisan feedback meetings on the Hill to
give groups and individuals the opportunity to comment on the bill
before they mark it up.  The Committee has also setup a temporary
email address to receive responses to the bill the individuals that
can not make the meetings.



TSA encourages all members to send the below email to this address:
idea_feedback@....  Emailed responses should be sent to
the attention of and titled "Annie and Connie – IDEA
Reauthorization
Feedback."  Please note that this email is only temporary and
will
not long work past June 25th.



EMAIL MESSAGE:



Subject Line:  Annie and Connie – IDEA Reauthorization Feedback



I am writing you today, a [parent, grandparent, relative, teacher,
friend or advocate] of a child with Tourette Syndrome, to applaud
the Senate Health, Education, Labor and Pensions Committee for
developing a bipartisan bill on many complex special education
issues.  This bill, S. 1248, is a drastic improvement over the bill
that passed the House of Representatives.



While you addressed many of my concerns with H.R. 1350: retaining
manifestation determination hearing, positive behavioral supports,
alternative assessments, and the annual IEP process, there are still
a few provisions that concern me.  First, the bill eliminates the
requirement to conduct a functional behavioral assessment.  How will
a behavioral intervention plan be implemented without an
assessment?  Second, S. 1248 alters the process by which students
with disabilities, including Tourette Syndrome, can be disciplined
for various violations of the school code of conduct.  While this is
a stark improvement over the House bill, the Senate bill permits
schools to remove certain students from their current placement for
specified violations even if the violation was a result of the
child's disability.  Third, S. 1248 removes short-term objectives
from a child's IEP and replaces them with a statement of the
child's
progress toward annual goals that includes quarterly reports.  This
new provision will make it more difficult for parents and schools to
measure a student's progress.  Finally, S. 1248 makes no mention
of
mandatory full funding.  As a [parent, grandparent, relative,
teacher, friend or advocate], I support mandatory full funding, as
opposed to discretionary full funding that was passed by the House.



Thank you for all of the time and hard work that you put into
crafting this bill.  As I already mentioned, this bill is drastic
improvement over what the House passes, but a lot more can be done.



Sincerely,







[Name]

[Address]







______________________________________________

Jeremy R. Scott

Government Relations Specialist

Tourette Syndrome Association

1301 K Street, N.W., Suite 600 East

Washington, D.C.  20005

Direct - 202.408.6443

Fax - 202.408.3260

tsdc@...

*****************************************************************
Please Post this to all your groups and message boards.  Thank you.

Paul Marshall Ph.D
admin@...
http://www.tourettes-disorder.com
***************************************************************

June 10, 2003: CAUTION: If your child is on Paxil (marketed as
Seroxat in Europe), be advised that the UK has banned its use in
children under the age of 18 due to safety concerns of increased self-
harm in children taking that medication. The U.S. FDA is also
reviewing the situation. Contact your prescribing physician or
pharmacist about the matter. When the FDA issues a statement, it will
be noted at

http://www.tourettesyndrome.net

BOSTON (Ivanhoe Newswire) -- According to the National Institute of
Mental Health, as many as 5 percent of all American children, or
about 2 million children, have attention deficit hyperactivity
disorder. Many of them rely on stimulant medications to control the
symptoms but these have many down sides. Now a new medication works
a different way.

Kale Brodie hall loves to play sports. His mom, Paige, says he's
full of creativity. But like other kids with ADHD, kale has
behavioral problems he can't control.

"If the child sitting beside him in class teases him or pushes his
papers off his desk, Kale will react negatively. He will push him
back," Paige tells Ivanhoe.

Stimulants like Ritalin and Concerta controlled Kale's impulses, but
they have to be taken throughout the day. Paige says, "I was
constantly looking at my watch, wondering, 'Do we need to give him
another dosage?'"

Now there's Strattera (atomoxetine). It lasts 24 hours, and it's not
a stimulant.

Child psychiatrist Thomas Spencer, M.D., of Massachusetts General
Hospital in Boston, says, "This is the first really new kind of
compound that's been proven and really tested for this condition.
So, it's really a big paradigm shift."

Dr. Spencer says it helps kids who don't benefit from stimulants --
especially those who are anxious, have tics, or who have trouble
sleeping. "It works primarily on a different system, in this case,
norepinephrine," he tells Ivanhoe. "It helps with inattention,
distractibility and hyperactivity," all problems Paige has watched
Kale struggle with.

"Basically, you have this screen around your brain when you don't
have ADD, and that keeps away all the distractions. But, a person
with ADD has holes in that screen. What the medicine does is it puts
up that screen. It fixes those holes," says Paige, and now they have
a new tool to patch the problem.

Strattera was FDA approved in November 2002 and is available by
prescription. One side effect of Strattera is weight loss. It also
has not been tested in children younger than 6.

This article was reported by Ivanhoe.com, who offers Medical Alerts
by e-mail every day of the week. To subscribe, go to:
http://www.ivanhoe.com/newsalert/.

If you would like more information, please contact:

Thomas Spencer, M.D.
Massachusetts General Hospital
725 ACC Building
Boston, MA 02114

Also you may copy and past the entire following url into a web
browser to get several resutls.

http://www.google.com/search?hl=en&ie=UTF-8&oe=UTF-
8&q=Strattera+&btnG=Google+Search

You need to copy and past the whole link into your browser. For the
access
to the file Atypical_Antipsychotics_in_Tourette's_Disorder_+ It only
shows
1/2 the link activated.  I apologize for the misunderstanding.

I.E. cut and past the entire link into your browser:

http://f2.grp.yahoofs.com/v1/AIDXPtOIPOTq78h9zrrRrXzUu4Mc2nZAAR8xfraU
uwoSeHwV229mCpiPgzkcIg4kpQWZquoxOUiR9kTj/pediatricpsych.pdf

If you are on a slow modem please note it will take a while for it to
download the page.  The file is quite large.  Sorry I did not create
the
file.  It comes as is and I did not want to retype it.

Alternately you may also log into the group files section on yahoo
and click
on the file pediatricpsych.pdf titled APA Clinical Highlights
Program A
Continuing Medical Education (CME) Program

http://groups.yahoo.com/group/Tourette-Updates/files


Paul Marshall
http://paul.tourette.info




----- Original Message -----
From: "Robbi Nester" <rknester@...>
To: <Tourette-Updates-owner@yahoogroups.com>
Sent: Friday, May 30, 2003 7:49 AM
Subject: Re: [Tourette-Updates] Atypical_Antipsychotics_in_Tourette'
s_Disorder_+


> Paul,
> The link didn't work.

A Continuing Medical Educational (CME) Program developed from a
symposium held during the American Psychiatric Association's 2001
Annual Meeting, May 9, 2001, New Orleans, Louisiana.

I chose to make this file available as it had some significant
information in regards to Tourette Syndrome and some of the co
morbid conditions associated.

1. Effects of Antipsychotics in Children with Disruptive
Behavior Disorders
2. Use of Atypical Antipsychotics in Tourette's Disorder
3. Use of Antipsychotics in Children and Adolescents with
Psychotic disorders
4. Long-Term Safety of Atypical Antipsychotics in children and
Adolescents Evidence from Maintenance Trials

Medications Covered in File
• Chlorpromazine and Thioridazine
• Haloperidol
• Resperidone
• Olanzapine
• Ziprasidone
• Clozapine
• Quetiapine

File is @3.49mb and may take a while to download on a slow modem.

The file is located in the Tourette-Updates group files.  Here is a
link.  You will need to log into yahoo when you get there.
http://f2.grp.yahoofs.com/v1/MMnWPm_kQRlbvVkfInQnPacztRk-wjVWq21x-
2BwbD4XaCPC9AqbpqWqYiZ-mZ-jCgPqSxqhzJ26tOjG/pediatricpsych.pdf


This file is in adobe format and you will need adobe reader to
view.  If you do not have adobe reader on your computer you can
download a copy and install it for free here.

http://www.adobe.com/products/acrobat/readstep2.html

----------------------------------------------------------------
Credits
----------------------------------------------------------------

APA American Psychotic Association http://www.psych.org

Paul Marshall***
Tourette – Updates Moderator
http://groups.yahoo.com/group/Tourette-Updates

To receive these updates in your personal mail box send a blank e-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
Paul@t...

For more information on Tourette Syndrome you may visit my site at:
http://paul.tourette.info we are always adding and updating files.

***Permission is granted for posting this message in other groups
and
forums when including everything from the credits lines in your post
for our service at Tourette – Updates.

----------------------------------------------------------------
End
----------------------------------------------------------------

Daily effort reaps rewards

By Denise-Marie Balona | Sentinel Staff Writer
Posted May 23, 2003
http://www.orlandosentinel.com/news/local/volusia/orl-
vlvgrad23052303may23,0,7859791.story?coll=orl-news-print-asec

DELTONA -- Sprawled across a white, embroidered comforter in the
solace of her bedroom, Nikki Patton writes.

Here, the teenager pens essays and poems that hint at her battle
with a perplexing disorder. Through words on reams of notebook
paper, Nikki doesn't have to hold back her emotions or actions.

It's a freedom she hasn't had at Deltona High School, where just
sitting through a class is a daily struggle, she said. Nikki, 18,
must constantly monitor her movements and thoughts outside her
Deltona home because she has Tourette's syndrome. Without
extraordinary control, her body moves without her wanting it to.

She might yell out or make noises, for example, and disrupt other
students. Her legs might kick out from beneath her desk or her arms
may flail, potentially hitting herself or a peer nearby.

Aside from being embarrassing, the disorder she has had since at
least age 6 makes concentrating tough and writing and taking notes
sometimes impossible. Just being at school can be physically
painful. Stress encourages repeated, muscle-straining episodes.

That's why this week is particularly noteworthy. After four years of
struggling, Nikki will graduate Saturday alongside approximately 560
classmates, some of whom she has known since toddler-hood. Her 3.3
grade-point average ranks her in the top third of her class.

It is an accomplishment Carol Patton, Nikki's mom, sometimes doubted
her only child would achieve. Nikki, a petite young woman with wide
eyes and big dimples, has been in and out of school since the eighth
grade.

Friends and family members say it is Nikki's upbeat attitude that
got her through the tough times. She makes those around her at ease
by joking about her disorder and helping them understand it.

"I'm in awe of her sometimes," Carol Patton said. "I don't think I
would have done as well as she did."

Nikki said she stuck it out because she didn't want to miss a chance
to go to school.

"Pretty much, you don't know what you've got until it was taken
away," she chirped. "Once I realized I could get that back, I jumped
at it."

Nikki was diagnosed with Tourette's syndrome in kindergarten. She
was on stage reciting the months of the year in Spanish when Patton
noticed the youngster's head jerking. In fact, Patton used a video
of the production to help a doctor determine that the girl had a
disorder that, according to the National Institute of Neurological
Disorders and Stroke, affects an estimated 100,000 Americans.

In the early years, it wasn't so hard to work around the involuntary
movements, or tics, which were mostly head jerking and rolling eyes
at the time. Nikki became a skilled gymnast and dancer. She won
awards for her science projects.

But in her last year at Galaxy Middle School, the episodes became
more frequent and more severe. Nikki's mother started teaching her
at home.

Missing friends and being in class, Nikki tried to go back to school
her freshman year at Deltona High. That lasted three days. It was
too hard for her to control the outbursts. She also had panic
attacks that made her late for school, said her guidance counselor,
Shirley Robinson.

The teen came back as a sophomore and took one class. Gradually, she
added others.

"For the average high school student who doesn't want anyone to look
at them negatively, it took a lot of guts to come back," Robinson
said.

Eventually, Nikki learned to better deal with her tics. She learned
how to delay them for hours, although that was hard -- like putting
off a sneeze or trying not to scratch an intense itch.

Soon she also learned that people didn't pay much attention when she
left the room. Students listened when she explained her disorder.

Learning was difficult. Nikki had to make up work she missed in
class while she was out of the room or focused on holding back a
tic. She spent extra hours at night studying and went to teachers
for more help.

Nikki's boyfriend, Dane Cass, a junior at Deltona High, calls her an
inspiration.

"Just to see her so determined and get through things, it makes me
try harder," he said. "I've learned a lot from her."

Her work paid off. Nikki recently earned a $500 scholarship to help
pay for college.

She plans to attend Daytona Beach Community College this year and
eventually study pharmacology or mental health issues.

She will also keep writing, and hoping her disorder gets easier to
live with.

Most people with Tourette's get better as they mature, according to
the Tourette Syndrome Association.

"There are some days you definitely look at it as a curse," Nikki
said. "But, most days I look at it like a school assignment. You've
got to get it done. You learn from it."

Denise-Marie Balona can be reached at dbalona@... or
386-851-7923.

FAMOUS TOURETTE'S VICTIM ON THAT SIGNING

Kevin Garside


THE Manchester United dressing- room is about to get a new hair-
dryer, and it will not be Sir Alex Ferguson pushing the buttons.

Goalkeeping Tourette's sufferer extraordinaire Tim Howard is
unlikely to utter a boo during a match, but before and after he will
need to clear the decks in a way that will have even Fergie running
for cover.

But Sir Alex, whose own "hair-dryer" outbursts are legendary, has
nothing to fear from his new signing. Indeed, the MetroStars
superstar could turn out to be the best he has ever made, because
Howard is probably a genius.

That is the view of Britain's most celebrated sufferer of Tourette's
Syndrome, John Davidson, the subject of two award-winning TV
documentaries who claims that those afflicted can be freakishly
gifted and urged Fergie not to hesitate in making Howard his man.

Like Davidson, Howard was born with Tourette's, a neurological
disorder characterised by, among other things, rapid and involuntary
tics and vocal outbursts. Howard was named New York Life
Humanitarian of the Year in 2001 for his role in raising awareness
of TS and is a member of the board of the Tourette Association of
New Jersey.

He is also the top-rated and best-paid goalkeeper in Major League
Soccer, who went to Japan as a member of the American squad and
enjoyed training spells with AC Milan and Feyenoord before
attracting the attention of Manchester United.

Ferguson's interest might be considered a gamble but not by
Davidson, who became a household name following his appearance in
John's Not Mad in 1989 and the 2002 follow-up, The Boy Can't Help
It, two documentaries which did so much to raise public awareness of
TS.

On the contrary, Davidson believes Howard may prove even better
business than the signing of Peter Schmeichel, who himself knew a
little about the scattering of expletives.

According to Davidson the condition is unlikely to affect Howard at
all during matches and can be managed by spending 15 minutes alone
in a room either side of a game.

"Tourette's affects people in different ways. Only a minority are
affected by outbursts and if Howard is one of those it will not
impact during a match. No-one knows why but in circumstances when
sufferers are required to concentrate hard over a defined period the
condition mysteriously disappears," said Davidson, who did not
suffer one outburst during a half-hour conversation with Mirror
Sport.

"Tim will be so focused on what he is doing that he will be able to
pass through an entire match without seeing any symptoms. It's the
same with me. If I'm playing football or driving I do not have an
outburst. But I might when I stop.

"Tim will probably have to manage the situation by sitting down for
15 minutes in a room by himself before and after a match to get the
outburst out of the way. A lot depends, too, on how the other
players and Sir Alex react to him.

"Thankfully there is much more awareness and understanding of
Tourette's these days. When I am having an outburst now around
people who know me it is not a problem. You can even have a laugh
about it. It is one of the ways you learn to cope.

"So in the atmosphere of the United dressing- room, where everyone
knows each other well, I should imagine the air might be blue after
a match, particularly if Fergie and Tim get going."

John has full-blown Tourette's but manages to hold down a job as a
caretaker at a community centre in Galashiels in the Scottish
Borders. His condition was diagnosed at 11 and first highlighted in
the programme John's Not Mad.

His management of the condition, centred on his refusal to take
drugs to control the symptoms and his marvellous relationship with
his mother, has won him widespread acclaim. He is heavily involved
in helping fellow sufferers and has welcomed United's interest in
Howard."Depending on the degree to which sufferers are affected it
can cause turmoil in people's lives," he said. "People just don't
know what is going on and even when they are diagnosed the
medication tends to be based on anti-psychotic drugs, which have
severe side effects.

"They are designed to slow you down. I was on so many drugs I was
walking around half-dead like a zombie. I thought there was no way I
could go on like that, so one day I faced up to the challenge and
decided I would not take the drugs any more. I accept that I have
the condition and just get on with it."

John's appearance in both documentaries raised awareness but also
prompted subsequent research into TS. Thanks in large part to him,
the veil of ignorance has been lifted.

It is also claimed that Mozart was a sufferer, which leads John to
believe that Howard may himself be a genius. "Those that succeed in
their chosen fields tend to do so spectacularly. The research does
not reveal why this is so, only that somehow Tourette's is linked to
examples of outstanding ability.

"I would urge Fergie to go for it. I'm quite sure Howard will become
a cult figure at United. The amount of fan mail I get is
unbelievable from people impressed and inspired by the way I deal
with the condition.

"It will be the same for Tim at United. It may be that Tourette's
has already made him a great and he just needs the right setting to
bring his talent to the widest possible audience. He will get that
at United."


From:

http://www.mirror.co.uk/sport/sporttop/page.cfm?
objectid=12992909&method=full&siteid=50143&headline=FAMOUS%
20TOURETTE'S%20VICTIM%20ON%20THAT%20SIGNING

Helping a Child with Tourette Syndrome
By Pamela S. Lewis

When my son, Daniel, first began to crawl, he made strange movements
and seemed uncoordinated. His pediatrician and naturopath told me
not to worry; every child has his own style, they said. When Daniel
was two, he began making odd stretching facial expressions,
especially when eating. I thought to myself, "Tourette?" I'd been an
RN for 20-some years and had never identified a case of Tourette
syndrome. I immediately went into denial and did not give Tourette
another thought for years.

Daniel developed other symptoms, such as pushing his fingers down
his throat and making himself gag. These symptoms would come
intermittently for about a year and then change into some other odd
behavior. At three, he suddenly began stuttering. This came
overnight following a stressful family trip, and I wondered about
the connection. I felt greatly alarmed, but treated it in a very
matter-of-fact manner, assuring him it would pass. Within a few days
the stuttering no longer debilitated his speech, but it reoccurred
intermittently in a milder version for some years. I felt crushed to
see my bright and verbal son struggle to communicate through his
stutters and what I now know as phonic tics.

Daniel has always expressed as a very happy person, but when he was
about four, he became clinically depressed. Because I had a history
of severe depression associated with wheat consumption, I
immediately removed wheat from his diet, and his mood changed back
to his happy norm within 48 hours. Daniel also had a small peculiar
cough, or sometimes snuffles, which would come for long periods of
time and then go away, and many other symptoms, such as mouth
biting. I suspected food allergies and eliminated several foods from
his diet. He did do better without wheat, dairy, corn, soy, citrus,
nuts, and sugar.

When Daniel reached seven, I was weary of acting as his "food
police" and decided to give him free rein to see how he would manage
his own diet. He ate free-range eggs every day and used large
amounts of honey for breakfast. Only a week went by before he began
throwing his head in a classic Tourette pattern. I could no longer
deny the diagnosis.

I talked with my husband about tics, and he confessed that he
himself had thrown his head in a like manner as an adolescent. He
had also had arm, hand, and facial tics. He had suppressed the
memory, and no wonder; when he exhibited symptoms, he was admonished
to control himself and banished when he could not-the
typical "treatment" of the time. He was not taken to a doctor, so
there was no diagnosis. Eventually my husband learned to control the
symptoms. When we talked with his mother, she recalled experiencing
uncontrollable eye-squinting as a teenager, which had been passed
off as "nerves."

Meanwhile, Daniel could not walk or see straight due to severe upper
body tics. I could hear the little bones in his neck crack when he
threw his head. The movement clearly hurt and exhausted him, and
vocal tics emerged in force. A playmate scolded him for his tics,
and Daniel experienced a despair and humiliation he could not even
verbally process because the tics would not let him.

Once I identified the syndrome, I had a focus to work with. I went
to our small city library and checked out the only book they had on
Tourette. I read words like "incurable" and "lifelong"; I read that
the cause was unknown, but that a genetic influence existed. I
learned that the disease worsened through adolescence (a
particularly difficult time of life anyway) and that the best modern
medicine had to offer came in the form of Haldol and Clonidine to
suppress the symptoms. As a psychiatric nurse, I had seen the
irreversible damage of Haldol in the form of Tardive dyskinesia. I
was aghast at the prospect of giving my child major tranquilizers. I
descended into a period of grieving, accompanied by frantic
activity.

I created an elaborate rotational diet based on specific foods for
my son's blood type. (I now believe that rotating foods is more
effective than using specific foods for blood type.) Eventually,
through a long process of elimination, I discovered Daniel's main
food sensitivities; other sensitivities have come and gone,
sometimes to reemerge. We have come to recognize them as they
present due in part to an increase in tics from those foods, and
also from his craving whatever food causes problems.

Peanuts take a very long time to digest, as long as 12 hours, and
frequently carry a toxin called aflatoxin, which can cause rage
episodes or depression. Daniel used to inhale the smell of peanut
butter and feel his tics worsen. Eggs presented another problem, and
so did most nuts and seeds. Intense sweet foods without a proper
protein back-up caused tics. (Nurses in newborn nurseries know about
the sensitivity of a baby's blood sugar. If it falls too low, the
infant can have a seizure. The nervous system has great sensitivity
to blood sugar changes.) Wheat, dairy, corn and soy all caused tics
if eaten too frequently. Food preservatives and red dye in any
amounts caused increased tics. Any food eaten too frequently became
a problem.

I learned that it takes the body 72 hours to clear 90 percent of any
food to the point where it will not cause a reaction when eaten
again. I found this to be true for many foods, but not all. My son
could eat eggs and chocolate about once every three or four weeks
without any problem. Red dye, food preservatives, and peanuts could
cause severe symptoms in any dose. Rancid or hydrogenated oils
caused the most severe symptoms, which sometimes came on two days
after the offending food was eaten and lasted for two to six weeks.
Wheat, dairy, corn, and soy seemed better given at least 96 hours
apart at first. Many commercial foods, such as ice creams, literally
poisoned Daniel.

I began the process of elimination by writing down whatever Daniel
ate on a given day on a calendar taped to the refrigerator. I kept
separate notes on symptoms. Often, as with peanuts, Daniel wouldn't
have an increase in symptoms until the next day, or even later. I
could find out what caused a problem by looking back and seeing what
he had eaten. I would test a food by giving him only foods I knew he
did not react to for several days before and after I gave him the
suspect food. I then observed the results. One pattern clearly
emerged: The foods he most desired and most often ate were the ones
that caused the biggest problems.

In Chinese medicine, the liver partly controls the phenomenon of
tics. Peanuts, aflatoxin, various chemicals, eggs, and intense sugar
changes all stress the liver's capacity to function. The hormone
storms of adolescence also add to the work of the liver. I began to
think that Daniel's tics might result from toxicity and an
assimilation defect. His nervous system simply did not get the
nutrients it needed in spite of his excellent diet. I began a more
vigorous supplementation with minerals, multivitamins, essential
fatty acids, amino acids, and antioxidants. I also began using
complex homeopathy along with classic constitutional homeopathy.
Daniel received a large dose of his constitutional remedy and lower
doses of liquid homeopathic remedies several times a day, specially
mixed to encourage digestive strength and cerebral balance and to
drain the nervous system of toxins.

Along with diet, homeopathy, and supplements, we provided movement
and kinesthetic education. In addition to neurodevelopmental
exercises to help the nervous system mature, we used the Feldenkrais
Method of Movement Education®. Because Daniel was so young, the
hands-on aspect of the Feldenkrais Method was especially valuable.
The mouth-biting aspect of the syndrome was eliminated with just one
Functional Integration lesson of the Feldenkrais Method. The
Feldenkrais movements also alleviated eye-rolling and other facial
grimaces.

Even though I felt certain of Daniel's diagnosis, I finally took him
to see a pediatric neurologist for a formal evaluation. With
Daniel's agreement, we took him off his diet for a week before the
appointment. His tics and other symptoms emerged in force. His usual
capacity for lengthy concentration and focus vanished within hours.
I felt unprepared for the emotional impact of having a formal
diagnosis of ADHD as well as Tourette syndrome. It took about three
weeks of his usual rotating diet before Daniel returned to his
previous level of functioning.

Because of Daniel's youth, there was much we could do to take
advantage of his neuroplasticity, including working with his belief
system. We never "sentenced" Daniel to having his syndrome worsen
through adolescence, and we enlisted the help of his neurologist to
reinforce the idea that he will outgrow it.

Daniel is now 12, and his tics have continued to come and go. He
manages his own diet to a large extent and tolerates many foods he
did not in the past. The tics emerge in a far milder manner now than
before we began working with diet and natural remedies. They do not
interfere with his life. Most people today do not realize Daniel has
Tourette syndrome. His many activities include martial arts,
baseball, soccer, campfire club, and music lessons. He excels at
reading and loves humor in any form. Although the syndrome is
supposed to worsen through adolescence, he already has broken that
pattern.

I believe we will see an increase in Tourette syndrome, along with
many other diseases, because of our increasingly toxic world. We
could view tics as informational messages about function. Do we
choose to see those messages as something to suppress or to listen
to? Does it work better to focus the attention on the symptom or
expand the view to the whole being and web of life? Do people with
syndromes such as Tourette and Chronic Fatigue have the role of
canaries in the coal mine? How can we look so far and wide for
exotic cures and overlook the food we eat several times each day or
the air we breathe? Food can act as medicine, but most people would
rather change their religion than their diet.

I believe in the intelligence of Nature, the intelligence inherent
in our bodies. Bodily mechanisms have purpose. Symptoms are not
capricious but a message regarding function. I view the complex
phenomenon of Tourette syndrome as grounded in toxicity, subtle
structural imbalances, and inefficient nutrient assimilation. The
elements that predispose a person to these defects seem genetic; but
then lifestyles, eating habits, and movement patterns fall into this
same category, and can change with the correct influences.

FOR MORE INFORMATION

Books and Articles

Anderson, Roy. First Steps to a Physical Basis of Concentration WBC
Book Manufacturers, 1999; see www.crownhouse.co.uk.

Leckman, James F., and Donald J. Cohen. Tourette's Syndrome, Tics,
Obsessions, Compulsions: Developmental Psychopathology and Clinical
Care. John Wiley & Sons, 1999.

"CNS Spectrums." International Journal of Neuropsychiatric Medicine
4, nos. 2 and 3 (February and March 1999).

Feldenkrais, Moshe. Awareness through Movement. Harper and Row, 1972

Goddard, Sally. A Teacher's Window into the Child's Mind and Papers
from the Institute for Neuro-Physiological Psychology. Fern Ridge
Press, 1996.

Gold, Svea. If Children Just Came with Instruction Sheets! Fern
Ridge Press, 1997.

"Links between Autism, Tourette, and Vaccinations." Autism Research
Review International Quarterly Newsletter 13, no. 3 (1999).

"THC Alleviates Tourette Symptoms." Science News 155, no. 14: 215;
www.sciserv.org.

Organizations

The Feldenkrais Guild of North America, 1-800-775-2118;
www.feldenkrais.com.

Tourette Syndrome Association Inc., 42-40 Bell Boulevard, Bayside,
NY 11361-2820

Latitudes, PO Box 210848, Royal Palm Beach, FL 33421-0848;
www.latitudes.org.

The HANDLE Institute, 1530 Eastlake Avenue E., Suite 100, Seattle,
WA 98102; www.handle.org.

Northwest Neurodevelopmental Training Center, P.O. Box 406, 152
Arthur Street, Woodburn, OR 97071; 503-981-0635, fax 503-981-6435.

Northeast Center for Environmental Medicine, P.O. Box 2716,
Syracuse, NY 13220, 315-488-2856.

Seroyal USA, 719 Creel Drive, Wood Dale, IL 60191, 630-227-9827, fax
630-227-9820, sells (to health care professionals only) natural
supplements especially made for Tourette syndrome. Call for a
practitioner near you, or introduce your practitioner to this
company.

Pamela S. Lewis lives with her family near Eugene, Oregon. She works
as an RN and has studied homeopathy, Chinese medicine, herbology,
nutrition, and various types of bodywork. A Certified Feldenkrais
Practitioner, she teaches both modalities of the Feldenkrais Method
of Movement Education.

Article Link:
http://www.mothering.com/10-0-0/html/10-2-0/tourette-syndrome.shtml

Treating Tourette Syndrome / Depression / ADHD
----------------------------------------------------------------------
----------------

New Treatments Combat Depression and Anxiety -- Web Column
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By Stephanie Watson, Ivanhoe Health Correspondent
(Ivanhoe Newswire) -- Millions of Americans suffer regular bouts of
depression or anxiety. Most never seek help, yet experts say new
treatments can effectively relieve symptoms and improve quality of
life.
Nearly 10 percent of American adults -- almost 19 million people --
are depressed, according to the National Institute of Mental Health
(NIMH). Depression can be inherited, or it can emerge following a
traumatic life event, such as a death in the family, childbirth, or a
serious illness.
Depression can vary in severity and duration. Patients with major
depression may experience overwhelming sadness, hopelessness, or
anger for two weeks or more. These uncontrollable feelings can get in
the way of work and relationships. A milder form of depression,
called dysthymia, is less life-altering, but symptoms can stick
around for two years or more.
Many people with depression also suffer from generalized anxiety
disorder (GAD), one of a family of anxiety disorders that includes
obsessive-compulsive and posttraumatic stress disorders. Almost
everyone worries from time to time, but people with GAD feel anxious
for six months or more at a time. As with depression, many GAD
sufferers never seek help.
"People don't know they have a real and treatable disorder," says
Jerilyn Ross, President and CEO of the Anxiety Disorders Association
of America. "A lot of health professionals don't recognize it, don't
know the symptoms, and don't know that it's treatable."
One effective way to treat anxiety and depression is with medication.
When researchers studied the brains of depressed people, they
discovered an imbalance in the neurotransmitters serotonin and
norepinephrine -- chemicals that facilitate communication between
nerve cells in the brain. Antidepressant medications called selective
serotonin reuptake inhibitors (SSRIs) restore balance to these
neurotransmitters. SSRIs are also used to treat generalized anxiety
disorder, along with antianxiety drugs like clonazepam (Klonopin),
Iorazepam (Ativan), and buspirone (BuSpar).
Older tricyclic antidepressants (TCAs) and monoamine oxidase
inhibitors (MAOIs) also balance out neurotransmitters, but they tend
to have unpleasant side effects. Researchers are investigating new
delivery systems, including a patch-release version of the MAOI
selegiline, that may eliminate some of these side effects.
Ongoing studies are focusing on several new medications to treat
anxiety and depression. Duloxetine, a serotonin and norepinephrine
inhibitor, appears to alleviate the symptoms of depression and put
patients into remission. A class of medications called corticotropin-
releasing factor (CRF) antagonists block the production of a chemical
in the brain that scientists believe triggers anxiety.
Medication may be used on its own, or in conjunction with
psychotherapy (also called "talk therapy"). Cognitive behavioral
therapy is a popular form of psychotherapy in which patients learn to
identify and control the negative thoughts and behaviors that trigger
their depression and anxiety.
"Both with depression and anxiety, often individuals have a
distortion in their thinking about what is going on in their life,"
explains Reg A. Williams, Ph.D., professor at the University of
Michigan School of Nursing, and adjunct clinical nurse specialist at
the school's Depression Center. "Helping them to readjust that
thinking can be very powerful."
About 80 percent of patients who don't respond to medication or
psychotherapy find relief in a controversial treatment called
electroconvulsive therapy (ECT). Electrodes attached to the patient's
head deliver electrical impulses that trigger a brain seizure. The
seizure works much like medication, releasing neurotransmitters in
the patient's brain. But experts caution that the procedure may cause
short-term memory loss.
For patients squeamish about undergoing shock therapy, magnetic
therapy is a new alternative. This still investigational treatment
sends powerful magnetic pulses to the brain. Unlike ECT, magnetic
therapy does not appear to cause memory loss.
An epilepsy treatment is also showing promise in depression therapy.
Vagal nerve stimulation (VNS) uses a pacemaker-like device to
stimulate the vagus nerve, which carries messages to and from the
brain. In early trials, VNS has shown good results in patients who
did not respond to standard treatments.
In recent years, researchers have turned their attention to
alternative therapies for depression. St. John's Wort, which has been
used by Europeans for centuries, is one of the most promising
candidates. Although a 2002 National Institutes of Health (NIH) study
found St. John's Wort no more effective than a placebo for treating
major depression, researchers say the herbal remedy still shows
promise.
"The jury is out on it, but we still feel that the data are
encouraging enough to not dismiss it yet," says Jonathan Alpert,
M.D., Ph.D., Associate Director of the Depression Clinical and
Research Program at Massachusetts General Hospital. But he cautions
that St. John's Wort can have adverse interactions when taken with
drugs used to treat AIDS and to stop organ rejection.
Researchers are also looking at a naturally-occurring compound in the
body called S-adenosylmethione (SAMe), which builds
neurotransmitters. In 1998, SAMe was released as an over-the-counter
dietary supplement. Studies thus far have presented compelling
evidence that SAMe has antidepressant properties.
The first step to treating depression, anxiety, or any other mental
health problem, is to consult with a primary care physician or
psychologist, says Alpert. A psychological evaluation can rule out a
medical condition, and identify the most appropriate course of
treatment.
This article was reported by Ivanhoe.com, who offers Medical Alerts
by e-mail every day of the week. To subscribe, go to:
http://www.ivanhoe.com/newsalert/.
If you would like more information on depression and anxiety
disorders, please contact:
Anxiety Disorders Association of America
(240) 485-1001
http://www.adaa.org
The Center for Mental Health Services
http://www.mentalhealth.org/cmhs/
Depression and Bipolar Support Alliance
(800) 826-3632
http://www.dbsalliance.org/
National Alliance for the Mentally Ill
(800) 950-NAMI
http://ocd.nami.org/
National Mental Health Association
(800) 969-6642
http://www.nmha.org
Further reading on depression and anxiety disorders:
Bassett, Lucinda. From Panic to Power: Proven Techniques to Calm Your
Anxieties, Conquer Your Fears, and Put You in Control of Your Life.
New York: HarperCollins, 1995.
Bourne, Edmund J. Healing Fear: New Approaches to Overcoming Anxiety.
Oakland, California: New Harbinger Publications, 1998.
DePaulo, J. Raymond. Understanding Depression: What We Know and What
You Can do About It. New York: Wiley, 2002.
O'Connor, Richard. Undoing Depression: What Therapy Doesn't Teach You
and Medication Can't Give You. New York: Berkley Publishing Group,
1999.
Solomon, Andrew. Noonday Demon: An Atlas of Depression. New York:
Simon & Schuster, 2001.
Reported April 7, 2003
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Study Confirms Concerta (methylphenidate HCl) Effective, Safe
Treatment For Attention Deficit Hyperactivity Disorder

FORT WASHINGTON, PA -- April 1, 2003 -- A study of children with
Attention Deficit Hyperactivity Disorder (ADHD) who had previously
responded to treatment with methylphenidate demonstrates that once-a-
day Concerta(R) (methylphenidate HCl) CII effectively controls ADHD
symptoms and maintains a consistent safety profile over one year. The
study, an interim analysis of one of the longest studies to date of
continued use of a stimulant medication, indicates that children with
ADHD are likely to continue to respond to Concerta for up to 12
months. The findings were published in the April issue of the Journal
of the American Academy of Child & Adolescent Psychiatry.

The findings also add to the literature in countering some long-
standing beliefs about the effect of methylphenidate, the active
ingredient in Concerta, as a long-term ADHD treatment. Investigators
reported that Concerta did not adversely affect growth (weight and
height); did not appear to induce or worsen tics; did not adversely
affect vital signs (i.e., blood pressure, pulse); and had no
clinically meaningful effect on a wide range of blood tests (i.e.,
red and white blood cell count, liver function tests). Additionally,
despite its extended-release pharmacokinetic profile and long
duration of action, Concerta apparently had little impact on parental
perception of sleep quality.

"While it is generally agreed that pharmacological treatment of ADHD
may be needed for extended periods, few treatment studies of ADHD
extend beyond a few months," said study lead author Timothy Wilens,
M.D., Director of Substance Abuse Services in the Pediatric and Adult
Psychopharmacology Clinics at Massachusetts General Hospital. "This
12-month analysis of a longer-term study establishes the safety and
efficacy of Concerta over one year, and addresses some concerns about
the effects of long-term methylphenidate treatment on growth (height
and weight), tics, vital signs, and sleep quality. Given the chronic
nature of ADHD, it is comforting to know that medications such as
Concerta continue to work in reducing ADHD and associated impairment."

About the Study

The study was designed to evaluate the effectiveness and tolerability
of Concerta administered openly over a period of up to 24 months. It
involved one of the largest samples of stimulant-treated ADHD
children followed systematically for at least one year.

A total of 407 children, ages six through 13, who had participated in
one of the previous efficacy or pharmacokinetic studies for Concerta
participated in this multicenter, open-label nonrandomized study.

Subjects were initially assigned to one of three daily dosing levels
of once-a-day Concerta (18, 36, or 54 mg) based on their dose in the
previous study. Doses could be adjusted upward or downward in 18 mg
increments if considered appropriate by the investigator, and
participants were permitted to stop taking the medication for
weekends or non-school days, or to have medication holidays.

At the beginning of the study, 116 (28.5%) subjects were taking the
18 mg dose, 193 (47.4%) were taking the 36 mg dose, and 98 (24.1%)
were taking the 54 mg dose. At the end of treatment (last dose before
completing or withdrawing from study), 61 (15.0%), 163 (40.0%), and
183 (45.0%) subjects were taking the 18 mg, 36 mg, and 54 mg doses,
respectively. During this period, 39.8% of children had no dose
change, 19.7% had dose increases only, and 38.4% of subjects
experienced both increases and decreases.

"Increases in dosage of ADHD medications over time is not unusual,
and in line with the published literature," explained Dr.
Wilens. "The findings from this research suggest that a 20 percent
upward titration of Concerta may be appropriate for some children to
receive the full benefit of the medication," he added.

Children's ADHD-related behavior in school and at home were rated at
various intervals of the study by parents and teachers, using
established tools such as the IOWA Conners Ratings Scale. Researchers
reported that teacher and parent/caregiver monthly IOWA Conners
scores remained relatively consistent throughout the 12-month period.

"The results of this study coupled with results from short-term
clinical studies support the usefulness of this once-daily
preparation of OROS(r) MPH for ADHD," said Dr. Wilens. "Further
studies of Concerta in adolescents, adults, and subgroups of
individuals with ADHD, and with concurrent psychosocial treatments
are warranted to determine the impact of this long- acting stimulant
preparation on the long-term outcome of ADHD." The majority of
adverse events reported during the study were judged mild in severity
and consistent with the known safety profile of methylphenidate.
There were no unusual or unexpected adverse events.

Of the 407 subjects who received study medication, 289 (71 percent)
completed 12 months of treatment. Of the 118 subjects who
discontinued treatment prior to 12 months, 31 subjects (7.6%)
discontinued for lack of effectiveness, 30 of whom were taking the 54
mg dose. Other reasons for discontinuation included adverse events
(n=28), lost to follow-up (n=16), noncompliance or protocol violation
(n=14), personal reasons (n=11), female reaching menarche (n=6), and
other (n=12).

About Concerta

Concerta is an extended-release formulation of methylphenidate for
ADHD treatment that is designed to last through 12 hours, with just
one morning dose. Concerta uses an advanced OROS(R) extended-release
delivery system. The OROS(R) trilayer tablet is designed to release
the medication in Concerta in a controlled pattern providing symptom
management throughout the day.

Concerta should not be taken by patients who: have significant
anxiety, tension, or agitation, since Concerta may make these
conditions worse; are allergic to methylphenidate or any of the other
ingredients in Concerta; have glaucoma, an eye disease; have tics or
Tourette's syndrome, or a family history of Tourette's syndrome; are
taking a prescription monoamine oxidase inhibitor (MAOI). Concerta
should not be administered to patients with preexisting severe
gastrointestinal narrowing. Concerta should not be used in children
under six years, since safety and efficacy in this age group have not
been established. In the clinical studies with patients using
Concerta, the most common side effects were headache, stomach pain,
sleeplessness, and decreased appetite.

Concerta should be given cautiously to patients with a history of
drug dependence or alcoholism. Chronic abusive use can lead to marked
tolerance and psychological dependence. (See Boxed Warning in the
full U.S. Prescribing Information for Concerta).

Concerta was approved by the U.S. Food and Drug Administration in
2000. It is marketed in the United States by McNeil Consumer &
Specialty Pharmaceuticals. For more information about Concerta, call
1-888-440-7903 or visit http://www.concerta.net.


SOURCE: McNeil Consumer & Specialty Pharmaceuticals
----------------------------------------------------------------------
----------------------------------------------------------------------
--------------------------------


----------------------------------------------------------------------
-----
Alleged Beating and Tourette Syndrome.
----------------------------------------------------------------------
-----
On stand, inmate recounts his alleged beating
There was nothing remarkable about Leonard Gibson as he walked into a
federal courtoom yesterday. Not at first. Dressed in track pants and
white sneakers, he looked like an ordinary 22-year-old, even if his
boyish face made him appear younger.
But as he settled into the witness chair in the US District Court
trial of three jail guards charged with beating inmates, Gibson
immediately began to show signs of the disorder he was diagnosed with
as a child -- the tics and sputtered slurs of Tourette's syndrome.
In 1999, when an arrest on stolen car charges left him awaiting trial
at Suffolk County's Nashua Street Jail, Gibson said the sounds and
movements he couldn't help making were met with taunts -- and
ultimately violence -- by the officers charged with his care.
To a jury captured as much by his outbursts as by the otherwise even
tones of his testimony, Gibson -- the youngest alleged victim of the
guards on trial -- recounted an assault he said left him bruised and
sleepless inside the jail's medical unit.
''My ears were throbbing,'' Gibson said of the alleged beating by
Officer William Benson and Lieutenant Eric Donnelly.
The pain from the punches to his ribs, Gibson said, made it hard to
go to the bathroom, to lie down on his side, even to breathe. ''My
sides were burning,'' he said.
Donnelly, the shift supervisor on the night of Gibson's alleged
beating, has already pleaded guilty to the charges against him.
Before the trial began this week, he and two other officers admitted
their roles in a number of inmate beatings and coverups. A fourth
officer is also expected to plead guilty.
The guilty pleas have left three officers facing trial on similar
civil rights charges. Of the three, only Benson is charged with the
1999 assault on Gibson.
All of the inmates allegedly beaten were awaiting trial, not serving
sentences. Still, defense lawyers have cast the inmates as aggressive
felons with histories of misconduct behind bars. Before Gibson took
the stand, defense attorney Stephen Pfaff attacked the credibility of
another alleged victim, Reginald Roscoe, ticking off a long list of
assault and drug convictions, as well as violent behavior inside the
jail where he said he was beaten.
But before his 1999 arrest, Gibson had never seen the inside of a
jail cell. He wound up at Nashua Street at 18, unable to make the
$500 bail ordered by a judge. Since his first arrest, Gibson
testified, he has had more problems with the law, but not major ones:
breaking into a boat to steal beer, shoplifting, and a repeat of the
crime that first landed him in jail, receiving a stolen car.
On the night of Oct. 16, 1999, Gibson said, he was eating dinner when
he got up to wash a piece of fruit. But he had not asked Benson for
permission, and that decision, he said, cost him dearly. Scolded by
Benson for leaving the table on his own, Gibson said he muttered
under his breath, ''What an attitude.'' But Benson heard something
much worse, and Gibson was taken back to his cell.
Inside the cell, Gibson said, the anger he felt at being forced back
inside fed his brain disorder, and he tried to expel all the nervous
energy from his system. He burst into jumping jacks and began lifting
his metal bed like a barbell. All the while, the twitches and
involuntary outbursts continued, he testified.
Moments later, Donnelly and Benson appeared at his cell, according to
Gibson. When he heard Donnelly shout the words, ''Crack 16,'' Gibson
said he backed up in his cell because he knew what it meant: the door
to his cell was about to open, and he feared Donnelly and Benson
would enter.
When they did, Gibson said, Donnelly grabbed him and put his knee
into Gibson's ribs. Standing behind Donnelly, Benson began hitting
Gibson's ears. When Gibson tried to cover his face with his hands, he
said Donnelly removed them. Benson then punched him in the forehead
before both men left his cell, Gibson said. He testified that he
watched the guards show the cuts they had suffered to the nurse on
duty.
As a group of new guards came to relieve the 3 p.m. to 11 p.m. shift,
Gibson said he heard the instructions Benson left for his colleagues
as they arrived.
''Watch 16,'' was what Gibson told the jury that Benson said. ''He's
a punk.''
Francie Latour can be reached at flatour@g...
This story ran on page B1 of the Boston Globe on 3/8/2003.
© Copyright 2003 Globe Newspaper Company.

----------------------------------------------------------------------
-----
Jail Officer Convicted in Beating Case

BOSTON - A federal jury convicted a former jail officer Monday of
beating inmates and trying to cover up the assaults, but acquitted
two co-defendants in a case that has been one of a series of
embarrassments for the sheriff's department in Boston.
Brian Bailey, 31, of Boston, was found guilty of criminal civil
rights violations, conspiracy to obstruct justice, obstruction of
justice and perjury, but was acquitted of another conspiracy charge.
Bailey was among seven Nashua Street Jail corrections officers
indicted in the alleged beatings of five pretrial detainees between
June 1998 and October 1999.
One former inmate, who has Tourette's syndrome, testified that prison
guards beat him after they accused him of insulting them under his
breath. Another former inmate said he was beaten for hiding a
sandwich in a laundry bag.
The case was one of several problems for the Suffolk County Sheriff's
Department, which has been buffeted by claims of mismanagement,
criminal activity, institutional violence and sexual abuse.
Jurors acquitted Officer William R. Benson, 51, of Kingston, and
Deputy Sheriff Thomas M. Bethune Jr., 51, of West Peabody, of all
charges. The other defendants have entered guilty pleas or are
expected to do so.
"Today's verdict should send a strong message that an individual's
rights do not stop at the jail cell door," U.S. Attorney Michael
Sullivan said in a statement.
Bailey's attorney, Evan Slavitt, said his client "was disappointed
with the jury's verdict, and he stands by what was said on the
stand." They were considering an appeal.
Bethune, reached at his home, said he was "ecstatic" over his
acquittal, and looked forward to his reinstatement.
Bailey is scheduled to be sentenced July 7. The conspiracy count
carries a maximum five-year sentence, and the other three counts
carry 10-year maximums.
Lt. Eric J. Donnelly, 36, of Boston, Deputy Sheriff Anthony Nuzzo,
32, of Boston, and Deputy Sheriff Melvin J. Massucco III, 39, of
Revere, have pleaded guilty in the case. Lt. Randall R. Sutherland,
45, of Randolph, is scheduled to plead guilty on April 15.
In a dramatic end to a four-year investigation of the state's largest
county corrections system, a federal jury yesterday cleared two of
three Suffolk County jail guards who were charged with beating
inmates and covering up the episodes.
Two years after the men were indicted, the jury acquitted veteran
officers Thomas Bethune Jr. and William Benson, both 51, of all
charges.
Benson was cleared in a case that brought forth one of the
prosecution's most dramatic witnesses: Leonard Gibson, who suffers
from Tourette's syndrome and testified that he was beaten by Benson
and another guard inside the medical unit of the Nashua Street Jail.
The jury, which deliberated for two days, returned guilty verdicts
against Brian Bailey, 31. Bailey was convicted of using excessive
force, obstructing justice, perjury, and conspiracy in the beating of
Nikolas Dais, a suicidal pretrial detainee.
----------------------------------------------------------------------
-----
Two guards acquitted in beatings
In a dramatic end to a four-year investigation of the state's largest
county corrections system, a federal jury yesterday cleared two of
three Suffolk County jail guards who were charged with beating
inmates and covering up the episodes.
Two years after the men were indicted, the jury acquitted veteran
officers Thomas Bethune Jr. and William Benson, both 51, of all
charges.
Benson was cleared in a case that brought forth one of the
prosecution's most dramatic witnesses: Leonard Gibson, who suffers
from Tourette's syndrome and testified that he was beaten by Benson
and another guard inside the medical unit of the Nashua Street Jail.
The jury, which deliberated for two days, returned guilty verdicts
against Brian Bailey, 31. Bailey was convicted of using excessive
force, obstructing justice, perjury, and conspiracy in the beating of
Nikolas Dais, a suicidal pretrial detainee. Bailey was acquitted of
one conspiracy charge.
Dais was the only one of three alleged victims not to take the stand.
Bailey's sentencing was set for July 7.
In a trial that encompassed three defendants and 15 counts, more than
a minute elapsed before US District Court Judge Reginald C. Lindsay
read off the second of Benson's two not-guilty verdicts. When it
came, Benson lowered his head and he began to tremble, wiping tears
from his eyes.
''After four long years, it's gratifying they finally got the
truth,'' Benson said outside the courtroom. In the moments between
his two verdicts, Benson said, ''My whole life was in front of me.''
Stephen Pfaff, the lawyer for Bethune, said, ''It's been a long, long
time,'' referring to the investigation that began in 1999. ''I was
nervous, like everyone else, but confident that the jury would do the
right thing.''
Following Benson's firing in 1999, a private arbitrator ordered the
Sheriff's Department to reinstate him with back pay. Bethune, who was
suspended without pay following the 2001 indictment, may also return
to the department.
But a sheriff's spokesman said yesterday that neither Benson nor
Bethune will return until department lawyers review their trial
testimony.
Gibson expressed shock at Benson's acquittal. ''Surprised? Of course
I'm surprised. He's guilty,'' he said. ''He's one of the ones who
beat me. ... If he can get away with that, what's to stop him from
doing it again?''
Bailey, Benson, and Bethune each took the stand in their own defense,
denying the charges and telling jurors that they never witnessed any
beatings while employed as guards at the jail.
Three other veteran guards, who were named in the original
indictment, Eric J. Donnelly, Anthony Nuzzo, and Melvin Massucco III
pleaded guilty to all of the brutality and conspiracy charges against
them before the case went to trial and are scheduled to be sentenced
in June.
Another indicted officer and former lieutenant, Randall Sutherland,
is expected to plead guilty in April.
US Attorney Michael Sullivan said that the two acquittals did not
undermine the basis of the lengthy investigation.
''I don't see it as a serious blow at all,'' Sullivan said. ''Proof
beyond a reasonable doubt is an extremely high standard, and the
defendants were members of a law enforcement agency. ... Looking back
on it, I'm not sure there's anything we could've or would've done
differently.''
Sullivan would not comment on the prosecution's most controversial
witness, Michael Ross, a former guard who kept his badge for two
years despite failing the department's training academy and its use-
of-force exam.
Ross was the only witness whose testimony implicated all three
officers on trial. In exchange for his testimony and for pleading
guilty to a misdemeanor, prosecutors agreed to ignore any other
crimes Ross may have committed while he was a guard, and to recommend
a one-year sentence.
But in two days of withering cross-examination by defense attorneys,
Ross repeatedly contradicted himself and often said he could not
remember testimony he had given the previous day.
This story ran on page B1 of the Boston Globe on 4/1/2003.
© Copyright 2003 Globe Newspaper Company.

----------------------------------------------------------------
Other Articles With Tourette Syndrome
----------------------------------------------------------------

'I'M DISABLED, I WAS NOT DRUNK,' MAN TELLS CITY COURT
----------------------------------------------------------------

BY ECHO REPORTER

12:00 - 07 April 2003
A disabled man landed in court after police mistook his handicaps for
disorderly behaviour. Officers thought Adrian Elvis Presley Chambers
was behaving drunkenly and being abusive outside his girlfriend's
block of flats in Exeter.

But Chambers was shaking because he moves unsteadily due to cerebral
palsy and an amputated arm.

He was swearing at officers because he suffers from fits similar to
Tourette's syndrome, which causes uncontrollable verbal outbursts.

The incident occurred when he was trying to get back into the block
of flats to help his disabled girlfriend who had fallen over.

Chambers, of Eaton Drive, Exeter, agreed at Exeter magistrates court
to be bound over in the sum of £20 to keep the peace for a month.
Magistrates agreed to withdraw a charge of causing a public order
offence by using threatening, abusive or insulting words or behaviour.

Prosecutor Derek Frame said: "Mr Chambers was outside a residential
block trying to gain entry to see a friend. He couldn't get in and he
pushed past police.

"His actions may have been misinterpreted. He has a previous good
character and no past convictions." Caroline Salvatore, in
mitigation, said police had made a genuine mistake.

"Mr Chamber's fiancee has cerebral palsy, is wheelchair-bound and has
a speech impediment so she cannot make herself easily understood,"
she said.

"When she falls, legislation means her warden is not allowed to raise
her and an ambulance has to be called.

"The police and an ambulance attended after the fall and Mr Chambers
was anxious to help.

"He knew the ambulance crew would need to ask her questions and might
not be able to understand her.

"Police didn't realise and thought he was being a busybody. They
thought he was drunk."

Magistrates told Chambers there had been a misunderstanding and they
realised he had never intended to cause trouble.

----------------------------------------------------------------
----------------------------------------------------------------
Bus ban
----------------------------------------------------------------
A FIVE-year-old girl faces being banned from Sheffield's buses unless
she carries a letter proving she can't control her swearing.
Chelsea Aheran has Tourette's syndrome – a condition where children
unconsciously blurt out foul language – and is diagnosed with a
hyperactivity disorder.
She is at the centre of a row between her parents, Tracey and Peter,
and bus operator First, which wants her to carry a letter on their
buses to inform drivers of her condition.
The argument follows a bust-up between Tracey and a driver in the
street in Birley Moor Road, Birley, after Chelsea swore at him.
First is investigating the incident. But the company has told the
family its drivers must be told of Chelsea's condition as she boards
their buses, or she may "face problems" staying on board.
Tracey, of Newstead Grove, Birley, said: "I know her swearing causes
problems, and we have lost friends over it.
"But how can you try and impose rules on a little five-year-old girl
to use a bus?
"Whenever my husband gets on with her and she starts swearing, he
tells people 'my daughter's got problems'.
"People are usually all right about it. I don't see why children with
problems should be treated like this. It's disgusting."
There have been at least two other occasions when First drivers have
been offended by her bad language, Tracey said.
Chelsea is taught at Birley Primary School, but her parents say she
could be soon moved out of mainstream schooling.
Her three brothers, Joel, aged seven, Joshua, two, Jason, one, and
her six-year-old sister Courtney do not have her behavioural problems.
First's communications director Brandon Jones said its drivers are
instructed to ban passengers who abuse their drivers physically or
verbally.
He said: "It is a very delicate situation, and obviously it would be
wrong to ban this little girl from our buses because of her problems.
"The solution we are presenting is that we will issue her with a
letter from one of our senior managers which will then explain to our
drivers the problems this young lady has.
"We are in a situation where our customers and staff are being
confronted with expletives, through nobody's fault."
FACTFILE
Tourette's syndrome (TS) is a neurological disorder.
Sufferers experience sudden outbursts of bad language.
The condition is also shown up by making rapid, sudden movements,
repeatedly.
The outbursts can occur many times a day, or intermittently.
Symptoms can disappear for weeks or months at a time.
Some people with TS are able to hold back their outburst for up to
hours at a time, but this only leads to a stronger outburst later.
27 March 2003
----------------------------------------------------------------
----------------------------------------------------------------
Support group helps families of children with severe mental illness
----------------------------------------------------------------

Sunday, April 6, 2003
By STEVE SCHMADEKE, sdschmadeke@n...
For Janette L'Heureux and her family, the process often starts with a
surge as sudden and unexpected as weather, an electrical storm in a 9-
year-old brain that leaves her son violent, tearing apart his room at
home or attacking playmates.
In many ways, the L'Heureuxs are more fortunate than other families:
Not only was their son, Josh, diagnosed with early-onset bipolar
disorder and Tourette's syndrome at a young age, but both parents
have good jobs with good insurance.
Even so, as their son grows older and more difficult to control, the
L'Heureuxs may be faced with a gut-wrenching decision faced by some
families who have children with severe mental illness.
In order to get the residential treatment he needs, they may have to
give up custody of their son and turn him over to the state-funded
foster care system, though for now they have no intention of doing so.
"We've heard the horror stories," said Janette L'Heureux, who has
started a parent support group called Caring4Kids. "It's really,
really sad."
The state Department of Children and Families does not track how many
mentally ill children are committed to the foster care system, but
says there are programs in place to prevent that from happening.
But even Pam Baker, administrator for DCF's mental health programs in
the five-county district that includes Lee and Collier counties,
acknowledges that the system needs money.
Her budget last year provided $19 million for adult mental health
services and less than $3 million for children.
"We've got it backwards," said David Schimmel, director of the David
Lawrence Center in Naples. "It's kind of a sad system. They (parents)
have to wait for things to get so bad with their kids or they have to
give up custody in order for them to get services."
The numbers are straightforward.
There are only 20 residential treatment beds for children in the
area, all located at the David Lawrence Center, but only five for
families who do not qualify for Medicaid.
The foster care system, on the other hand, has many more available
beds and every child in it receives Medicaid benefits, but it was
never intended as a service for the mentally ill.
"Resources for children in the state outside of the welfare system
are really pretty scarce," said Jan Eustis, director of the Ruth
Cooper Center, a mental health facility in Fort Myers. "It is not a
well-funded system. We've heard a lot of parents say, 'I just don't
know where to go.'"
"The biggest frustration these families have is trying to access to
those services," said Stan Applebaum of the Florida Advocacy Council.
Families who try to pay for residential treatment programs, which
typically run a minimum of four months, are looking at tens of
thousands of dollars in medical bills.
"I don't know many families who make $50,000 who can afford that," he
said.
The L'Heureuxs have already spent time searching for a residential
treatment program in which they feel comfortable placing their son.
They found a center in Wisconsin they liked, but it cost $12,000 a
month and a six- to 12-month enrollment was encouraged.
"I could maybe pay that for one month, but that is not long enough to
help him," Janette L'Heureux said.
Parents and mental health leaders also are concerned that the state
Legislature will cut back on mental health money even more this year
at a time when the number of children diagnosed with mental illness
is rapidly increasing.
The six-bed emergency unit that serves about 750 children a year at
David Lawrence has been financed by a $280,000 special appropriation,
but local politicians have indicated there is a good chance the money
won't be there this year.
Officials at the Ruth Cooper Center are concerned that a grant for a
program that provides in-home counseling for about 130 mentally ill
children a month at risk of hospitalization will also be left by the
wayside.
And some parents find it ironic that, at a time when politicians,
physicians and community leaders say they are scrambling to keep Lee
Memorial Health System's trauma center open to prevent patients from
being sent to Tampa or Miami, that is exactly what happens to many
children with severe mental illness.
It has happened to the L'Heureux family twice — their son, Josh,
stayed at a Miami hospital for five days and a Sarasota children's
facility for nine days.
Still, DCF's Baker said she and others were lobbying the Legislature
to allow mentally ill children to be classified as a family of one,
which would let them qualify for Medicaid.
The process of privatizing the mental health and foster care system
started this month when Camelot Community Care, the organization
heading up the effort in this district, began a $1 million phase-in
and planning project.
The organization is scheduled to take over much of DCF's functions by
the end of the year.
Executive Director Lee Scherrer said he plans to remove redundancies
and add more responsibility to the system by changes such as
appointing a single case worker to follow each child.
"They (parents) will see a more streamlined agency with more
flexibility and choices," he said.
But mental health officials such as Schimmel say that, without more
money, these changes will not mean much.
"DCF gets battered all the time, but they are simply a product of the
state Legislature," he said.
Meanwhile stand-in parents like Liza Williams, a teaching assistant
at the David Lawrence-affiliated SunshinWe've heard the horror
stories," said Janette L'Heureux, who has started a parent support
group called Caring4Kids. "It's really, really sad."
The state Department of Children and Families does not track how many
mentally ill children are committed to the foster care system, but
says there are programs in place to prevent that from happening.
But even Pam Baker, administrator for DCF's mental health programs in
the five-county district that includes Lee and Collier counties,
acknowledges that the system needs money.
Her budget last year provided $19 million for adult mental health
services and less than $3 million for children.
"We've got it backwards," said David Schimmel, director of the David
Lawrence Center in Naples. "It's kind of a sad system. They (parents)
have to wait for things to get so bad with their kids or they have to
give up custody in order for them to get services."
The numbers are straightforward.
There are only 20 residential treatment beds for children in the
area, all located at the David Lawrence Center, but only five for
families who do not qualify for Medicaid.
The foster care system, on the other hand, has many more available
beds and every child in it receives Medicaid benefits, but it was
never intended as a service for the mentally ill.
"Resources for children in the state outside of the welfare system
are really pretty scarce," said Jan Eustis, director of the Ruth
Cooper Center, a mental health facility in Fort Myers. "It is not a
well-funded system. We've heard a lot of parents say, 'I just don't
know where to go.'"
"The biggest frustration these families have is trying to access to
those services," said Stan Applebaum of the Florida Advocacy Council.
Families who try to pay for residential treatment programs, which
typically run a minimum of four months, are looking at tens of
thousands of dollars in medical bills.
"I don't know many families who make $50,000 who can afford that," he
said.
The L'Heureuxs have already spent time searching for a residential
treatment program in which they feel comfortable placing their son.
They found a center in Wisconsin they liked, but it cost $12,000 a
month and a six- to 12-month enrollment was encouraged.
"I could maybe pay that for one month, but that is not long enough to
help him," Janette L'Heureux said.
Parents and mental health leaders also are concerned that the state
Legislature will cut back on mental health money even more this year
at a time when the number of children diagnosed with mental illness
is rapidly increasing.
The six-bed emergency unit that serves about 750 children a year at
David Lawrence has been financed by a $280,000 special appropriation,
but local politicians have indicated there is a good chance the money
won't be there this year.
Officials at the Ruth Cooper Center are concerned that a grant for a
program that provides in-home counseling for about 130 mentally ill
children a month at risk of hospitalization will also be left by the
wayside.
And some parents find it ironic that, at a time when politicians,
physicians and community leaders say they are scrambling to keep Lee
Memorial Health System's trauma center open to prevent patients from
being sent to Tampa or Miami, that is exactly what happens to many
children with severe mental illness.
It has happened to the L'Heureux family twice — their son, Josh,
stayed at a Miami hospital for five days and a Sarasota children's
facility for nine days.
Still, DCF's Baker said she and others were lobbying the Legislature
to allow mentally ill children to be classified as a family of one,
which would let them qualify for Medicaid.
The process of privatizing the mental health and foster care system
started this month when Camelot Community Care, the organization
heading up the effort in this district, began a $1 million phase-in
and planning project.
The organization is scheduled to take over much of DCF's functions by
the end of the year.
Executive Director Lee Scherrer said he plans to remove redundancies
and add more responsibility to the system by changes such as
appointing a single case worker to follow each child.
"They (parents) will see a more streamlined agency with more
flexibility and choices," he said.
But mental health officials such as Schimmel say that, without more
money, these changes will not mean much.
"DCF gets battered all the time, but they are simply a product of the
state Legislature," he said.
Meanwhile stand-in parents like Liza Williams, a teaching assistant
at the David Lawrence-affiliated Sunshine School, see firsthand the
scars left on mentally ill children who have gone through the foster
care system.
Williams, who hopes to adopt the 15-year-old schizophrenic girl she
has cared for for about a year, says that the girl still asks
permission to use the bathroom and also asks to be told what to do
with her free time.
"I just wish she could feel comfortable," Williams said.
e School, see firsthand the scars left on mentally ill children who
have gone through the foster care system.
Williams, who hopes to adopt the 15-year-old schizophrenic girl she
has cared for for about a year, says that the girl still asks
permission to use the bathroom and also asks to be told what to do
with her free time.
"I just wish she could feel comfortable," Williams said.

We've heard the horror stories," said Janette L'Heureux, who has
started a parent support group called Caring4Kids. "It's really,
really sad."
The state Department of Children and Families does not track how many
mentally ill children are committed to the foster care system, but
says there are programs in place to prevent that from happening.
But even Pam Baker, administrator for DCF's mental health programs in
the five-county district that includes Lee and Collier counties,
acknowledges that the system needs money.
Her budget last year provided $19 million for adult mental health
services and less than $3 million for children.
"We've got it backwards," said David Schimmel, director of the David
Lawrence Center in Naples. "It's kind of a sad system. They (parents)
have to wait for things to get so bad with their kids or they have to
give up custody in order for them to get services."
The numbers are straightforward.
There are only 20 residential treatment beds for children in the
area, all located at the David Lawrence Center, but only five for
families who do not qualify for Medicaid.
The foster care system, on the other hand, has many more available
beds and every child in it receives Medicaid benefits, but it was
never intended as a service for the mentally ill.
"Resources for children in the state outside of the welfare system
are really pretty scarce," said Jan Eustis, director of the Ruth
Cooper Center, a mental health facility in Fort Myers. "It is not a
well-funded system. We've heard a lot of parents say, 'I just don't
know where to go.'"
"The biggest frustration these families have is trying to access to
those services," said Stan Applebaum of the Florida Advocacy Council.
Families who try to pay for residential treatment programs, which
typically run a minimum of four months, are looking at tens of
thousands of dollars in medical bills.
"I don't know many families who make $50,000 who can afford that," he
said.
The L'Heureuxs have already spent time searching for a residential
treatment program in which they feel comfortable placing their son.
They found a center in Wisconsin they liked, but it cost $12,000 a
month and a six- to 12-month enrollment was encouraged.
"I could maybe pay that for one month, but that is not long enough to
help him," Janette L'Heureux said.
Parents and mental health leaders also are concerned that the state
Legislature will cut back on mental health money even more this year
at a time when the number of children diagnosed with mental illness
is rapidly increasing.
The six-bed emergency unit that serves about 750 children a year at
David Lawrence has been financed by a $280,000 special appropriation,
but local politicians have indicated there is a good chance the money
won't be there this year.
Officials at the Ruth Cooper Center are concerned that a grant for a
program that provides in-home counseling for about 130 mentally ill
children a month at risk of hospitalization will also be left by the
wayside.
And some parents find it ironic that, at a time when politicians,
physicians and community leaders say they are scrambling to keep Lee
Memorial Health System's trauma center open to prevent patients from
being sent to Tampa or Miami, that is exactly what happens to many
children with severe mental illness.
It has happened to the L'Heureux family twice — their son, Josh,
stayed at a Miami hospital for five days and a Sarasota children's
facility for nine days.
Still, DCF's Baker said she and others were lobbying the Legislature
to allow mentally ill children to be classified as a family of one,
which would let them qualify for Medicaid.
The process of privatizing the mental health and foster care system
started this month when Camelot Community Care, the organization
heading up the effort in this district, began a $1 million phase-in
and planning project.
The organization is scheduled to take over much of DCF's functions by
the end of the year.
Executive Director Lee Scherrer said he plans to remove redundancies
and add more responsibility to the system by changes such as
appointing a single case worker to follow each child.
"They (parents) will see a more streamlined agency with more
flexibility and choices," he said.
But mental health officials such as Schimmel say that, without more
money, these changes will not mean much.
"DCF gets battered all the time, but they are simply a product of the
state Legislature," he said.
Meanwhile stand-in parents like Liza Williams, a teaching assistant
at the David Lawrence-affiliated Sunshine School, see firsthand the
scars left on mentally ill children who have gone through the foster
care system.
Williams, who hopes to adopt the 15-year-old schizophrenic girl she
has cared for for about a year, says that the girl still asks
permission to use the bathroom and also asks to be told what to do
with her free time.
"I just wish she could feel comfortable," Williams said.


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----------------------------------------------------------------
Treating Tourette Syndrome Tics / Movement Disorders
----------------------------------------------------------------

Xenazine It has a high success rate for movement disorders.  It is
Xenazine (formerly called Tetrabenazine) from Cambridge
Laboratories.

Commentary Provided by Tom
Spokane WA.  I'm a 43 year old male with Tourettes, OCD, and Restless
legs.
tom.deanna@...

  My name is Tom.  I live in Spokane WA.  I'm a 43 year old male with
Tourettes, OCD, and Restless legs

My Neuro Dr. has had me on quite a few prescriptions with limited or
no
success.  I started a new one on 12/18/02.  It is not offered in the
U.S.  My
Dr. found out about a drug (I think he said at a world conference)
that has
been around for 30 years in the U.K.  It has a high success rate for
movement
disorders.  It is Xenazine (formerly called Tetrabenazine) from
Cambridge
Laboratories.  I started with 1/2 of a 25 mg. pill at night.  After
the first
night starting it, my tics were almost gone.  I could not believe it!
I had
been so sore for quite a long time from hard, slamming tics to my
shoulders,
neck and the back of my head, it felt wonderful to stop moving.  It
is now
1/29/03 and I am still on my original dose with the same results.
The only
time I have any significant tics is at night when I go to bed.  I
will end my
day with about 3 - 6 head shakers.  Not too bad from what I was going
through
all day long.  I am also on Seroquel that I am slowly taking my self
off of.
I had been on 200 mg. each night and now I am down to 75 mg. and
still doing
good.  (every 5 days I reduce by 25 mg.)  Another points of interest
(at least
to me), each night when I split my pill, it never divides exactly in
two.  I
have always taken the smaller half and put the larger one back in the
bottle.
Also when ever anyone would touch the back of my neck, shoulders or
head, my
tics would increase like crazy.  Now when I am touched there, it does
not
bring out any tics at all.

My Dr. is almost as excited as I am.
If anyone has any questions, I will try to answer as best that I
can.

I cannot put into words the relief and calm that I feel.

If you want my Dr. name, I am sure he would not mind.

Tom

On the info that came with the Xenazine it says -
"Active ingredient is Tetrabenazine, and the inactive ingredients are
starch,
lactose, talc, magnesium stearate and the colorant iron oxide yellow
(E172).
Tetrabenazine affects some chemicals in the brain and by so doing it
helps to
control jerky and irregular movements."
"Xenazine is used for treatment of diseases which cause kerky
irregular,
uncontrollable movements such as Huntington's chorea, senile chorea,
tardive
dyskinsia and hemiballisumus."
"Before taking medicine.  Make sure that it is safe for you to take
Xenazine.
If you answer YES to any of the following questions, or are not sure,
tell
your doctor, nurse or pharmacist:
Have you ever had an allergic reaction to any of the ingredients on
Xenazine?
Are you taking any medicine containing reserpine?
Have you recently been treated for depression?
Are you taking any medicine containing levodopa?"

It then has a warning about being or becoming pregnant or breast
feeding.
Then - taking your medicine.
"While taking your medicine - Unwanted affects from this medicine
usually mild
in nature.  The main unwanted effect is sleepiness and drowsiness,
particularly when taking high doses."

I am currently on 12.5 mg. per night and I do not have any sleepiness
or
drowsiness problems.  I have only taken it at night, so I am not sure
if I
would be sleepy during my waking hours.

"Occasionally, patients have experienced a lowering of their normal
blood
pressure.  Some patients have experienced digestive problems.  In
rare cases,
Xenazine can cause depression or symptoms similar to those seen in
Parkinson's
disease.  (Uncontrollable movements of the hands, arms, legs and
head.)  If
this happens you must tell your doctor. He/she may want to take a
lower dose."

Into on How to store your medicine.

That is pretty much all the info on it that I have.

Below is the e-mail and web sites.  When I do a Google search for
Xenazine, a
few different area of Cambridge Laboratories come up.

email: marketing@...

http://www.camb-labs.com/products.htm


----------------------------------------------------------------
Treating Tourette Syndrome / Anti-aggressive properties
----------------------------------------------------------------

Celexa / Lexapro Citalopram shows anti-aggressive properties
http://www.psychiatrymatters.md/index.asp?
sec=news_story&story_id=10237&usedate=20030129

The selective serotonin reuptake inhibitor citalopram may be
effective for reducing impulsive aggressive behavior, preliminary
study findings indicate.
"A large body of literature now exists indicating that disturbances
of central serotonin function have an important role in suicidal
behavior, aggression, and other personality traits that are
characterized by impulsivity," Christopher Reist and colleagues, from
the Veteran Affairs Beach Healthcare System in Long Beach,
California, USA, observe.
In an 8-week trial, the team treated 25 patients with cluster B
personality disorders or intermittent explosive disorder with 20–60
mg/day of citalopram.
Among 20 patients who completed the study, there was a significant
improvement in Overt Aggression Scale-Modified (OAS-M) aggression
scores, which were reduced from 32.82 to 4.73. Similarly, subjective
irritability scores decreased from 3.5 to 1.45, and overt
irritability scores were reduced from 3.23 to 0.91.
These improvements were evident from week two, and were maintained
throughout the study.
Improvements with citalopram were also evident on the Barratt
Impulsiveness scale and the Buss-Durkee Hostility Inventory.
The team notes that decreases in OAS-M measures were of similar
magnitudes in patients with and without depressive symptoms,
dismissing the suggestion that improvements were a consequence of
nonspecific antidepressant effects.
"Future studies, therefore, should compare the anti-aggressive
effects of serotonergic antidepressants with those with non-
serotonergic mechanisms," Reist et al conclude in the Journal of
Clinical Psychiatry.



----------------------------------------------------------------------
-----
Other articles that mention Tourette Syndrome.
----------------------------------------------------------------------
-----

Reported February 10, 2003
Childhood Injuries and Behavioral Disorders
OTTAWA, Ontario (Ivanhoe Newswire) -- Children and adolescents with
attention deficit/hyperactivity disorder (ADHD), or other behavioral
problems, are more likely to suffer injuries, a new study shows in
this month's Pediatrics.
The first well-designed research to look at the issue noted more than
a 1.5-times greater incidence of injuries among children prescribed
Ritalin than those not taking the drug.
Many studies have suggested a link between injuries in childhood and
adolescence and behavioral disorders, but most have not met the
strictest standards for scientific study. These researchers conducted
the first population-based study to measure the incidence of injuries
in this group.
The research included all children age 19 and under living in British
Columbia as of December 31, 1996. Children prescribed Ritalin were
included in the behavioral disorders group. Investigators analyzed
injury data for all the children, including fractures, open wounds,
poisoning, concussion, burns, falls, postoperative complications,
motor vehicle accidents, suffocation, drowning, and adverse effects
of drugs, among others.
A comparison of the two groups of children showed those with a
Ritalin prescription were more likely to suffer these types of
injuries than those without a prescription. The finding held true
even after results were adjusted to take other factors that could
have influenced injury risk into account.
Write the authors, "Our findings suggest that targeted preventive
strategies, including parental counseling on injury risk and
specialized driving instruction, may be beneficial for this group of
children and youth."
This article was reported by Ivanhoe.com, who offers Medical Alerts
by e-mail every day of the week. To subscribe, go to:
http://www.ivanhoe.com/newsalert/.
SOURCE: Pediatrics, 2003;111:262-269

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Featured Up-Date  New treatment alternative

This article was reported by Ivanhoe.com.
Reported January 17, 2003
Levodopa Treating Tourette Syndrome

ST. LOUIS (Ivanhoe Newswire) -- Nearly 230,000 people in the United
States are living with Tourette syndrome. Doctors say it's difficult
to diagnose and even harder to treat. Now, they may have a new way to
treat the condition.
As a detective, Bob Marbs is good at cracking cases and those
sleuthing abilities have come in handy. He says, "I had always
suspected or at least for the last 10 or 15 years that I did have
Tourette's because I did a lot of reading on it."
His suspicions were right. Marbs was diagnosed with Tourette syndrome
last year after 53 years of living with tics.
"I had a lot of eye-blinking and I would open my eyes a lot real
wide," he says. His tics include shoulder shrugs, clearing his
throat, and excessive blinking.
Neuropsychiatrist Kevin Black, M.D., says Tourette's may be connected
to the hormone dopamine in the brain.
"There's some suggestions that there are abnormalities in the cells
on the other side of the synapse, the ones that are actually
releasing the dopamine," says Dr. Black, of Washington University in
St. Louis.
To test the theory, he studied the Parkinson's drug levodopa. It
boosts dopamine production in the brain. In patients who received
levodopa, there was a 40-percent reduction in tics.
Dr. Black says, "This might be a new treatment alternative for people
with Tourette syndrome."
Marbs is taking part in a larger study on the drug. For the study,
he's not sure if he's getting the drug or not, but says he's happy to
be contributing to research. He says, "The tics that I have, I'm used
to, but we're not good friends. I would like to be rid of these tics
and if there was a drug, and hopefully there is, I would take it."
And after 50 years, he could finally close the case.
Side effects of levodopa may include nausea and lightheadedness, but
Dr. Black says most people don't suffer any side effects. He also
says about 3 percent of the population will have at least one tic in
their lifetime even while taking the drug.

----------------------------------------------------------------
Education
----------------------------------------------------------------

Slim chance of smaller classes

EDUCATION - HUGH REILLY

MANY people imagine that if class sizes could be reduced as easily as
the size of Kate Winslet's bottom is for magazine covers, teachers
would call out "Gouranga! Be happy!"

This is as spurious as suggesting that banning hip-hop music will
lead to a decrease in gun culture.

Given the choice, most teachers would rather rap with a class of
malleable 33 first-year greenhorns than a dozen disaffected S4 raging
bulls.

Present class limits were set in the 1970s, a golden age of education
when rote learning and routine thrashing of teenagers made the
Scottish school system the envy of the world. A maximum of 33 pupils
in first and second year and 30 in the upper school was deemed to be
the ideal, figures that were probably the result of a compromise, ie
the Educational Institute of Scotland said 20, the government of the
day said 34, thus 33 was another union victory.

Quite why it drops from 33 to 30 for older pupils is beyond me -
perhaps the legislators foresaw the obesity crisis causing a
classroom crush. My guess is that the figures were plucked out of the
air, the tried-and-tested method of creating education visions (see
target reductions in exclusion and truancy for details).

These days, the class maximum has, in reality, become the minimum, as
school managers strive to be cost effective. It's much more efficient
to have 60 pupils sitting in two classes of 30, even if eight kids
are dyslexic, six have severe learning difficulties, three are on
Ritalin and another soul suffers from Tourette's Syndrome. When class
sizes were set decades ago, social inclusion was not part of the
agenda.

Recently, I had the privilege of teaching a class of 22 fourth-year
foundation pupils, six of whom were starlets of the school's anger
management troupe. Each lesson was a rerun of Jesus Christ Superstar,
with me in the role of Ciaphas - "Tell the rabble to be quiet, I
anticipate a riot."

The sad truth is that mainstream schools across Scotland are not
coping with the influx of special needs pupils and, allied to general
pupil indiscipline, there has been growing pressure to reduce sizes
as if it were the panacea for every education ill. Of course, the
real solution is to put proper support into the classroom for those
pupils who need it and who are in fact legally entitled to it.
Bizarrely, such is the scarcity of Support For Learning (SFL) staff,
subject teachers have to "bid" for their presence. Better to say that
the bidding system is rather like a lottery funding application;
those with the savvy to sell their case receive assistance.

Like the Lotto, this means that the least deserving are often the
greatest beneficiaries of management largesse. Think private school
sports complexes funded by Thunderball.

In secondaries, shyster science staff, already limited to teaching a
maximum of 20 pupils and whose classroom activity is assisted by lab
technicians, somehow manage to convince management that the presence
of SFL teachers is essential. Meanwhile, down in the social subjects
area, poor chalkies are expected to get on with the job of teaching
33 kids with a variety of educational needs.

Slimming down classes will do a fat lot of good if we persist in
merely going through the motions of helping special needs students
and learners with emotional and behavioural disorders.

  Article URL
http://www.thescotsman.co.uk/index.cfm?id=49812003

----------------------------------------------------------------
Individual Achievement with TS
----------------------------------------------------------------

From Gloucester Daily Times Home Page January 22, 2003

Building his future ... one Popsicle stick at a time

By GREG COOK
Staff writer
Brian Polizzia has always been good with his hands. Even though he
has long struggled with Tourette's syndrome, attention deficit
disorder and bipolar disorder, he could draw and he could build
things -- house models and club houses and bird houses.
"As soon as I was strong enough to hold a hammer and strike a nail I
was building things," he says.
Polizzia is a short, solid man, with wavy brown hair, a mustache and
goatee. His palms are calloused and his fingers marked with cuts that
are healing.
Polizzia was born in Gloucester 28 years ago but moved with his
parents to the San Diego, Calif., area when he was 5. He helped his
father fix up their first house there -- painting the front fence and
a wall in his bedroom, gardening. He used to take his homework and go
sit at construction sites and watch the guys work. One time, when he
was 7 or 8, one of the guys helped him hammer together a bird house
from construction scraps.

To Read the whole Article URL
http://www.ecnnews.com/cgi-bin/g/gwed.pl?slug-GPOLIZ21

----------------------------------------------------------------
More TS in Hollywood
----------------------------------------------------------------

Ed Norton
Invisible man
By Sam Allis, Globe Staff, 1/12/2002
NEW YORK - Edward Norton could be a dweeb on the tenure track in
anthropology at Princeton. Or a tyro at Morgan Stanley. He probably
isn't asked much to take his shoes off at airports. You forget him
the minute you see him. Except on the big screen. You remember him
there. Norton is an actor with the benign looks of a suburban soccer
dad and an uncommon intelligence infused by a gorgeous natural
talent. He leaves indelible tracks all over a film. It's usually
after the credits roll that audiences start to grasp what he just did…
Norton's next project is to adapt to the screen ''Motherless
Brooklyn,'' a book about a gang in Brooklyn, one of whose members has
Tourette's Syndrome. He'll write and star in it as that member, and
perhaps direct it. It's classic Norton, a complicated part requiring
Oscar-obvious, high-wire virtuosity.
''I laugh when I read the book about Tourette's because I think I'm
about three synapses away from being autistic,'' he says. ''I
compulsively mimic people's rhythms and ticks. I like doing funny
voices and putting on clothes and beards and stuff.''

The Boston Glob
http://www.boston.com/dailyglobe2/012/living/Ed_Norton+.shtml

----------------------------------------------------------------------
-----
Other articles that mention Tourette Syndrome.
----------------------------------------------------------------------
-----

HOPES FOR A NEW HOME FOR MUM IN MIX-UP OVER RENT ARREARS
12:00 - 13 January 2003
BY SHANE DEAN
http://www.thisisnorthdevon.co.uk/displayNode.jsp?
nodeId=103352&command=displayContent&sourceNode=103341&contentPK=36131
32

Raising a relative's child? There's help
By Lola Sherman
UNION-TRIBUNE STAFF WRITER
January 15, 2003
http://www.signonsandiego.com/news/northcounty/20030115-
9999_1mc15kin.html

If links do not work because they are not completely active, simply
cut and past the entire url/link into a browser window on your
computer.   Sometimes the active links are cut off in the line wrap
of the text  If you have any difficulty contact me below.

----------------------------------------------------------------
Credits
----------------------------------------------------------------

Paul Marshall***
Tourette – Updates Moderator
http://groups.yahoo.com/group/Tourette-Updates

To receive these updates in your personal mail box send a blank e-
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Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
Paul@...

For more information on Tourette Syndrome you may visit my site at:
http://paul.tourette.info  we are always adding and updating files.

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forums when including everything from the credits lines in your post
for our service at Tourette – Updates.

----------------------------------------------------------------
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----------------------------------------------------------------

----------------------------------------------------------------
Treating Tourette Syndrome
----------------------------------------------------------------

!!!THURSDAY, Dec. 19 (HealthScoutNews) -- The drug mecamylamine,
which blocks nicotine receptors in the brain, seems to relieve mood
instability and depression in adolescents and children with Tourette
Syndrome.
So says a preliminary study in the latest issue of Depression and
Anxiety.
The national randomized study by University of South Florida College
of Medicine researchers included 50 children and adolescents with
Tourette Syndrome and at least one of several mood disorders,
including depression, attention-deficit disorder, oppositional
defiance disorder, obsessive compulsive disorder and hypomania.
Of the 50 study participants, 38 completed the eight-week trial -- 21
taking a placebo pill and 17 receiving mecamylamine, a drug
originally used to treat hypertension.
The study found the greatest mecamylamine-related improvements in the
behavioral and emotional symptoms of four Tourette's patients who
also had major depression. They had significant decreases in sudden
mood changes, irritability, inattention, anxiety, restlessness,
impulsiveness and demanding attention.
The study participants with Tourette's and depression who received
the placebo showed no improvement.
The researchers recently began a controlled study of mecamylamine in
children and adolescents with bipolar disorder, also called manic
depression.

----------------------------------------------------------------
Tourette's In Hollywood
----------------------------------------------------------------

!!!Williams travels to 'Big White' for Artisan comedy
By Zorianna Kit
LOS ANGELES (The Hollywood Reporter) --- Robin Williams has come
aboard to star in Artisan Pictures' comedy "The Big White," to be
directed by British helmer Mike Mylod.
No start date has been set as Artisan is looking for a
production/distribution partner for the project.
"White," written by Collin Friesen, is set in Alaska and follows a
hapless travel agent whose wife suffers from psychosomatic Tourette's
syndrome. Convinced that a warmer climate might cure her ailment, he
hatches a scheme to cash in on a million-dollar life insurance policy
by stealing a corpse and pretending that it is his long-missing
brother.
Producing "White" are Michael Birnbaum of Empire Pictures,
Christopher Eberts and Chris Roberts of Ascendant Pictures and David
Faigenblum.
Williams is repped by CAA and MBST Management.


!!!Actor gives voice -- and body -- to vile Gollum
Susan Wloszczyna USA TODAY
  NEW YORK -- Andy Serkis thought he had a three-week voice-over stint.
But the actor's pivotal part as Gollum in The Lord of the Rings
trilogy ballooned into four years of grueling labor in confining
skintight suits that isn't over yet.
Gollum, the hobbit-turned-tortured-creature after being corrupted by
the evil ring that Frodo the hero hobbit (Elijah Wood) now carries,
briefly slithered on screen in last year's The Fellowship of the
Ring. But in The Two Towers, which opens today, he crawls out of the
dark and into a major subplot as guide to Frodo and Sam
Serkis, 38, a British character actor (Mike Leigh's Topsy-Turvy),
says he often approaches roles physically. After Rings master Peter
Jackson saw tapes of his recording sessions in which he acted out
Gollum's reptilian crawls, the director decided to use motion-capture
technology to trap that performance on film. In other words, an
emoting human lurks under the digital skin and bones.
Says Serkis: ''He wanted Gollum to be the most fully integrated
digital character ever, actor-led as opposed to being led by
animation with a voice dropped in.'' Yes, he's far-far from Jar Jar.
First, Serkis invented a strangulated rasp of a voice for Gollum, who
craves the ring like a drug addict. ''He carries his pain in his
throat. I wanted it to be like a Tourette's muscle-memory thing.''
Serkis also had to suggest the vengeful Gollum's suppressed alter
ego, Smeagol, who speaks in high-pitched nasal tones. ''When Frodo
shows Gollum mercy, Smeagol is like an abused child. He's been outed
and finds the courage to speak.''
Each scene with Gollum, Frodo and Sam was shot three times. First,
Serkis wore a light greenish Lycra suit (''like a tie-dyed downhill
skier'') to match his character's skin and performed opposite Wood
and Astin.
And don't think those naughty hobbits didn't tease Serkis about his
offbeat attire. ''It was nothing but mockery from them for two
years,'' he says with a laugh.
Another version was done with Serkis speaking off-camera while the
other actors reacted to an empty space where an animated Gollum would
be inserted. Finally, Serkis donned a motion-capture outfit covered
with dots that act as coordinates for cameras to follow.
''Every movement you see is pretty much what I've done,'' he says.
Gollum's froggy visage even echoes his features.
Some might think Gollum is just another jabbering sidekick, like
Harry Potter's elf pal, Dobby. But Jackson and New Line Cinema, the
studio behind the Rings series, are pushing for an acting Oscar for
Serkis, a first for an effect.
''The Elephant Man had John Hurt buried under rubber,'' Jackson says
of a nominated performance from 1980. ''Whether it is foam latex for
John Hurt or a skin of pixels for Andy Serkis, the actor still drives
the performance.''
Serkis has yet to do the motion capture for The Return of the King,
which is due next December.
But the final episode probably will contain a bonus: flashbacks that
reveal Gollum before he became Gollum.
Which means, Serkis says, ''I get to show my own face.''

----------------------------------------------------------------
Tourette's in Politics
----------------------------------------------------------------

!!!This is an article that they used the term Tourette in an odd
way.  Here is the clip, you can click on the link if you would like
to read the whole story.
… The idea that Lott took the occasion of an old timer's birthday
to
introduce a new policy initiative to bring back segregation -- a
Democrat policy -- is ludicrous. Lott is a fine fellow; he just has
some sort of liberal-Tourette's syndrome that makes him spout
Democrat ideas at random. A few years ago, Lott practically wanted to
give the adulterous Air Force pilot Kelly Flinn a silver star for her
service. Remember that?
http://story.news.yahoo.com/news?tmpl=story&u=/021220/51/2wgtu.html

----------------------------------------------------------------
Clinical Trials for TS
----------------------------------------------------------------

!!!Clinical Trials, recruiting patients.
http://www.clinicaltrials.gov/ct/gui/c/a2r/action/SearchAction/screen/
OpeningScreen?Term=Tourette


----------------------------------------------------------------
Credits
----------------------------------------------------------------

For more information on Tourette Syndrome you may visit my site at:
http://paul.tourette.info  we are always adding and updating files.

Thank you,

Paul Marshall
Tourette – Updates Moderator

Comments or Questions:
Paul@...

Permission is granted for posting this message in other groups and
forums when including everything from the credits lines in your post
for our service at Tourette – Updates.
----------------------------------------------------------------
End
----------------------------------------------------------------

Tourette Updates and Info for December 2002

Not a whole lot new this month here are some points of interest to
look at:

New Opinion Article by Jones_kacm;
Tourette syndrome gets a lot of bad press.  But sometimes I wonder
whether you can blame an impulse control disease.
(Apologies to anyone who is offended by this article)
http://au.geocities.com/jones_kacm/blame.htm

Artistic Changes to Tourette Syndrome – Spectrum Disorder;
Stop by and tell us what you think in the Guestbook
www.mrindianajones.com

Hope everyone has a Very Merry Christmas and a Happy New Year!

Paul Marshall
Tourette-Updates Moderator
http://groups.yahoo.com/group/Tourette-Updates

If you have something new or of interest that needs to be looked at
or into, send it to me here at:
Paul@...

This was the question and the answer follows:

Q:     I was searching around for the meds my son uses...he is now on
75 mg. of Imipramine (and 10mg Lorazepam)...so what kind of relation
is this to what I noticed on the website--Clomipramine...sounds kinda
like Clondine & Imipramine together...or is that a coincidence??

A:     "Clomipramine is simply imipramine with a chloride atom added
onto it.  That very small change makes a very big difference.  It
gives the new med extra SRI (serotonin increasing) action which makes
Clomipramine a better anxiety med and gives it good OCD (obsessive
compulsive disorder) benefit which imipramine doesn't have.
Clonidine is unrelated.  I don't know your son's age, weight, or the
target symptoms (i.e., what the meds are supposed to be helping) but
lorazepam 10 mg is a very big dose; 1 mg makes more sense.  Lorazepam
(=Ativan) is usually used for panic attacks or sleep or temper and
not given every day to kids as it has a small habit forming effect.
Imipramine is a fine old med but the newer meds are often, but not
always, an improvement.  You might want to talk more with your son's
doctor."

Source;
Dr. Kevin Leehay M.D.

Paul Marshall
http://paul.tourette.info
Tourette - Updates
http://groups.yahoo.com/group/Tourette-Updates

Lexapro, The Single-Isomer of Celexa, Receives FDA Approval for the
Treatment of Major Depression
http://biz.yahoo.com/prnews/020815/nyth063_1.html

Became available September 5, 2002

Lexapro(TM), (Escitalopram oxalate)SSRI

SSRI (selective serotonin reuptake inhibitor) is a commonly used
pharmaceutical to treat many depression's.  Given the Serotonin
factor in Tourette Syndorme (TS), it could have significant use in
treatment of TS.  If you are not familiar with Serotonin here is a
link to research it's  purpose in the body.
http://www.google.com/search?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=serotonin

If you would like to understand more about how Serotonin effects
Human Behavior, you can find many books in your local library as well
as on line.  I refer to Tourette Syndrome and Human Behavior, Dr.
David E. Comings, Hope Press, Chapter 61.  http://www.hopepress.com
He has made it very easy to understand.

For more information on Lexapro, you can search this link here;
http://www.google.com/search?hl=en&lr=&ie=UTF-8&oe=UTF-
8&q=Lexapro&btnG=Google+Search

Paul Marshall
http://paul.tourette.info
Paul@...

Hope Press announces an exciting new book -

ADHD: A Survival Guide for Parents and Teachers

by Richard A. Lougy, MFT and David K. Rosenthal, M.D.

goto: http://www.hopepress.com
for details, to order, and to check the awesome table of contents!


Paul aka mrindianajonesprm
http://paul.tourette.info