Aripiprazole in a Patient Vulnerable to Side Effects

TO THE EDITOR: Although the involvement of infection/ inflammation
in the pathogenesis of Tourette's syndrome has been discussed,
antipsychotics are still the first choice in pharmacotherapy (1).
Haloperidol and pimozide are well-established therapies (2), but
increasing literature on this topic points out the advantages of
atypical antipsychotics, at least regarding side effects (3, 4).
Adherence to medication is a problem in Tourette's syndrome, often
because of the side effects that patients experience. In the
following, we describe a patient suffering from Tourette's syndrome
who withdrew treatment from different neuroleptics, thus leading to
severe social consequences for many years.

Ms. A, a 19-year-old patient, had suffered from motor and vocal tics
since the age of 6. Her vocal tics included grunting, snorting,
neighing, palilalia, and motor tics, such as beating and strangling
herself. Additionally, she developed compulsions of washing and
controlling. The course of her illness was chronic, not waxing and
waning. She had experienced no tic-free interval during the last 13
years. Pharmacotherapy over the last years included 300 mg/day of
tiapride, leading to an improvement of her motor tics only.
Additional therapy with 300 mg/day of sulpiride first and 400 mg/
day of amisulpride later each caused galactorrhea, without
substantial therapeutic effect. Ms. A stopped taking both
substances. Ms. A also stopped taking 4 mg/day of pimozide and later
80 mg/day of ziprasidone, each taken over several weeks; both caused
amenorrhea and had only marginal effects on the tics.

Afterward, we started treatment with 10 mg/day of aripiprazole
because of the side effect profile. In the first week, Ms. A's motor
and vocal tics showed a marked improvement; after 2 weeks, Ms. A was
nearly tic free for the first time in 13 years. Amenorrhea or
galactorrhea was not present during the next months; other side
effects, such as sedation or weight gain, did not occur. Ms. A
started working as a waiter for the first time. The compulsions were
much improved. Only a blinking tic, which exacerbated during stress,
persisted.

Aripiprazole is an antipsychotic with partial dopamine antagonism
and agonism, showing effects on serotonin 5-HT^sub 2A^ and 5-HT^sub
1A^ receptors. Its advantageous side effect profile has been
described earlier (5); however, no effects in Tourette's syndrome
have been observed. This case might encourage collecting not only
further experience with aripiprazole in the treatment of Tourette's
syndrome but in performing systematic studies in both short- and
long-term therapy.

References

1. Mller N, Riedel M, Zawta P, Gnther W, Straube A: Comorbidity of
Tourette's syndrome and schizophrenia: biological and physiological
parallels. Progr Neuropsychopharmacol Biol Psychiatry 2002; 26:1245-
1252

2. Sallee FR, Nesbitt L, Jackson C, Sine L, Sethuraman G: Relative
efficacy of haloperidol and pimozide in children and adolescents
with Tourette's disorder. Am J Psychiatry 1997; 154: 1057-1062

3. Robertson MM, Schnieden V, Lees AJ: Management of Gilles de la
Tourelle syndrome using sulpiride. Clin Neuropharmacol 1990; 13:229-
235

4. Sallee FR, Kurlan R, Goetz CH, Singer H, Scahill L, Law G,
Dittman VL, Chappell PB: Ziprasidone treatment of children and
adolescents with Tourette's syndrome: a pilot study. J Am Acad Child
Adolesc Psychiatry 2000; 39:292-299

5. McGavin JK, Goa KL: Aripiprazole. CNS Drugs 2002; 16:779-786

SANDRA DEHNING, M.D.

MICHAEL RIEDEL, M.D.

NORBERT MLLER M.D., PH.D.

Munich, Germany

Copyright American Psychiatric Association Mar 2005



Source: American Journal of Psychiatry, The





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

Source: http://www.rednova.com/news/display/?
id=137033&source=r_health

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

Tourette-Updates
Paul Marshall
editor@...

I am posting the following because it is just interesting reading.
It has some information in it regarding different types and reasons
for self-mutilation, which is not that common, though has been seen
in various Tourette Syndrome cases.

The self-abusive behaviors could include, head banging especially as
young children, hitting one's self, licking lips sometimes until
they
are bleeding and infected, washing hands until they are raw, constant
picking at sores, grinding and pulling teeth, biting hands, lips,
cheeks, nails or tongue until they bleed, Carving or serious
scratching of the skin, scraping or dragging toes.

Tourette-Updates
Paul Marshall
editor@...
  -----------------------------

Equine Self Mutilation
by: Sue McDonnell, PhD, Certified AAB
March 2000 Article # 3039


It's a beautiful winter weekend, and finally you have a full morning
to spend at the barn. You're happily grooming your horse when you
notice a cluster of patches of wet hair on his side. Peculiar pattern
to the wet hairs -- all are lying forward as if combed with a wet
brush. Oh well, odd but probably nothing, you think. But wait, some
of the wet spots have hairs missing or chopped off bluntly. You check
the other side, and there you find some more patches, like the wet
ones, but as if they have now dried. What's going on? There are more
of these patches on the left side than on the right side, but they
all are in the same area of the abdomen, from the ribs to the stifle.
Just then the barn manager comes in all excited. She's glad you're
there early today, because when she was feeding this morning, she
found your horse spinning in his stall, tearing at his blanket and
biting at his sides. Her first reaction was to scream at him to stop--
and he did. She figured the blanket was the problem, maybe it was
rubbing or pinching him under the leg. She got some help to
investigate. They couldn't find anything out of order with the straps
or the blanket, but took it off anyway. Then, just as they closed the
stall door, he really went nuts, spinning in a very tight circle,
biting his left flank. With each bite, he squealed and kicked out. As
he was turning and nipping, he sometimes was bucking and squealing.
They were too scared to open the door. He went on for what seemed
like forever, as if he wouldn't stop until he tore up the stall or
killed himself. Then he gradually came out of it.

"When we screamed his name, he turned toward the stall door, looking
at us with a sort of a worried, glassy eye, like he didn't know what
was happening. We threw him his hay, and he's been pretty quiet
since."

You run your fingers over the wet areas on his flanks and feel some
crusty bumps on the underlying skin. Separating the hairs, you can
feel little marks in the skin -- anywhere from one-quarter to one
inch in diameter. Some are fresh nicks, some are scabbed over, some
look healed. The rest of his coat is unblemished. No marks, no wet
spots, no chopped or missing clumps of hair other than on his flanks
and over his ribs.

So what is going on here?

This behavior commonly is called flank biting or flank sucking. The
biting is one aspect of a cluster of behaviors called self-
mutilation, because the horse likely will incur serious self-injury
during these explosive episodes.

In addition to biting the flanks, self-mutilation sequences can
include seemingly uncontrollable violent behavior. From horse to
horse, the sequence and form can vary, but most typically includes
spinning in circles, bucking, and kicking out with one or both back
legs while nipping at the flank, shoulders, or chest. In the photos
at the bottom of page 76, there is an example of a horse biting more
violently at his chest, and a resulting chest avulsion.
In extreme cases, the horse can violently lunge its body or head into
a wall or other solid object. More rarely, a horse might "throw
itself" to the ground (from standing to lateral recumbency). A single
episode can last from a few seconds to several minutes,
uninterrupted. The horse can work up a lather and steam in cool
weather. Episodes usually occur in a series separated by a few
seconds to a few minutes over a period of minutes, to hours. The
total daily time spent self-mutilating can vary from a few seconds to
an hour or more. In addition to bite wounds, the most common injuries
are to the legs and feet from the spinning and kicking.

Self-mutilation behavior of one form or another has been described in
many different species, including humans. Dog and cats lick and chew
on their paws or tails. People do all sorts of things--pull out their
hair, bite their fingernails or lips, scratch themselves, or
deliberately inflict burns, cuts, or other wounds.

People who have seen a horse in the midst of attacking itself often
describe the episodes as the most bizarre animal behavior they ever
have seen. Mental health professionals or others with first-hand
experience with human psychopathology often ask whether this might be
the horse equivalent of severe neurotic or even truly psychotic
behavior seen in people. For example, Dr. Nicholas Dodman, a
veterinary animal behavior specialist at Tufts New England Veterinary
College, said he has wondered whether certain forms of self-
mutilation in horses might be similar to Tourette's Syndrome in
humans. There are some interesting similarities, and some clear
differences.

Since self-mutilation occurs in other animal species and a variety of
human psychopathologic syndromes, it's probably too early to conclude
that any of the self-mutilation seen in horses represents the same
pathology as Tourette's in people. In other species, the trend in
clinical veterinary behavior has been to label self-mutilative
behavior "obsessive-compulsive disorder," or OCD.

This syndrome in humans has two distinct components. One component is
the compulsive, repetitive behavior, such as repeatedly checking to
see if the stove has been left on. The other component is the
accompanying obsessive thoughts or worries, such as concerns about
being caught in a burning building. Often the thoughts or worries are
related to the compulsive behavior and logically appear to drive it.
In the case of animals, we don't know whether they think or worry, so
this label of obsessive-compulsive behavior might be too elaborate.
Some behaviorists now are calling these behaviors in animals simply
compulsive behavior.

There are at least three distinct types of self-mutilative behavior
in horses. One type is simply an "extreme" behavioral response to
physical discomfort. We know that physical pain alone, particularly
in the abdominal area, can evoke behavior similar to that of the
horse in the situation described above. We know it is physical pain
because coincident with finding and correcting an apparently or
potentially painful condition, the self-mutilative behavior stops
without any other treatment. For example, the classic behavior we
associate with colic or early labor in broodmares involves turning
the head back toward the flank, either looking or nipping at the
flank, and sometimes kicking out. Although it is not as common, some
horses' behavioral response to physical pain has more violent
episodes, including spinning, kicking, bucking, and serious self-
biting. Some of the less-common physical root causes for violently
colic-like behavior have been a twisted testicular cord, an abdominal
abscess, urethral tears, or gastric ulcers. These sometimes can be
intermittent and difficult to find. This is in contrast to the other
types of self-mutilation. When there is a physical cause, there often
is an increase in the behavior in association with work. The most
explosive episodes might be during or soon after work. As time goes
on, the horse might anticipate the exacerbation of pain with work, so
can become agitated when being prepared for work.

A second type of self-mutilation is what could be called self-
directed intermale aggression. This type occurs in stallions and
geldings. The sequence follows what two stallions at liberty would do
when meeting, except that the stallion himself is the target of his
own behavior. When stallions meet, they typically stand parallel to
one another, head-to-tail. They investigate each other's flank area,
usually sniffing and nipping at the flank and genitals. The encounter
can be pretty noisy. The stallions usually squeal and kick out with
each nip or bite. They also might spin, buck, stomp, and romp, going
around one another in circles. The sniffing of each other's flank and
genitals, and of each other's feces, is an important trigger for the
nipping and biting.

Sometimes the self-mutilation process begins over a stud pile. In the
stallion which is sniffing and biting himself, each episode begins
with the sniffing of his own feces or feces of other stallions in
shared turn-out facilities. Oily body residues on stall walls,
fences, or doorways can trigger episodes. We have seen several cases
of self-mutilation that appeared to have started when a stallion was
exposed to the smelly residues of another stallion in a trailer.
Unlike the pain-related self-mutilation, this type usually develops
over a period of months. It can start as early as the first year of
life or as late as the teens. It typically continues for the life of
the stallion.

A third type of self-mutilation is a more quiet, rhythmic, repetitive
nipping at various areas of the body. It looks similar to stereotypic
weaving or stall walking in that it appears that the horse has
nothing better to do. By formal definition, stereotypic behavior is
characterized by repetitive, highly stylized, and seemingly
functionless movements and sequences of movements.

Spanning the top of pages 76 and 77 is a series of photos of a
stallion which had a very fixed pattern of biting himself from flank
to shoulder to chest to opposite shoulder to opposite flank and on
and on. He did it at the same place in the pasture at the same time
of day for the same length of time, just as some horses walk their
stall in very complex and fixed patterns day after day.
Stereotypies occur in one form or another in all captive wild and
domestic animal species, and are a common feature of human
psychopathology, as well as developmental and neurologic disorders.
Subadequate environment and nutrition seem to be the major factors
predisposing animals to stereotypies.

In horses, the classic stereotypies are cribbing, weaving, pacing,
stall-circling, and head-shaking. Certainly, in cases in which a
physical root cause is not apparent, self-mutilation fits this
definition of a stereotypy. Of course, the performance of a
stereotypy, no matter what the initial precipitating cause, is self-
rewarding. Endorphins are released, and they can be positive
reinforcement sufficient to sustain the behavior as a habit. We often
wonder if self-mutilation, for which we can find no contemporary
physical cause and that doesn't quite fit the self-directed intermale
aggression type, might have started during a period of physical
discomfort, but now is a lingering habit.

How Common Is Self-Mutilation?

It's very difficult to estimate how many horses suffer from self-
mutilation. My guess would be that the problem occurs in less than
0.005% of all horses. Most equine veterinarians might see only a few
cases in their entire careers. Self-mutilation can occur in
stallions, mares, and geldings. Of course, the self-directed
intermale aggression type is almost always in stallions and geldings.
We don't know whether or not the predisposition for self-mutilation
is highly heritable. We know that the behavior probably is the result
of domestic environmental and nutritional factors, in that it
apparently does not occur in wild or feral horses.

Where Does It Hurt?

For those horses whose self-mutilation episodes looks like a violent
form of colic, it is critical to look for and immediately treat any
possible causes of discomfort. Except for classic colic, this often
is easier said than done. It sometimes can be tough to find (see the
boxed table of examples of possible physical causes of discomfort on
page 74). No matter what the slickest animal psychic would have us
believe, our animals, like human infants, have only their non-verbal
behavior as clues to tell us where they hurt. After years of losing
sleep trying to find causes of self-mutilation in horses, I think our
best hope for figuring out potential physical sources of discomfort
that might be provoking episodes of self-mutilation turns out to be
pretty inexpensive and very low tech. It is simply to critically
observe the horse for hours at a time. This can be done live, but
there are many advantages to video recording the behavior.
Long, continuous observation periods allow the horse to go back to
its ongoing behavior, as opposed to being distracted by human
presence. Long observation periods also will enable you to see how
the self-mutilation episodes start and stop, and what in the
environment might provoke them. When casually watching a self-
mutilating horse, your attention is drawn to the noisy, more violent
episodes. When watching the horse continually for hours, you likely
will see mild and violent episodes. The milder episodes often are
more useful than the explosive episodes in localizing potential sites
of discomfort.

Once you have a clue as to where the pain might be, you can be
aggressive with veterinary diagnostics. This might include classic
radiography, scintigraphy, endoscopy, and ultrasound imaging.
Even if it appears to be a classic stereotypy, or a psychological
behavior problem, we should never stop looking for a possible
physical cause. A great example illustrating this point in horses is
the case of head shaking behavior. For many years, veterinarians have
looked for possible sources of discomfort in cases of head shaking.
Many times a source could be found--things like ear mites, tooth
abcess, guttural pouch problems, or allergies. But many times,
nothing physical could be found and it was assumed that the problem
was psychological. Only a few years ago did scientists in the United
Kingdom and California find that some headshaking in horses appears
to be induced by bright light or loud sound. It is a real physical
problem involving hyperactivation of a nerve tract that is physically
irritating to the horse. (See The Horse of October 1996, page 70.)

What Else Can You Do?

The best outcome of immediate and aggressive veterinary evaluation is
to identify and quickly treat a physical cause. An equine behavior
specialist can be a valuable member of a veterinary team. By
evaluating the behavior, possible sites of discomfort can be
identified, and an opinion can be offered on primary or secondary
psychological components to the episodes. If physical discomfort is
eliminated, the self-mutilation typically stops almost immediately.
We have seen cases in which months or years passed before a root
physical cause was found, in which the self-mutilation stopped
immediately when the discomfort was alleviated.

Unfortunately, often a physical cause is not found and the conclusion
is drawn that this is the self-directed intermale aggression type, or
is simply a stereotypy. Over the years, mostly by trial-and-error, we
have found a number of different treatment approaches, each of which
typically is either helpful, or at least does not exacerbate the self-
mutilation. Most are simple management changes that seem to work by
distracting the animal to another activity; some involve
sophisticated pharmacology.

Physical restraint Traditionally, a large percentage of the effort,
thought, and expense of treatment of self-mutilation has involved
various methods of physically preventing or discouraging the
behavior. This often is the first thing you will want to consider
while further evaluation is organized. Special neck cradles and side
poles, grazing muzzles, bibs, and protective wraps and blankets can
be used to prevent injury. Physical restraint alone rarely "cures"
self-mutilation. All too often when the horse is effectively
restrained from performing one behavior, another problem behavior
develops. If biting is prevented, the horse might start kicking or
lunging into walls. In the short term, while looking for and treating
possible causes, it is wise to creatively work at keeping the animal
from further injury.

For any restraint, care must to taken in devising materials that
don't cause new rub sores or other irritations. My favorite of all
the restraints for self-biting is the grazing basket shown on page
78. The horse effectively can eat hay and grass through the openings.
The basket inhibits a substantial grab of flesh, although the
persistent horse still can work a small nip of hair or skin through
the basket openings.

Social, feeding, and work distractions Typically, the most effective
management changes are those that seem to provide motivation for a
substitute behavior or a strong distraction to focus on something
else. For a stallion, self-mutilation sometimes can be relieved
significantly if the stallion is turned out to live in a large
pasture with one or more mares. In that situation, the stallion
becomes a harem stallion with great responsibility to herd and defend
the mares. Those harem maintenance behaviors seem to occupy the
stallion's time and distract him from the problem behavior. If he is
not supplemented with concentrated feed, his grazing and resting
fully occupy the remainder of his time.

Of course, this often is not a plausible solution for the fancy
breeding or busy performing stallion. There might be some difficulty
and danger in taking such a stallion or his mares in and out of such
a situation. Most stallions will not want to leave their mares. But
to the extent that the stallion can be distracted socially, in some
cases it is worth trying.

Horses appear to find meaningful social companionship from animals of
other species. Donkeys, goats, rabbits, and even chickens are useful
as stall or pasture companions. In my experience with chickens as
stall companions for self-mutilators, it seems that the horse
sometimes is reluctant to move around the stall, lest it cause the
chicken to scurry and flutter. Some stallions also seem distracted by
their effort to avoid stepping on the chicken.

Another effective distraction for many self-mutilators is a vigorous
appetite. A change in diet from one heavy with grain to one of grass
and grass hay only (without any grain or richer forage) often can
lead to a remarkable change in behavior. The horse might spend almost
all of its time eating and resting, with seemingly no time for
anything else, including self-mutilation. A grazing muzzle like the
one described earlier can effectively prolong the eating time.
The all-grass, no-grain diet might have other benefits for behavior.
We know from work in horses and other grazing species that grain
diets predispose an animal to stereotypies and other behavior
problems. The grain diet might alter the brain neurochemistry,
setting the animal up for developing abnormal behavior. We long have
appreciated that grain increases the risk of behavior problems and
high-forage diets reduce the risk of behavior problems.

Work For the self-directed intermale aggression type of self-
mutilation, the behavior seldom is seen during work. Moderate work
also stimulates appetite. A horse which works one to two hours a day
and which is fed ad lib grass and grass hay almost always will spend
60% or more of his time eating and 20% of his time resting. This
approaches the natural time budget of a horse at liberty or in the
wild. Breeding work sometimes reduces and sometimes increases the
frequency and intensity of self-mutilation.

Gelding stallions? For the self-directed intermale aggression type
self-mutilating stallions, some veterinarians recommend castration,
and in some cases it works very well. Unfortunately, it also can get
worse or won't change. When advising clients on this option, I always
am reminded of the dozen or so geldings we have known which seemed
normal as colts, but were first seen to self-mutilate soon after
castration.

Medications Pharmacologic aids, which in some cases have appeared
helpful in relieving self-mutilation, include long-acting
tranquilizers, tricyclic anti-depressants such as imipramine and
clomipramine, progesterone, and the nutritional supplement l-
tryptophan. Some of these have been discovered by accident and some
are based on theories of brain neurochemistry. None of these
medications alone or in combination is likely to eliminate self-
mutilation completely. The particular choice depends on the severity
and nature of the self-mutilation. In combination with management
changes, medications often are judged to be valuable parts of the
plan to eliminate self-mutilation. The tendency is for people to over-
estimate their potential. An important concern for clinicians who
medicate the horse early in the evaluation is that the drugs might
help a horse to cope with physical discomfort, thus could effectively
mask the symptoms and delay diagnosis of a treatable physical
problem.

Other treatment tips For horses whose self-mutilation seems to be
triggered by male odors and feces, any number of creative steps can
be taken to reduce the stimulation. Odor-masking preparations can be
applied to the nostrils, the horse can be bathed frequently, and
feces and oily residues can be removed from stalls and pastures.
Sometimes, the sight or smell of another stallion seems to provoke
episodes. Housing changes can reduce the frequency and severity of
self-mutilation.

In our clinic we find that long-term video surveillance of the horse
can reveal events and situations that provoke the behavior. Often
these "provokers" can be simply and inexpensively eliminated. For
example, occasionally you find a horse which only bites himself when
the feed cart is coming down the aisle, or when other stallions are
on their way to the breeding shed.

Tie-stalls For reasons I'm not sure we ever will understand, simply
housing a horse in a tie-stall can effectively eliminate self-
mutilation. Recent work with tie-stalled horses in the pregnant mare
urine industry has indicated that abnormal behavior in general is
very low in tie-stalled horses compared to box-stalled horses.
No one treatment alone is likely to be effective. The cases for which
the greatest relief has been achieved have involved simultaneously
implementing as many of the treatment steps as possible. We recommend
spending time with your veterinarian to develop a custom plan based
on everything you know about the horse. Once everything is organized,
we recommend implementing all the changes and treatments at once.
This is not good science in that you might never know which of the
changes were most effective, but experience has taught us that major
change often is more effective than a systematic, step-wise approach.
In summary, we really know very little about the causes of self-
mutilation, other than physical discomfort. It is important to
realize that except for those cases for which a physical discomfort
can be identified and eliminated, the self-mutilation likely will
never be cured. The current treatments for the self-directed
intermale aggression and stereotypy types of self-mutilation rarely
effect a cure. At best, diligent attention and care will keep the
levels of injury low.
---------------------------

Source:   http://www.thehorse.com/viewarticle.aspx?ID=3039

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

Tourette-Updates
Paul Marshall
editor@...

We are looking for personal stories or relevant information and ideas
to add and update some of our pages on http://www.tourettes-
disorder.com

If you have any content or personal experience that you feel might be
useful to others with Tourette Syndrome or for persons looking for
information and support about Tourette's Disorder, please forward us
your information and comments to:

editor@...

Please let us know if you would like to receive credit for
information or for personal stories, or if you would rather stay
anonymous.  Names and some information can be changed for privacy.

Thank you,

Paul Marshall
Editor

HOUSTON – (Dec. 17, 2004) – The cosmetic cure-all Botox may have
found another market: sufferers of Tourette's syndrome.

Researchers at Baylor College of Medicine in Houston are using
botulinum toxin type A (Botox) to treat the neurological disorder,
which can cause involuntary motor and vocal tics. Dr. Joseph
Jankovic, professor of neurology and director of the Parkinson's
Disease Center and Movement Disorders Clinic at BCM, was the lead
author of a recent article in Clinical Neuropharmacology, which
showed that Botox can suppress tics in disorders like Tourette's.

"While we have an enormous amount of data showing that Botox is an
extremely safe and effective treatment for a variety of therapeutic
and cosmetic uses, the important thing for patients is whether this
translates into meaningful improvements in their daily lives,"
Jankovic said. "Our review makes clear that treatment with Botox
accomplishes this across a wide range of chronic and debilitating
disorders and conditions."

Although public awareness about Tourette's has generally improved
since medieval times – when it was thought to be demonic possession –
the disorder remains largely elusive to researchers and greatly
misunderstood by the masses.

"We still don't know exactly what causes Tourette's syndrome, but we
do know that it is a genetic disorder," Jankovic said.

Unlike most genetic disorders, Tourette's is caused by bilineal
transmission, a rare event in which both parents contribute defective
genes to their child. Nevertheless, Tourette's syndrome remains
relatively prevalent: roughly three percent of the population carries
some form of the disorder, according to Jankovic.

"We have made tremendous progress with treatments, and even though we
don't know the cause of the disease, we are able to significantly
improve the quality of life for patients with Tourette's syndrome by
a variety of medications," he said.

A common misperception of Tourette's is that coprolalia, the
involuntary utterance of obscenities, is the predominant symptom,
when actually less than half of all patients exhibit it. Furthermore,
most people with Tourette's develop other behavioral problems such as
attention deficit disorder and obsessive compulsive disorder.

In addition to Botox, medications like fluphenazine, pimozide and
risperidol, which block dopamine receptors, suppress involuntary
movements. Jankovic is also conducting studies with other drugs
including tetrabenazine, an investigational drug that depletes
dopamine, and topiramate, an anti-epileptic drug. Finally, new
surgical procedures developed at BCM and The Methodist Hospital hold
promise for curbing uncontrollable tics and other neurological
problems associated with Tourette's.

"Tourette's clearly deserves more attention than it has been paid by
either the scientific community or the funding agencies," Jankovic
said. "For every patient we diagnose in our clinic, there are
probably dozens who suffer the consequences of Tourette's syndrome
without knowing that they have it."

As part of an initiative to spread public awareness and dispel false
notions about the disorder, a biannual conference organized by
Jankovic and other BCM physicians targets both medical professionals
and lay audiences.

The "Tourette Syndrome and Related Neurobehavioral Disorders
Conference" will be held Jan. 14 at the InterContinental Hotel in
Houston and features internationally recognized speakers. The
conference will focus not only on tics but other problems associated
with Tourette's syndrome, including attention deficit disorder,
obsessive compulsive disorder, loss of impulse control, and other
behavioral co-morbidities. For further information about the
conference, contact Baylor Office of Continuing Medical Education at
713-798-8237.

----------------------------------------------------------------
SOURCE: http://www.bcm.edu/pa/tourettes_botox.htm
----------------------------------------------------------------

Note, If a link does not work, try cutting and pasting the entire
link into a new browser.


----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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

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

Brain region identified that controls collecting behavior

Perhaps the Beanie Baby craze wasn't so weird after all.
Most people have a collection of some kind at some point in their
lives. Indeed, historical studies show that acquiring and retaining
objects, even when they are not necessary for survival, is not only
nearly universal, but also has been part of human behavior since the
earliest human societies. Yet despite the ubiquitous nature of this
trait, very little is known about what drives humans to collect.
By studying patients who developed abnormal hoarding behavior
following brain injury, neurology researchers in the University of
Iowa Roy J. and Lucille A Carver College of Medicine have identified
an area in the prefrontal cortex that appears to control collecting
behavior. The findings suggest that damage to the right mesial
prefrontal cortex causes abnormal hoarding behavior by releasing the
primitive hoarding urge from its normal restraints. The study was
published online in the Nov. 17 Advance Access issue of the journal
Brain.

Hoarding behavior is common among animals; around 70 species hoard
and mostly they hoard food, which makes sense from a survival
standpoint. Studies of hoarding behavior in rodents have shown that
collecting is driven by certain primitive structures deep in the
brain and most mammals, including humans, share these subcortical
regions.

"But human collecting goes beyond items that are solely useful for
survival," said Steven Anderson, Ph.D., UI associate professor of
neurology and lead author of the study. "People often collect art or
stamps or pretty much anything. Clearly there is some higher
structure in humans that modulates the collecting drive and that's
what we think we have tapped into."

The UI team studied 86 people with focal brain lesions - very
specific areas of brain damage – to see if damage to particular
brain regions could account for abnormal collecting behavior. Other
than the lesions, the patients' brains functioned normally and these
patients performed normally on tests of intelligence, reasoning and
memory.

A questionnaire completed by a close family member was used to
identify problematic collecting and the behavior was classified as
abnormal if the collection was extensive; the collected items were
not "useful" or aesthetic; the collecting behavior began only after
the brain injury occurred; and the patient was resistant to
discarding the collected items.

The questionnaire very clearly split the patients into two groups –
13 patients who had abnormal collecting behavior and a majority (73
patients) who did not. Unlike normal collecting behavior such as
stamp collecting, the abnormal collecting behavior of these patients
significantly interfered with their normal daily life. Patients with
abnormal collecting behavior filled their homes with vast quantities
of useless items including junk mail and broken appliances. Despite
showing no further interest in the collected items, patients resist
attempts to discard the collection.

To determine if certain areas of damage were common to patients who
had abnormal collecting behavior, the UI researchers used high-
resolution, three-dimensional magnetic resonance imaging to map the
lesions in each patient's brain and overlapped all the lesions onto
a common reference brain.

"A pretty clear finding jumped out at us: damage to a part of the
frontal lobes of the cortex, particularly on the right side, was
shared by the individuals with abnormal behavior," Anderson
said. "Our study shows that when this particular part of the
prefrontal cortex is injured, the very primitive collecting urge
loses its guidance.

"This finding sheds some light on a ubiquitous, nearly universal
human behavior that we really don't know much about, and we can use
this as springboard to think about normal collecting behavior."

Anderson added that the findings also may have implications for
understanding certain neurological conditions such as obsessive-
compulsive disorder (OCD) where abnormal collecting behavior occurs
but the patient has no readily detectable brain defect.

"Patients with OCD and some other disorders such as schizophrenia,
Tourette's syndrome and certain dementias, can have similar
pathological collecting behavior but we don't have a pointer to
locate where in the brain the problem is occurring," Anderson
said. "Our hope is that our findings with these brain lesion studies
will lead to insights in these conditions as well."

Anderson's co-authors on the study were Antonio Damasio, M.D.,
Ph.D., the Maurice Van Allen Professor of Neurology and head of the
department, and Hanna Damasio, M.D., UI Foundation Distinguished
Professor in the Department of Neurology. The study was funded in
part by a grant from the National Institute of Neurological
Disorders and Stroke.

University of Iowa Health Care describes the partnership between the
UI Roy J. and Lucille A. Carver College of Medicine and UI Hospitals
and Clinics and the patient care, medical education and research
programs and services they provide.

----------------------------------------------------------------
SOURCE: University of Iowa Health Science Relations, 5135 Westlawn,
Iowa City, Iowa 52242-1178
http://www.uihealthcare.com.
----------------------------------------------------------------

Note, If a link does not work, try cutting and pasting the entire
link into a new browser.


----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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

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

Habit Learning Impaired in Tourette Syndrome

Children and adults afflicted with the tic-causing disease known as
Tourette syndrome have a harder time with tasks requiring habit
learning, report investigators publishing in this month's Archives
of General Psychiatry.

The finding could lead to an animal model of the disease that
researchers could use to study the areas of the brain affected by TS
and to come up with new medications aimed at treating its symptoms.

The study was carried out among 56 children and adults with TS and
67 healthy children and adults who served as the study controls. All
were given a standard test designed to measure people's ability to
learning through habit. Participants also took tests to see how well
they learned through declarative memory functioning, which includes
memorization of facts, words and experiences.

Results show people with TS had a significantly harder time learning
with the habit test than the healthy controls, and learning ability
decreased with the severity of TS symptoms. Conversely, TS
participants scored about the same as healthy controls on tests that
measure the ability to learn via declarative memory functioning.

The researchers believe further study of habit learning in animal
models of TS offers "the exciting promise not only of improving our
knowledge of the neurobiological origins of TS but also of
developing novel therapeutics through bona fide translational
research programs and methods that are not available to human
clinical studies alone."

----------------------------------------------------------------
SOURCE:(Ivanhoe Newswire)Reported December 9, 2004
http://www.ivanhoe.com/channels/p_channelstory.cfm?storyid=10122
----------------------------------------------------------------

2nd Source Content

Habit Learning in Tourette Syndrome
A Translational Neuroscience Approach to a Developmental
Psychopathology

Rachel Marsh, PhD; Gerianne M. Alexander, PhD; Mark G. Packard, PhD;
Hongtu Zhu, PhD; Jeffrey C. Wingard, MPhil; Georgette Quackenbush,
BA; Bradley S. Peterson, MD


Arch Gen Psychiatry. 2004;61:1259-1268.

Background  The etiology of Tourette syndrome (TS) involves
disturbances in the structure and function of the basal ganglia. The
basal ganglia mediate habit learning.

Objective  To study habit learning in persons with TS.

Design  Patients with TS were compared with normal controls in
performance on a probabilistic classification, or habit-learning
task (weather prediction).

Setting  University research institute.

Participants  One hundred twenty-three children and adults, 56 with
a diagnosis of TS and 67 healthy control subjects.

Main Outcome Measures  Habit learning was assessed by the extent of
improvement in accuracy of predictions and reaction times over trial
blocks during performance of the weather prediction task.
Declarative learning was assessed by performance on 3 tasks that
required intact declarative memory functioning.

Results  Children with TS were impaired at habit learning relative
to normal controls (P = .01). This finding was replicated in the
independent sample of adults with TS (P = .01). The rate of learning
correlated inversely with the severity of tic symptoms across both
samples (r = –0.34; P = .01). Thus, impaired learning accompanied
more severe symptoms. Measures of declarative memory functioning, in
contrast, were normal in the TS groups.

Conclusions  Striatal learning systems are uniquely dysfunctional in
both children and adults with TS. The correlation of habit learning
with symptom severity suggests that the number and severity of tics
are a function of the degree to which the system for habit learning
is dysfunctional. Thus, both the deficits in habit learning and the
tic symptoms of TS are likely to be consequences of the previously
reported anatomical and functional disturbances of the striatum in
children and adults who have TS. The existence of a well-developed
animal model for this learning system, which permits study of the
neural and molecular bases of habit learning, has important
implications for the neurobiological study of TS and for the
development of new or improved therapeutics for this condition.


Author Affiliations: Division of Child and Adolescent Psychiatry in
the Department of Psychiatry, New York State Psychiatric Institute
and College of Physicians and Surgeons, Columbia University, New
York (Drs Marsh, Zhu, and Peterson and Ms Quackenbush); Department
of Psychology, Texas A&M University, College Station (Drs Alexander
and Packard); and Department of Psychology, Yale University, New
Haven, Conn (Mr Wingard).



----------------------------------------------------------------
SOURCE: Archives of General Psychiatry, 2004;61:1259-1268
http://archpsyc.ama-assn.org/cgi/content/short/61/12/1259
----------------------------------------------------------------

Note, If a link does not work, try cutting and pasting the entire
link into a new browser.


----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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

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

Solving a medical mystery

Winter 2004/05

For the vast majority of people, a sore throat is no more than an
irritation that lasts a few days. But in a minority of cases — and
more frequently in children — a throat infection caused by
streptococcus bacteria can lead to devastating brain damage…

Paediatric neurologist Dr Russell Dale was working at Great Ormond
Street Hospital when he was struck by the terrifying and dramatic
nature of the symptoms he was seeing in some of his patients.
Previously healthy children would suddenly develop movement and
psychiatric disorders, to the extent that their parents described
them as having `changed personality overnight'.

Often these children required hospitalisation. Dr Dale started to
research the area in his spare time, but what began almost as a
hobby became more and more important to him, eventually leading to
an application for an Action Medical Research grant. "Having seen
the terrible effects on children, and their parents, I wanted to
understand what causes these brain disorders and do my best to
help," says Dr Dale.

Three years on, Dr Dale's research at the Neuroimmunology Unit in
London's Institute of Neurology has formed part of a great leap
forward in the medical world's understanding of this phenomenon. His
work may lead to treatments for a wide range of physical and
psychiatric disorders, from tics and obsessive behaviour to
Tourette's syndrome, Parkinson's disease and encephalitis lethargica
or `sleepy sickness'. And it is all due to a grant of £141,000 from
Action Medical Research.

What's the connection?
It seems incredible that something as banal as a sore throat might
cause brain damage. Dr Dale explained to Touching Lives how this can
happen: "When you get an infection of any sort, the body produces
antibodies to try to fight it off. The antibody usually recognises
which cell to attack by the kind of protein found on the cell's
surface.

"What we found in the laboratory stage of our research is that the
proteins on the surface of streptococcus bacteria are very similar
to those on the surface of brain cells. This means that antibodies
produced when you get a streptococcal throat infection can `cross-
react' — the antibodies produced to fight the sore throat attack the
brain as well. It's basically the body making a mistake and
overreacting. It thinks the brain cells are foreign, whereas in fact
they're not."

A wide range of symptoms
The particular range of symptoms is the result of damage to a part
of the mid brain called the basal ganglia, which seems particularly
vulnerable to the antibodies produced. "This part of the brain co-
ordinates and sends out information," says Dr Dale. "It acts as a
modulator, regulating the quality of movements and emotions."

So when this balancing system is damaged, both movements and
emotions are unregulated and can become extreme or unpredictable.
That's why the physical symptoms of the disease include the body
either making extra movements or moving too quickly, resulting in
tics or similar repeated movements, or moving too slowly, resulting
in the stiffness associated with, for example, Parkinson's disease.

Alongside these physical changes are arguably more important
psychiatric symptoms. Sufferers experience emotional changes,
including extreme anxiety, obsessive behaviour and depression. And
what makes these changes even more traumatic is the speed with which
they come on. "There's usually a lag of about two weeks between the
infection and the onset of the symptoms. But when they arise, the
onset is explosive — previously healthy children can suddenly become
very ill. Some even have to be hospitalised. It's extremely
distressing both for children and parents. And that's in part what
motivated me to do this research."

Developing a test, minimising suffering
What's so important about this new discovery is that bacterial
infections, and the antibodies they produce, are relatively easy to
treat. "The general aim of treatment is to remove the antibodies,
which can be done in two ways," says Dr Dale. "Steroids can be used
to suppress the immune system generally, so that fewer antibodies
are produced. But these are quite toxic drugs, with unpleasant side-
effects.

"Alternatively, more specific treatments can be used to remove just
the antibodies — that's a `cleaner' treatment with fewer side-
effects. There is now a test which looks for these antibodies so
that we can treat them directly, but it's very complicated and
expensive to administer, so we're looking for one we could use on
lots of patients. Ultimately an antibiotic could be developed to
reduce the brain damage and improve the patients' condition."

Not everyone who suffers from these disorders will end up with
permanent damage. The earlier they are treated, the less likely it
is that permanent damage will occur — which is why a test of the
kind Dr Dale is looking for is so important. And children are in
fact more receptive to treatment than adults. This is because, up to
the age of about 11, children's brains are more `plastic' than
adults' brains, which means that the brain is more able to take on
different roles and so respond quickly to treatment.

An historic discovery
Dr Dale's work forms part of a distinguished strand in the history
of medical research. "The idea of infection leading to a brain
disorder is very old," explains Dr Dale. "It's been known for over a
hundred years that one particular brain disorder, called Sydenham's
Chorea, is linked to streptococcus. What wasn't known before was how
many other types of brain disorder might be triggered by this sort
of infection."

After clinical work with 60 children with a variety of brain
disorders, together with his laboratory-based research, Dr Dale has
established a connection between the antibodies produced after
streptococcal infection and brain cell death in a much wider range
of conditions than was previously recognised. "This wider
recognition is very important for accurate diagnosis," says Dr
Dale. "Now, a child with any type of movement or psychiatric
disorder after a streptococcal throat infection will be examined for
these antibodies. And given how widespread some of these disorders
are, this could be relevant for up to one per cent of the
population."

What next?
This is only the beginning of the story for Dr Dale. There are still
a number of questions to be asked — why, for example, is it only the
streptococcal infection which causes sore throats that trigger this
brain damage, and not the other common streptococcal infections? "We
still don't understand the brain very well," says Dr Dale, "which is
one of the reasons I chose to specialise in neurology — it's a
fascinating area, with lots of scope for work in the future. And I
wanted to work in paediatrics in particular because working with
children and their parents is so much fun! I've had very positive
experiences as a paediatrician, and you feel you're doing good."

The importance of the Action Medical Research grant to Dr Dale's
work can't be overestimated. "I'm overwhelmingly grateful to the
Charity for supporting this project. Having seen the effects of this
disorder on sufferers, I know how important it is to try to find a
treatment. We simply wouldn't have been able to do this without
Action Medical Research."

Medical Mysteries
Dr Dale's work was featured on the BBC documentary `Medical
Mysteries' earlier this year. The documentary explored a particular
condition called encephalitis lethargica, or `sleepy sickness',
which causes a range of extreme symptoms, including paralysis,
uncontrollable movements, and speech disorders.

Sleepy sickness was brought to popular attention by the Hollywood
film `Awakenings' starring Robert de Niro. It had been thought that
the disease died out after the last major outbreak in the 1920s. But
the BBC programme picked up on a number of cases which have suddenly
appeared over the last few years, and explored the work being done
to try to explain the condition.

The programme featured Dr Dale explaining his alarm at coming across
patients with encephalitis lethargica — a disease he thought he
would never see. And when he let the medical community know that he
was interested in studying the disease, many more cases came to
light. It had long been thought that, as with Sydenham's Chorea,
there was a link between encephalitis lethargica and some kind of
infection — influenza was at one point the prime suspect.

But when he looked for a common factor, Dr Dale found that half the
patients with encephalitis lethargica had reported a sore throat
before they developed the disease. It was this that triggered Dr
Dale to consider streptococcus, the commonest cause of sore throats,
as a possible cause. And sure enough, blood tests showed that every
patient had been infected by a particular strain of streptococcus —
an invaluable insight into the cause of this devastating disease.

The eminent neurologist Dr Oliver Sachs (author of `The Man Who
Mistook His Wife for a Hat') was featured talking about his life-
long work with sufferers of encephalitis lethargica, and hailed Dr
Dale's work as "brilliant, and original, and maybe revolutionary."

Thanks go to the Barnwood House Trust for their support of this
grant.

----------------------------------------------------------------
Source:http://www.action.org.uk/touching_lives/2004/winter/medical_my
stery/
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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's Patient Hopes Surgery Holds Cure
Nov. 11, 2004
Ed Yeates Reporting

Imagine muscle spasms so bad it's like doing uncontrollable,
exhausting high impact aerobics 24 hours a day. That's what a Utah
man is going through right now - and why a Cleveland hospital wants
to try an experimental procedure that just might cure him.

If I was in Peter Jensen's shoes right now, I might suddenly, and
without warning, break into violent muscle movements. The spasms
coming through my voice would also make it so I could no longer talk
to you.

Peter Jensen's physical and vocal tics are so bad, so continuous, he
sweats profusely. He wears loose clothes and no shoes, trying to
keep his body from overheating -- even going out on the patio in the
winter to cool down.

Peter Jensen: "I'm gone by the end of the day. I mean I have a
headache. It's just so overwhelming."

Peter has Tourette Syndrome, one of the worst cases Dr. Jason North
has ever seen. Though this young 29-year old father of four is
trying to finish school, he can't hold onto a job to support his
family.

Peter Jensen: "Constant effort to get each word out, to just talk."

Tourette Syndrome produces a chemical overload of signals in the
brain. The body can't handle them and goes into spasm. One minute
you're talking and functioning normally, the next you're not.

Peter weighs only 118 pounds right now because in between trying to
control the tics and eat, by the time he's finished he's lost his
appetite.

Earlier this year, surgeons at University Hospital in Cleveland,
Ohio, performed an experimental surgery on Tourette victim Jeff
Matovic. They implanted electrodes deep inside his brain, connecting
them under the skin to pacemaker devices on each side of the upper
chest.

After the surgery Jeff was 85 to 90 percent tic free. For the first
time he could walk and sit in a chair. When Peter saw what
happened..

Peter Jensen: "Honestly, I wept. I was so overcome that I wept."

Now, pending FDA approval, Peter could become only a handful of
Tourette patients in the United States to undergo the same
experimental surgery.

Peter Jensen: "I think that would be a wonderful thing."

Roshana Jensen, Peter's Wife: "It's going to be a pretty incredible
change when it does happen."

Dr. North says it's only a matter of time now until Peter's body
wears out. His options are running out.

Dr. North: "This is pretty much the last straw."

Peter's friends are trying to raise $100,000 to help him get the
Cleveland experiment. So far, they've raised about $30,000.


----------------------------------------------------------------
Source: http://tv.ksl.com/index.php?nid=5&sid=132254
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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

Anti-seizure drug inhibits the glutamate system

By David Hodges

MONTREAL – The anticonvulsant topiramate (Topamax) may be an
effective second-line strategy for patients with obsessive-
compulsive disorder (OCD) who do not respond to serotonin reuptake
inhibitors (SRIs), concludes a preliminary study presented at the
Canadian Psychiatric Association meeting here.

Scientists at McMaster University found that topiramate works by
reducing levels of glutamate, a common brain chemical that has been
found in abnormally high concentrations in children with OCD.
Previous research has shown that a decrease in OCD symptom severity
was associated with a decrease in concentrations of glutamate
following SRI treatment.

"We looked at the drug topiramate, which is on the market for
seizures and convulsions. And so we gave it to these (OCD) patients
in the hope that this drug would work on the glutamate system and
improve the patient's symptoms. And low and behold in our
preliminary work . . . we did find that effect in almost two-thirds
of the people," said researcher Dr. Michael Van Ameringen, an
assistant professor in the department of psychiatry and behavioural
neurosciences, and co-director of the anxiety disorders clinic at
the Hamilton Health Sciences Corp.

"Topiramate inhibits the glutamate system," Dr. Van Ameringen
said. "We think there is a group of patients with OCD who get a very
robust effect from this. It clearly does not work in all OCD
patients, but there is a group who go from having very significant
symptoms to virtually nothing on this treatment. That's why were
excited about it."

For the study, Dr. Van Ameringen and colleagues investigated the
adjunctive use of topiramate in 16 consecutive OCD outpatients
referred to their institution's anxiety disorders clinic who were
partial or nonresponders to SRI monotherapy or to SRI combination
therapy with antipsychotics, antidepressants or benzodiazepines.
These patients had topiramate added over 14 to 26 weeks, and were
seen approximately every four weeks for the first 16 weeks or until
a treatment response was achieved. The sample included five men and
11 women who had a mean of age of 41 years, a mean age of onset of
14.9 years and a mean duration of illness of 26.2 years.

Patient responses were measured using the Clinical Global Impression
Scale for Severity (CGI-S), which rates patients' severity of
symptoms from one ("normal/not at all") to seven ("among the most
extremely ill patients"), and the Clinical Global Impressive Scale
for Improvement (CGI-I), which rates patient improvement from one
("very much improved") to seven ("very much worse").

Following a mean response time of 9.2 weeks, the researchers found
11 of the 16 patients (60%) responded to adjunctive topiramate, with
a CGI-I score of two ("much") or one ("very much improved"). The 60%
response rate was considered a good response, said researchers.

CGI-S scores also improved significantly, to an endpoint score of
4.6 ("moderately ill" to "markedly ill") from a mean baseline score
of 6.1 ("severely ill").

During the course of the study, adverse events were experienced by
13 of 16 patients, but no individual withdrew from the study because
of them. The most commonly reported adverse events included weight
loss, sedation and fatigue, memory and word-finding difficulties and
paresthesia (see table).

Some of Dr. Van Ameringen's previous research has also looked at the
adjunctive use of topiramate in women with OCD who were on the drug
and then had to stop taking it when they became pregnant. Within
four weeks of discontinuation, these women were getting all their
OCD symptoms back. But after resuming the drug following the
completion of pregnancy, their symptoms were again alleviated.

Right now, Dr. Van Ameringen and colleagues are working on a placebo-
controlled study of topiramate in obsessive-compulsion disorder
patients.

Pointing to other research initiatives, Dr. Van Ameringen said there
are also some new agents being studied in SRI-refractory OCD
patients that purely work on the glutamate system.

"These drugs may have some really big applications in this area," he
said.

----------------------------------------------------------------
Source: http://www.medicalpost.com/mpcontent/article.jsp?
content=20041108_200253_5904
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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 Syndrome research at WMU explores tic suppression

By JP Gaylord
News Writer
November 04, 2004


The psychology department at Western Michigan University begun a
study that will extend through mid-2005 on Tourette Syndrome and the
suppression of its related tics.

Jim Carr, associate professor of psychology at WMU, will be the
principal investigator in a study focusing on children with the
syndrome. WMU will be working as a data collection site along with
North Dakota State University and the University of Wisconsin at
Milwaukee.

"What we're looking to do is find out how children can voluntarily
stop their own tics," he said.

Tics are involuntary motor movements. Tourette Syndrome can involve
vocal and motor movements simultaneously.

"They're more complex than a simple tic," said Wayne Fuqua, chairman
of the department of psychology at WMU.

The study will use children as its subjects in order to deepen
knowledge on their ability to suppress their own tics.

Suppression is also known as habit reversal and involves a fairly
simple, self-administered intervention, Fuqua said.

Suppression techniques, Carr said, will be tested in both adults and
children.

"We're relatively confident about adults, but we're really
unconfident about younger children," he said.

There are a number of treatments that involve suppression, he said,
but researchers don't know what happens to children after they stop
suppressing.

The study will find out if tics come back after suppression is
stopped and if they come back more intensely, which is known as a
rebound effect, Fuqua said.

The study is not meant to be a treatment study, but researchers hope
that the knowledge they come away with will be able to influence the
development of future treatment methods.

Researchers will be doing a number of assessments and interviews
with the participants of the study about their tics and history,
Carr said.

The study qualified as a greater than minimal risk study, and needed
to be approved by the Human Subjects Institutional Review Board
(HSIRB) because of the vulnerable population that is being targeted
and the use of a new therapy that has not yet been tested.

The protocol for the study was approved by both the University of
Wisconsin at Milwaukee HSIRB and the WMU HSIRB, said Vicki Janson,
research compliance coordinator at the WMU HSIRB.

"Anything with more than a minimal risk needed to be approved by the
12-member board," she said.

After some suggested revisions, the study's protocol was modified
and then it was approved, she said. A study with minimal risk
involves no risk beyond what a normal person would face in daily
activities if he lives prudently.

The cause of Tourette Syndrome is not fully known to researchers.

"It clearly has some familial and genetic influences," Fuqua
said. "Genetics probably reflect a propensity or a risk for it."

The syndrome tends to emerge in adolescence and early childhood, he
said, beginning with simple motor tics that become more complicated
as a person ages.

"It's very common for people with Tourette Syndrome to have a large
set of tics," Fuqua said.

The severity of the tics can have a major impact on daily life.

"Sometimes they are so severe that they attract attention," Fuqua
said. "They end up with social ostracism."

Tourette Syndrome can also affect the ability to do a job depending
on the frequency, severity and controllability of the tics, he said.

Treatment options involve either behavioral or pharmacological
treatments.

"There's pretty good evidence that behavioral treatments work,"
Fuqua said.

All of the data collection at WMU will take place in Wood Hall.

"We have a history of researching Tourette Syndrome at WMU," Carr
said. "More researchers in psychology have been interested in
Tourette Syndrome."

----------------------------------------------------------------
Source:
http://www.westernherald.com/vnews/display.v/ART/2004/11/04/418982b98
8823

Or
http://www.westernherald.com
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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

News Releases

ADVANCES IN UNDERSTANDING BRAIN CIRCUITS RESPONSIBLE FOR TICS IN
TOURETTE'S SHED LIGHT ON DISORDER

Recent advances are producing a much greater understanding of the
brain circuits responsible for the tics and problem behaviors seen
in Tourette's syndrome.

In one groundbreaking study, investigators have for the first time
measured the number of neurons in a particular area of the basal
ganglia-the brain area involved in Tourette's-in patients with the
disorder. Other studies suggest an imbalance in the basal ganglia's
inhibitory function could interfere with its ability to suppress
unwanted movements and vocalizations and thus lead to Tourette's
syndrome.

One of the least understood brain disorders, Tourette's syndrome
affects about one in 200 children. Symptoms usually appear between
the ages of four and eight and include repetitive involuntary
movements and utterances, or "tics." Tics vary according to where,
how often, and how strongly they are expressed. They are often
preceded by a sensory cue or "urge to tic" that can besiege the
individual's consciousness. Tics wax and wane in severity and are
typically worse during periods of emotional stress or fatigue.

Although many children experience their worst symptoms around the
age of 10 or 11 and then improve, some patients show their worst
symptoms as adults. In its most extreme form, the tics can be
virtually nonstop and include "purposive"-appearing repetitive
behaviors including obscene or socially inappropriate speech and
more rarely self-injurious behaviors. In addition to tics,
individuals with Tourette's also often have obsessions, compulsions,
and attentional deficits.

Scientists now know that symptoms of Tourette's syndrome likely
arise from dysfunction in a region deep within the brain called the
basal ganglia. Neurons in the basal ganglia inhibit or initiate
action plans by processing the information they receive from
the "executive centers" in the brain's prefrontal cortex and sending
it back to motor and sensory areas of the cortex through the
thalamus, new studies suggest.

"Recent imaging and postmortem studies now implicate the ventral
striatum and caudate nucleus—two regions of the basal ganglia—as
areas associated with the brain dysfunction seen in Tourette's,"
says Neal Swerdlow, MD, PhD, of the University of California-San
Diego department of psychiatry, co-chair of a symposium at this
meeting titled "Tourette's: The Self Under Seige."

"Although there is general agreement that the basal ganglia are
implicated in Tourette's syndrome, we know relatively few details.
For example, we know that increased activation in the caudate and
prefrontal cortex is associated with better tic control," says James
Leckman, MD, of the Yale University School of Medicine Child Study
Center and co-chair of the symposium. "There is also evidence that
the actual size of the caudate nucleus is reduced in many
individuals with Tourette's. But we don't know how these findings
are linked to the clinical features of Tourette's including its
waxing and waning course and why the tic symptoms usually peak in
early adolescence."

Knowing that dopamine antagonist drugs reduce the tics associated
with Tourette's and that selective serotonin reuptake inhibitors
reduce the symptoms of obsession and compulsions, Roger Albin, MD,
and colleagues at the University of Michigan department of neurology
investigated the idea that the ventral striatum—a brain region where
both dopamine and serotonin have important functions—could be
involved in Tourette's syndrome.

Noninvasive imaging studies show that the ventral striatum of
Tourette's patients has an excessive amount of dopamine-containing
nerve terminals. Other studies suggest that in normal brain
development, dopamine-containing nerve terminals are overproduced in
the years leading up to adolescence, and that these nerve terminals
are pruned back during adolescence.

"This raises the possibility that Tourette's syndrome is due partly
to abnormal persistence of excessive dopamine terminals in the
ventral striatum due to subtle changes in the timing of brain
development," Albin says.

The ventral striatum is known to be involved in the formation of
habits and is also involved in repetitive, stereotyped movements of
the face and limbs, some of which may be socially significant, Albin
says. "The tics of Tourette's syndrome may disrupt the unconscious
social communication normally mediated by these facial movements,
head position, and other stereotyped movements," he says. "This
could be the basis for the perception of tics as disruptive."
In other work, Flora Vaccarino, MD, also of the Yale University
School of Medicine Child Study Center, shows that patients with
Tourette's have an increased number of neurons that normally silence
brain activity in the internal segment of the globules pallidus and
a decrease in neurons in the caudate nucleus.

Using postmortem brain tissue, Vaccarino and her colleagues found
that Tourette's syndrome patients had about twice as many inhibitory
neurons in the globus pallidus, a part of the basal ganglia that
connects to the thalamus and inhibits its function. Inhibitory
neurons were decreased in other areas of the basal ganglia,
including the caudate nucleus, says Vaccarino.

Vaccarino suggests that the imbalance in inhibitory neurons could
change the timing of activity in the basal ganglia and thus lead to
the tics and other compulsive symptoms of Tourette's syndrome.
"The next step is to increase the number of brains studied, which
may allow us to relate severity of symptoms and anatomical
findings," Vaccarino says.

Leckman and his colleagues at Yale and Columbia University studied
patients who had had brain images taken during childhood to
determine if the size of any basal ganglia structures measured
before the age of 14 predicted their outcome years later as they
entered adulthood. Based on the earlier studies, they predicted that
caudate volumes would influence the course of the disorder.

"We found that the volume of the caudate nucleus and adjacent
structures in the subgenual region, which includes areas of the
ventral striatum and the limbic cortex, could account for nearly a
third of the variance of tic severity at follow-up," says Leckman.
These striatal and limbic regions are involved in the processing of
motivational and affective cues, which in turn may contribute to the
well-known sensitivity of Tourette's patients to emotionally laden
stimuli.

One of the challenges facing a complex nervous system with the
capability for many different behaviors is the need to prevent
potentially competing behaviors from interfering with desired
behaviors, says Jonathan Mink, MD, PhD, of the University of
Rochester Medical School department of child neurology. Mink
hypothesizes that a central role of the basal ganglia is to
facilitate desired behaviors and inhibit those that might compete
with the desired behavior. In Tourette's syndrome, clusters of
neurons in the ventral striatum of the basal ganglia may become
abnormally active, leading to inhibition of neurons in the globus
pallidus and substantia nigra (the basal ganglia's output centers).

"Neurons in these areas normally act to suppress unwanted
movements," says Mink. "But when the neurons themselves are
inhibited, they can no longer act to suppress unwanted movements,
leading to tics."

----------------------------------------------------------------
Source:
http://apu.sfn.org/content/AboutSFN1/NewsReleases/am2004_tourettes.ht
ml
----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.
----------------------------------------------------------------
Other 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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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

Behavior Therapy Best for Kids With OCD
Tuesday, October 26, 2004
By Salynn Boyles


Children and teens with obsessive-compulsive disorder respond better
to talk therapy than to antidepressants alone, but a combination of
the two approaches to treat OCD may work wonders, a government-
funded study group finds.

The findings are being reported less than two weeks after federal
health officials ordered makers of the most widely used
antidepressants to include warnings on their packaging about an
increased risk of suicidal thoughts and behaviors in children and
adolescents who take the drugs.

Medications that were originally approved for treatment of
depression are effective for anxiety disorders. Some of the newer
types of selective serotonin uptake inhibitors (search), such as
Fluoxetine, sertraline, fluvoxamine, paroxetine, and citalopram, are
among the SSRIs commonly prescribed for OCD.

Just more than half of the children and adolescents in the 12-week
study treated with a combination of behavioral therapy (talk
therapy) and the drug Zoloft (search) for three months had no
evidence of OCD four months later. Nearly two in five children
responded to talk therapy. While one in five participants taking
Zoloft alone had similar responses as did just under one in 20
treated with placebo.

The response rate for cognitive-behavior therapy alone was slightly
lower than for behavior therapy with the antidepressant, but
researchers concluded that either approach is an appropriate initial
treatment. The findings are reported in the Oct. 27 issue of the
Journal of the American Medical Association.


"The message is that we now have a clearly effective treatment for
obsessive-compulsive disorder in children and it is cognitive
behavior therapy (search)," researcher John March, MD, tells
WebMD. "In a relatively short period of time we have gone from
having no effective treatment to being able to bring half of the
kids with this disorder into the normal range within three months."

No Evidence of Suicidal Thoughts in OCD Patients

It is estimated that as many as one in 200 children have OCD,
characterized by intrusive thoughts, images, or impulses that lead
to repetitive or compulsive behaviors, such as frequent hand washing
or checking. Between a third and half of adults with OCD develop the
disorder during childhood.

In this study, 97 kids and teens with OCD completed 12 weeks of
treatment with either behavior therapy alone, treatment with Zoloft
alone, a combination of the two, or placebo. Four months later, just
nearly 54 percent of the kids treated with behavior and drug therapy
were considered to be in remission, meaning they were not engaging
in frequent repetitive behaviors. Remission rates, defined as an
obsessive-compulsive behavioral score of less than 10, were 39
percent, 21 percent, and nearly 4 percent for those treated with
behavior therapy alone, Zoloft alone, and placebo, respectively.

There was no evidence of an increase in suicidal thoughts among the
children taking the antidepressant drug Zoloft.

"It is reassuring in this study, as in others, that [antidepressant]
treatment was well tolerated, with no evidence of treatment-emergent
harm to self or others," the researchers wrote.

Drugs Relied on Too Much With OCD

The clear superiority of behavior therapy over drugs alone in this
study, along with the FDA warning, should have a major impact on how
OCD in children is treated in the U.S., child and adolescent
psychiatrist Rachel Ritvo, MD, tells WebMD.

"The sad fact is that economic considerations drive child mental
health care today, and treating a child with drugs is much, much
cheaper than psychotherapy," she says. "We have learned that kids
are very responsive to psychotherapy and psychosocial interventions,
probably even more so than adults."

Ritvo says a parent seeking treatment for a child with OCD should
push for psychotherapy, but she acknowledged that finding a
qualified therapist could be a challenge.

"There are fewer than 100 behavioral pediatricians in this country
and only about 7,000 child psychiatrists. That's it," she says. "I
turn away four or five people a week from my practice."

March counters that the behavioral therapy techniques used in the
treatment of children with OCD are easily learned and can be
administered by any good psychiatrist, psychologist, or mental
health social worker.

"Cognitive behavior therapy is a lot like physical therapy, but
instead of, say, rehabing a damaged knee you are retraining the
brain," he says. "This is a neurobehavioral illness (search) and
there are skillful and unskillful ways to treat it. The wrong
approach is relying on drugs alone or traditional psychotherapy. The
best treatment is clearly evidence-based cognitive behavior therapy."

By  Salynn Boyles, reviewed by  Brunilda Nazario, MD

SOURCES: Pediatric OCD Treatment Study, Journal of the American
Medical Association, Oct. 27, 2004, vol 292: pp 1969-1976. John S.
March, MD, MPH, department of psychiatry, Duke University Medical
Center, Durham, N.C. Rachel Ritvo, MD, general child and adolescent
psychiatrist; clinical associate professor of medicine, George
Washington University, Washington; and spokeswoman, American Academy
of Child and Adolescent Psychiatry




----------------------------------------------------------------
Scource:
http://www.foxnews.com/story/0,2933,136692,00.html

----------------------------------------------------------------
Note, If a link does not work, try cutting and pasting the entire
link into a new browser.

----------------------------------------------------------------
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-
mail to:
Tourette-Updates-subscribe@yahoogroups.com

Comments or Questions:
editor@...

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


  CPA: Therapy-resistant Obsessive-Compulsive Patients Respond to
Topiramate
By Louise Gagnon

MONTREAL, QUEBEC -- October 19, 2004 -- Topiramate is effective add-
on therapy for some patients with obsessive-compulsive disorder
(OCD) who have proved resistant to traditional treatment, according
to results of an open-series study presented here at the 54th
Canadian Psychiatric Association Annual Meeting.

"A sub-group of patients…responded to the addition of topiramate in
their therapy," said Michael Van Ameringen, MD, Principal
Investigator and Associate Professor of Psychiatry, Department of
Psychiatry and Behavioural Neurosciences, McMaster University,
Hamilton, Ontario, Canada. "We have taken [patients'] OCD from very
severe to very minimal by adding topiramate to their therapy. It
appears promising."

In 5 men and 11 women with a mean duration of illness of 26.2 years –
the researchers added topiramate at a mean dose of 253.1 mg/day to
selective serotonin reuptake inhibitor (SSRI) monotherapy or SSRI
combination therapy over 14 to 26 weeks. At baseline, the mean
Clinical Global Improvement (CGI) score was 6.1, indicating patients
were regarded as "severely ill".

By the end of the treatment period, 68.8% had a significant drop in
their CGI score. Specifically, 43.8% of subjects had a score of 2,
which indicates they were "much improved," and 25% had a score of 1,
which indicates they were "very much improved."

Dr. Van Ameringen, who is also Co-director of the Anxiety Disorders
Clinic at McMaster University Medical Centre, said that patients
with OCD are typically on SSRIs, which produce response rates of 42%
to 53%.

Dr. Van Ameringen said his team decided to investigate the role of
topiramate therapy in OCD as a result of previous basic science
research showing promise in this area.

"Neuroimaging studies found a deficit in the glutamate system in a
group of children who had [OCD]," he explained. "That may say
something about the neurobiology of the disorder. It made us explore
what agents had an effect on glutamate, such as topiramate."


[Presentation title: "Adding Topiramate to an SRI in Treatment-
Resistant Obsessive-Compulsive Disorder." Abstract 37]
----------------------------------------------------------------
Scource:
http://www.docguide.com/news/content.nsf/news/8525697700573E1885256F3
2004AD410?
OpenDocument&id=48DDE4A73E09A969852568880078C249&c=Psychiatry%
20Other&count=10
----------------------------------------------------------------
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@...

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

Food and Drug Administration (FDA) asks manufacturers of all
antidepressant drugs to include in their labeling a boxed warning
and expanded warning statements that alert health care providers to
an increased risk of suicidality (suicidal thinking and behavior) in
children and adolescents being treated with these agents, and
additional information about the results of pediatric studies.


Text of the "black box" warning that the Food and Drug
Administration ordered included on all antidepressants:

Antidepressants increase the risk of suicidal thinking and behavior
(suicidality) in children and adolescents with major depressive
disorder (MDD) and other psychiatric disorders. Anyone considering
the use of (drug name) or any other antidepressant in a child or
adolescent must balance this risk with the clinical need. Patients
who are started on therapy should be observed closely for clinical
worsening, suicidality, or unusual changes in behavior. Families and
caregivers should be advised of the need for close observation and
communication with the prescriber. (Drug name) is not approved for
use in pediatric patients except for patients with (approved
pediatric claim).

Pooled analyses of short-term (four to 16 weeks) placebo-controlled
trials of nine antidepressant drugs (SSRIs and others) in children
and adolescents with MDD, obsessive compulsive disorder (OCD), or
other psychiatric disorders (a total of 24 trials involving over
4,400 patients) have revealed a greater risk of adverse events
representing suicidal thinking or behavior (suicidality) during the
first few months of treatment in those receiving antidepressants.
The average risk of such events on drug was 4 percent, twice the
placebo risk of 2 percent. No suicides occurred in these trials.

http://www.fda.gov/cder/drug/antidepressants/default.htm

---------------
Paul Marshall
editor@...

http://www.tourettes-disorder.com

Our Tourette Updates List

Relevant, new updates & breakthroughs about Tourette Syndrome -
Tourette Spectrum Disorders. Notices only, not a discussion forum.
Notices about once a month.

To subscribe via e-mail, send a blank e-mail to:
Tourette-Updates-subscribe@yahoogroups.com

To subscribe via the web click here:
http://groups.yahoo.com/group/Tourette-Updates/join?referer=1

To just visit and take a look click here:
http://groups.yahoo.com/group/Tourette-Updates/

I know what made Mozart tic
(Filed: 13/10/2004)

Mozart was obsessed with filthy verse and breaking wind - evidence,
says the composer James McConnel, that his hero was a fellow
Tourette's sufferer. He tells Robert Gore-Langton why music is his
medicine, too.

You could go quite a while without spotting anything untoward about
him. But sooner or later you become aware that James McConnel has a
bizarre affliction.

At one point, we are sitting in the composer's study in his
magnificent Norfolk rectory, rabbiting on about Mozart. Out of the
blue he does a strange facial twitch - a little one.

By midday lunch is ready. As I pass him the peas, he has a full-
blown twitch, jabs the air repeatedly with his finger, brushes his
face with his other hand, and lets out a brief snort. None of his
family - least of all his wife, the Country Life cartoonist Annie
Tempest - seems to notice this.

McConnel is what you might call Bohemian posh, and looks and sounds
like a hyperactive version of Hugh Grant. He has a background in
musicals but also composes for television and film.

His face, too, is about to become familiar as the presenter of a
documentary for Channel 4 called What Made Mozart Tic?, in which he
suggests that Mozart had Tourette's Syndrome. It's not a new theory.
But it is one which McConnel is in a unique position to argue
because he himself is a sufferer.

"It's horrible; of course, if you've got the swearing and spitting
kind of Tourette's [this affects about 20 per cent of sufferers].
But I haven't. I've got the more charming version, touch wood."

The only time McConnel doesn't twitch (put a gun to his head and you
could make him stop, he says, but only for so long) is when he's at
his piano, composing. In the program he argues that Mozart,
too, "self-medicated" by writing music.

"The self-medicating theory is that music is a replacement for the
twitching. With me it was subconscious. It wasn't until I was about
25 that someone pointed out that I wasn't twitching when I was at
the piano.

"I suspect Mozart didn't have physical jerks as much as me. But
there is definite evidence of his grimacing and feet-tapping.
"We also know a lot about his inability to rein in impulses, the
sudden boredom, his sense of mischief and his scatological
obsession, which all point to Tourette's. He even had a morbid fear
of the trumpet until he was nine. Seriously! He would lie down and
scream if he heard one."

The filthy, excrement-obsessed letters Mozart wrote provide a useful
starting point for McConnel.

"There's a very rare condition in Tourette's called coprographia -
the need to write down filth. We Touretters have filthy minds!
"When you write a song, as Mozart did, called Lick Out My Arsehole,
that in itself is not so shocking judged by the standards of his
day. But what is very odd and Touretty about it is that he set it to
the most gorgeous, sublime tune. It's Tourettishly inappropriate.
"My sense of humor is the same. I never know when to stop."

McConnel - like Mozart - passes wind a lot, staging elaborate wind-
breaking competitions with his daughter. "I love farting," he beams.
Because he suffers from obsessive compulsive disorder (OCD) McConnel
takes half an hour to go through all his bedtime rituals - checking
lights, looking behind doors and so forth.

"When I am doing them I know it is completely barking," he
says. "But I can't not do it and feel comfortable. If I don't, the
house will burn down, the children will fry, there will be some
terrible calamity as a consequence. That's how it feels."

The same was apparently true for the young Mozart. "When he was a
child he had to do his bedtime rituals with his father, Leopold, and
if they weren't right he would do them all over again."

Although Tourette's wasn't recognized in Mozart's day, much has been
made of his constant childhood illnesses. These, apparently, could
have triggered Pandas (pediatric auto-immune neuro-psychiatric
disorder), which can lead to Tourette's. McConnel himself wasn't
diagnosed with Tourette's until 12 years ago - he's now 46. He can,
however, pinpoint the onset.

"I can remember the very instant I started twitching. It was during
the third verse of Hark the Herald Angels Sing at my school carol
service when I was six. It was a sniff and I didn't have a cold. I
started sniffing, which became permanent.

"Later, I heard a man and a woman having a row. She stormed off with
a loud 'huh' and the seeds of my OCD started then, because I started
copying that 'huh' obsessively. Huh, huh, huh, huh. I had to get it
just right."

McConnel believes the root of Mozart's Tourette's is to be found in
the music itself - something McConnel knows from his own experience
of composing.

"Tourette's is a constant battle between having a compulsion and
trying to control it, and that can translate into music. Mozart let
his music run off in chaotic directions but then always brought it
back under control.

"His interest in counterpoint and fugue - its unfashionable
complexity - appealed to his Touretty side. The music for me has
just so much happiness, for want of a better word. There's no
residual misery. You always come away from Mozart feeling better."
Scientific tests have proved the efficacy of Mozart in music
therapy: it is indeed deeply calming. Not that this stops his
greatest fan going about the house trilling, farting and twitching
like a dervish.

The family, however, clearly regard the condition with a sense of
humor; McConnel's e-mail name is McTwitch and there is a plate in
the kitchen inscribed: "Warning: mad twitcher on the loose."
I ask McConnel's wife, Annie, what it's like living with a one-man
tic-ing bomb. "It's his OCD that is the worst of it," she says. His
constant switching off the fax machine in the study drives her mad.
Or as she puts it, rather wittily: "James has Tourette's, whereas I
suffer from it."

It runs in the family. Their son Freddie, 12, is also classed as
having Tourette's. A member of Mensa, he was recently on Mastermind.
His specialist subject? Mozart.

•  What Made Mozart Tic?, October 18, Channel 4, 8pm


Source:
http://www.telegraph.co.uk/arts/main.jhtml?
xml=/arts/2004/10/13/bmoz12.xml&sSheet=/arts/2004/10/13/ixartleft.htm
l

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

Tourette-Updates

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

Surgery helps short-circuit Tourette's syndrome

An implant that flips the off-switch on misfiring brain cells could
eventually help treat everything from addictions to depression, PAUL
TAYLOR writes

PAUL TAYLOR

From Tuesday's Globe and Mail


POSTED AT 7:49 AM Tuesday, October 12

Jeff Matovic used to eat with a plastic spoon to prevent himself
from accidentally gouging out one of his eyes.The 31-year-old has
Tourette's syndrome, a neurological disorder characterized by
involuntary muscle movements. Mr. Matovic, who developed symptoms at
age 3, could not sit, walk or even sleep without his body exploding
in an endless series of jerking motions and verbal outbursts. He has
broken glasses in his bare hands and dented walls with his head
because of sudden muscle contractions.
Things got so bad, Mr. Matovic sought out doctors who would implant
electrodes in his brain to quiet his restless body, after hearing
about another patient who had the treatment. The operation took
place six months ago at the University Hospitals of Cleveland, and
his body has been calm ever since.

"It's just amazing. It is truly phenomenal," Mr. Matovic said in a
telephone interview from his home in a Cleveland suburb. Before the
operation, he could barely talk on a phone because of an
irrepressible urge to clear his throat, grunt and hiss -- not to
mention the difficulty of holding the receiver.

Mr. Matovic underwent a treatment known as deep-brain stimulation,
increasingly used to treat a wide range of brain disorders. Much
like a heart pacemaker, the treatment provides a stream of
electrical current to counteract a part of the brain that is
misbehaving.

During surgery, electrodes are inserted into specific spots in the
brain. They are then connected through wires under the skin (beneath
the scalp, neck and upper chest) to a replaceable battery unit
implanted beneath the collarbone.

Only a handful of people (none in Canada) has received the treatment
for Tourette's. But deep-brain stimulation has been used for more
than a decade to treat other movement disorders, such as Parkinson's
disease, tremors and dystonia, which distorts posture. About 30,000
people around the world now have such brain implants.

As neurosurgeons refine their skills, medical experts speculate that
deep-brain stimulation could be used to treat everything from drug
addictions to depression. Studies are under way at various medical
institutions to expand its use. The technique is proving effective
partly because the brain itself operates like an electrical circuit.
When even just a few brain cells are misfiring, they can cause
widespread problems resulting in either a physical or mental
disorder.

A little electrical current, applied in the right place, seems to
restore harmony to the discordant symphony of the disordered brain,
said Dr. Robert Maciunas, the neurosurgeon who operated on Mr.
Matovic.

Years ago, Dr. Maciunas noted, surgeons performed lobotomies in
which connections between dysfunctional parts of the brain were
permanently severed.

"Remember, this was an era when there was no medication for these
horrible psychiatric disorders. So somebody who could demonstrate a
significant benefit in some of these hopeless patients was a
godsend," he said. The problem with lobotomies was that they were
overused -- and irreversible, he added. Surgeons also attempted to
destroy small areas of the brain, which appeared to be the source of
specific disorders. It finally occurred to them that they could
achieve the results though electric probes, and the current could be
fine-tuned to fit the ailment.

Most of the initial deep-brain stimulation operations were performed
on people with Parkinson's disease (which results from the death of
brain cells that produce the neurotransmitter dopamine, which is
involved in body movements). Parkinson's sufferers have difficulty
moving with ease. They develop a stony stare, a shuffling walk and,
at times, their body trembles like leaves in the wind.

"The treatment turns back the clock five to 10 years on the illness,
to a point when the patient had less severe symptoms," said Dr.
Andres Lozano, a neurosurgeon at Toronto Western Hospital, who has
performed the operation on almost 200 Parkinson's patients. But he
cautioned that it is not a cure: It merely controls symptoms for a
time. Parkinson's is a degenerative neurological disorder in which
brain cells continue to die. Eventually, patients develop dementia
and their bodies shut down.

It is uncertain how long deep-brain stimulation can control the
symptoms of Tourette's. But there's a good chance it could be long-
lasting. Unlike Parkinson's disease, Tourette's does not involve the
progressive death of increasing numbers of brain cells.

"If it [Tourette's] is a disorder of brain function only, and if we
improve that function, then the disease should not continue
progressing," said Dr. Lozano.

Mr. Matovic, however, wasn't made any promises when he went under
the knife. As one of the first Tourette's patients to receive deep-
brain stimulation, his doctors were unsure of his outcome.

Yet Mr. Matovic was willing to take a risk because the usual
treatment of drugs and various therapies had failed. What's more, he
was fed up with strangers laughing at his incessant muscle tics. And
even though he has a college education, he had to take menial
jobs. "I'm so grateful they did the operation," Mr. Matovic said,
adding that he is 99-per-cent symptom-free. He now has an office
job, is planning to write a book and his wife is expecting a
baby. "We are certainly very excited about it."

Source:
http://cfcn.theglobeandmail.com/servlet/RTGAMArticleHTMLTemplate/B/20
041012/gthtourettes12?
brand=generic&hub=&tf=CFCNPlus/generic/hubs/frontpage.html&cf=CFCNPlu
s/generic/hubs/frontpage.cfg&slug=gthtourettes12&date=20041012&archiv
e=RTGAM&ad_page_name=&nav=&subnav=fullstory&site=Technology&vg=BigAdV
ariableGenerator&id=RTGAM.20041012.gthtourettes12


Paul Marshall
Editor

Fluphenazine effective for Tourette syndrome
Fluphenazine is an effective treatment for abnormal movements in
Tourette syndrome, according to a study published in the April 13,
2004, issue of Neurology. From 1349 patients diagnosed with Tourette
syndrome at 1 center since 1981, 272 were randomly selected for
chart review. Of these, 63 had been treated with fluphenazine for at
least 1 year (mean 3.9 years). Marked or moderate improvement was
seen in 84% of patients, at a mean daily dose of 3.9 mg/day. Adverse
effects included drowsiness, weight gain, dystonic reaction, and
akathisia. No patient developed tardive dyskinesia. The authors
conclude, "Our study provides evidence that fluphenazine is a safe
and effective drug in long-term treatment of tics." (This summary is
courtesy of WeMove (Worldwide Education and Awareness for Movement
Disorders).

Hundreds of health problems have been caused by, misdiagnosed as or
mimicked by Lyme disease, including facial palsy, Alzheimer's
disease, anxiety, ADD, ADHD, Bell's Palsy, bipolar disorder, brain
tumor, Chronic Fatigue Syndrome, depression, epilepsy, respiratory
distress syndrome, fetal death, fever, fibromyalgia, hearing loss,
heart block, hepatitis, lupus, memory impairment, meningeal
lymphoma, meningitis, migraines, mono, Multiple Sclerosis, Non-
Hodgkin's lymphoma, restless legs syndrome, Rheumatic Fever,
rheumatoid arthritis, seizure disorders, stroke, sudden infant death
syndrome, thyroiditis, Tourette's syndrome, urticaria and vertigo.
Nevertheless, even in late disseminated Lyme disease, intravenous
antibiotic therapy has a high success rate.

      - Information provided by Colin Nicholl

Take precautions to prevent Lyme disease



You and your family live in an area with a high incidence of Tick
Borne Diseases, including Lyme disease, a potentially serious
affliction caused by spiral-shaped bacteria transmitted by infected
deer ticks, tiny spider-like creatures that live in woodland and
grassy areas.

      Named for Old Lyme, Conn., the location where it was discovered
in 1975, Lyme can significantly undermine the quality of your life
if left untreated. The highest risk from these ticks is from April
to October when they are smallest and most active, but they are
active whenever the temperature is above 40 degrees.

      One of the early signs of Lyme disease may be a bull's-eye red
rash. Later signs may include fluish symptoms such as muscle aches,
fever, tiredness and joint pain. More serious complications include
a whole host of symptoms, especially involving the joints, nervous
system and heart. Where there is a combination of severe fatigue,
muscle aches/stiffness, and neurological or arthritic
symptomatology, a diagnosis of Lyme disease should be considered.

      Lyme disease, especially in its early stages, can be treated
with antibiotics. If you suspect that you have Lyme disease, do not
delay consulting with your doctor.

      Take precautions

      Take the following precautions, especially when walking in a
wooded area:


Wear light-colored clothing, making ticks easier to spot.


Avoid common tick habitats such as tall grass, bushes, brush and
woods.


Keep to the center of pathways. Do not rest on fallen logs or sit on
the forest floor.


Wear long trousers and long-sleeved shirts; tuck your trousers into
socks.


Use a tick repellent.


Before going indoors, brush off your clothing.


Once indoors, check your whole body carefully for ticks, removing
and crushing unattached ticks, and following the procedure below if
you find ticks attached to you.

      Note: most people do not feel a tick biting, nor do they sense
the drawing of blood by the tick over the next 2 to 4 days of
attachment.

      Know how to remove a tick

      If you find a tick imbedded in your skin, take the following
measures:


Remove the tick promptly. Ticks removed within 24 hours are less
likely to infect you.


Use a tick removal device (tickedoff.com) or tweezers to remove the
tick. Grasp the tick's head, including its mouth parts, and tug
gently and repeatedly until the tick withdraws its barbed mouth from
your skin. Remember that the bacteria are in the tick's saliva, so
do not squeeze its body, suffocate it with Vaseline, or burn its
bottom with a match, which can cause it to spit or spew.


Preserve the tick in a jar of alcohol, noting the date and location
of the bite and where you think you picked up the tick.


Wipe the area of attachment with antiseptic and wash your hands and
tweezers with antibacterial soap.

      Diagnosing Lyme disease

      If you develop a striking red bull's-eye red rash (typically
within 4-6 weeks of a bite) photograph the rash and keep a record of
the date on which it first appeared. Have a doctor examine the rash,
mentioning your concern that it may be an erythema migrans rash. (If
your doctor suspects that you have a Lyme rash, he/she will
typically prescribe a course of oral antibiotics, which, if taken
faithfully, should take care of the infection.)

      If you develop a "summer flu" (whether or not you recall a
rash), consisting of aching muscles and/or joints, swollen glands,
headaches, exhaustion, fever, neck stiffness or cold sweats, consult
with a medical doctor and request a Lyme test, preferably
the "Western Blot," as the frontline blood test (ELISA) has been
widely questioned.

      All Lyme tests are difficult to interpret and far from
foolproof. Consequently, the CDC insists that Lyme disease is a
clinical, rather than a laboratory, diagnosis.

      If you have Lyme disease and it is undetected and left
untreated, you may develop strange arthritic, neurological and/or
cardiological symptoms over the following months and years, which
could prove difficult to diagnose.

      Hundreds of health problems have been caused by, misdiagnosed
as or mimicked by Lyme disease, including facial palsy, Alzheimer's
disease, anxiety, ADD, ADHD, Bell's Palsy, bipolar disorder, brain
tumor, Chronic Fatigue Syndrome, depression, epilepsy, respiratory
distress syndrome, fetal death, fever, fibromyalgia, hearing loss,
heart block, hepatitis, lupus, memory impairment, meningeal
lymphoma, meningitis, migraines, mono, Multiple Sclerosis, Non-
Hodgkin's lymphoma, restless legs syndrome, Rheumatic Fever,
rheumatoid arthritis, seizure disorders, stroke, sudden infant death
syndrome, thyroiditis, Tourette's syndrome, urticaria and vertigo.
Nevertheless, even in late disseminated Lyme disease, intravenous
antibiotic therapy has a high success rate.

      - Information provided by Colin Nicholl



Paul Marshall
http://www.tourettes-disorder.com
editor@...

Posting this to let you know the soon you will be able to get info
for free on TS if it is Government Funded research, as our tax payer
dollars are paying for the research, therefore we should not have to
pay for it again to discover the results.

Paul Marshall
editor@...


Taxpayers Support "Open Access" to NIH Research; Public Interest
Advocates Join Forces to Support Congress and NIH Leadership

Tue Aug 24,12:07 PM ET





To: National Desk


Contact: Bob Witeck, 202-887-0500 ext. 19 or
bwiteck@..., for the Alliance for Taxpayer Access


WASHINGTON, Aug. 24 /U.S. Newswire/ -- An unprecedented coalition of
public interest groups today announced the formation of the Alliance
for Taxpayer Access. The Alliance will urge the National Institutes
of Health (news - web sites) as well as Congress to ensure that peer-
reviewed articles on taxpayer-funded research at NIH become fully
accessible and available on line and at no extra cost to the
American public.


The Alliance formation precedes the public interest meeting slated
for Tuesday, August 31 where NIH will receive input on how to
improve public access to the results of NIH-funded biomedical
research.


The Alliance is an informal coalition of libraries, patient and
health policy advocates, and other stakeholders who support reforms
that will make publicly funded biomedical research accessible to the
public. Details and FAQ's on the Alliance may be found at
http://www.taxpayeraccess.org.


Today the vast majority of research funded with public dollars is
available only through increasingly costly journal subscriptions
(often costing thousands of dollars annually for a single journal),
institutional licenses (more than a million dollars annually for
many universities), or per article purchases (as much as $30 per
article). Alliance supporters believe the current system of
subscription-based access to scientific research is economically
unsustainable and effectively impedes the dissemination and use of
research that has been paid for with public dollars.


Alliance supporter Sharon Terry, President and CEO of the Genetic
Alliance, said, "This consumer-centered approach is a long-overdue
means by which to enhance public health education, speed the
translation of genetic advances into quality, affordable health
care, and inform and empower patients in their health care
decisions."


"It is sometimes suggested that this information is not available to
the 'homemaker in Iowa' because she is ill equipped to deal with
this information. We know, from our 600 members -- disease-specific
advocacy organizations -- that the homemaker has many resources to
help her use that information. This access is critical; we know
first-hand that clinicians are unable to keep up with information on
6000 rare diseases, and patients must be the bridge to new
knowledge."


Acknowledging the key role of individuals volunteering for clinical
tests, Mitchell Warren, Executive Director of the AIDS (news - web
sites) Vaccine Advocacy Coalition, said that, "Open access is
consistent with cornerstone principles of respect for persons when
conducting research on human subjects and will contribute to the
willingness of individuals to participate in subsequent research
because they have full, shared, knowledge of results."


"In the digital age, with the extraordinary public benefits of
cutting-edge research, it is counter-productive for there to be
costly barriers preventing the fullest possible availability of
quality information about current research findings," said Rick
Johnson, spokesman for the group. Johnson also serves as director of
the Scholarly Publishing and Academic Resources Coalition (SPARC), a
member of the new Alliance. "We agree with leaders at NIH and on
Capitol Hill that the status quo is unacceptable when most American
taxpayers do not have access to the reports on biomedical research
conducted with U.S. Government funds."


Barbara Redman, Dean of the College of Nursing at Wayne State
University, echoed concerns of educators' within the
Alliance: "Access to emerging NIH-funded medical research is
invaluable to the transfer of knowledge in every instructional
setting. Faculty and students alike benefit from access to
biomedical reports in all fields, and we applaud NIH leadership in
furthering this initiative."


Dr. Richard Roberts, 1993 Nobel Laureate in medicine and currently
with New England Biolabs, added his support: "Open access to the
scientific literature is the single most important advance that we
can make in the distribution of research results to scientists and
the public alike. I find that a majority of my fellow scientists and
Nobel Laureates agree that this new initiative is groundbreaking,
long overdue and will ensure that we all can read about the results
of our government's support of research. I am heartened that
taxpayers representing broad stakeholders in this issue have joined
forces to endorse the principle of open access to the scientific
literature we produce through our investment of public dollars. This
is good for science and good for the American public."


Members of the Alliance for Taxpayer Access, at formation (in
alphabetical order), include: AIDS Action Baltimore; AIDS Vaccine
Advocacy Coalition; American Association of Law Libraries; American
Library Association; American Medical Student Association; Arthritis
Foundation; Association of Academic Health Sciences Libraries;
Association of College & Research Libraries; Association of Maternal
and Child Health Programs; Association of Research Libraries;
Association of Southeastern Research Libraries; Autosomal Recessive
Polycystic Kidney Disease and Congenital Hepatic Fibrosis Alliance;
Boston College Libraries; Christopher Reeve Paralysis Foundation;
Coalition for Heritable Disorders of Connective Tissue; Colorado
State University Libraries; Conquer Fragile X Syndrome; Down
Syndrome Treatment and Research Foundation; Facing Our Risk of
Cancer Empowered; Genetic Alliance; International Mosaic Down
Syndrome Association; IsoDicentric 15 Exchange, Advocacy & Support;
Medical Library Association; National Alliance for Autism Research;
National Coalition for PKU & Allied Disorders; National Fragile X
Foundation; National Tay-Sachs & Allied Diseases Association, Inc.;
New England Biolabs; Parent Project Muscular Dystrophy; Prader-Willi
Syndrome Association; Public Knowledge; PXE International; Scholarly
Publishing and Academic Resources Coalition; Spina Bifida
Association of America; Tourette Syndrome Association; University of
Connecticut Libraries; Wayne State University College of Nursing


http://www.usnewswire.com/


-0-


/© 2004 U.S. Newswire 202-347-2770/

There has not been a lot to post that is new to TS besides Human
Interest stories.

If you would like those listed inside of the Tourette Updates every
month I can add those in a single posting for the month.

Otherwise to find out the latest human interest stories on TS you
can go to a major search engine like Google, Yahoo, or MSN and just
do a search with Tourette Syndrome or Tourettes and it will bring up
alot of results.  You can sort them by date.

If you would like to have human interest stories included in the
monthly updates please let me know with the pole here:

http://health.groups.yahoo.com/group/Tourette-Updates/surveys?
id=11839661

Enter your vote today!  A new poll has been created for the
Tourette-Updates group:

Would you like only new relevant
updates from this mailing list
regarding Tourette Syndrome, or would
you like me to add all the latest
human interest stories as well?

   o Just latest updates regarding TS.
   o Related updates and human interest stories.


To vote, please visit the following web page:
http://groups.yahoo.com/group/Tourette-Updates/surveys?id=11839661

Note: Please do not reply to this message. Poll votes are
not collected via email. To vote, you must go to the Yahoo! Groups
web site listed above.

Thanks!

Tourette Updates

Dopamine-sensitive abnormality in Tourette syndrome

For many years, researchers have thought that people with Tourette
syndrome, a neurological disorder characterized by abrupt movements
called tics, have sensitivity to dopamine levels in the brain. In a
study, Washington University School of Medicine researchers found
abnormal brain activity in people with Tourette syndrome during
memory tasks. When given levodopa, a form of dopamine used to treat
Parkinson's disease, the brain activity normalized. The researchers
have begun a study of whether levodopa can help control the tics in
Tourette syndrome.

Source ( about.com)
----------------------------------------------------------------

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



----------------------------------------------------------------
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@...

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

A major cable network (see letter below) is filming a documentary on
Tourette syndrome and wants to include success stories of
alternative or complementary treatments with children. This is a
wonderful opportunity to spread the word and help others!

PLEASE contact Beth if you have had this experience. Thank you very
much--Sheila Rogers, ACN Today
- - - - - - - - - - - - - -
Dear Friends:

We are producing an educational documentary on children with
Tourette's Syndrome and are very interested in finding families who
have children between 7 and 12 years old who are not taking the
usual concoction of medications for tics, ADHD, OCD, etc.

I can tell you more about this project via email or phone and verify
my credentials - I hope you'll be interested enough to get in touch.

You can email me at bgaala@...     Many thanks, Beth Aala

212.512.5970 (Office)
212.512.5009 (Fax)

Surgeons explore new treatment for Tourette syndrome
Patient experiences significant resolution of symptoms following
brain surgery
NOTE: THIS RELEASE HAS BEEN UPDATED SINCE ITS ORIGINAL POSTING
CLEVELAND, April 1, 2004: A neurosurgical team at University
Hospitals of Cleveland (UHC) has, for the first time in North
America, applied a new surgical approach to the treatment of
Tourette syndrome, resulting in the immediate and nearly complete
resolution of symptoms for the patient, who has suffered from this
neurologic disorder since he was a child.

"We were genuinely amazed at the patient's response," says Robert J.
Maciunas, MD, neurosurgeon at UHC and professor at Case Western
Reserve University School of Medicine. He has used the technique
called deep brain stimulation (DBS) for the treatment of Parkinson's
disease and tremor, and was impressed with this patient's dramatic
reaction: the disappearance of the jerking motions, muscle tics and
grunting associated with his Tourette's. "This technique holds great
promise for patients suffering from this movement disorder, which
often is diagnosed in childhood or early adolescence and can be
completely debilitating."

Jeff Matovic, a Lyndhurst, Ohio, resident who grew up in Bay
Village, was six years old when he was diagnosed with Tourette
syndrome, a neurobehavioral disorder characterized by sudden,
repetitive muscle movements (motor tics) and vocalizations (vocal
tics). Though standard therapy with medication controlled his
movements for much of his boyhood, his condition severely worsened
with age.

"I had to drink with a sippy cup; otherwise, I would spill liquid
all over and even break glass or plastic cups with the severity of
the muscle spasms that were so forceful and unpredictable," says
Jeff, now age 31. "To grow up being made fun of, always feeling
different, and then, as an adult, unable to hold a job and support a
family, I was feeling devastated by my Tourette's. I had heard about
deep brain stimulation for other movement disorders. I knew that
brain surgery was risky, and the doctors could not guarantee any
positive outcome, but I wanted them to take a chance on me. And I'm
so grateful that they did."

Prior to brain surgery, physicians at University Hospitals Movement
Disorders Center mapped out regions of Jeff's brain, through MRI
(magnetic resonance imaging) scans and 3-D computer images. Their
goal was to locate the safest and most direct route to reach the
cells inside the thalamus portion of the brain, involved in
controlling Jeff's movements. By placing electrodes around those
cells to deliver continuous high-frequency electrical stimulation,
control messages are rebalanced throughout the movement centers in
the brain. The electrodes are connected from the brain through wires
under the skin (beneath the scalp, neck and upper chest) to an
implanted battery just beneath the collarbone. In Jeff's case, since
both sides of his body were affected by the movement disorder, he
has electrodes implanted on both sides of his brain and tiny battery
packs implanted on each side of his chest.

The doctors at University Hospitals of Cleveland are careful to
point out that not everyone with Tourette syndrome requires
treatment. The first line of treatment is medication, which can be
very effective. Surgical treatment is considered a last resort, and
it is not clear how effective deep brain stimulation will ultimately
prove for patients with this particular disorder.

In the United States, the Food and Drug Administration has approved
deep brain stimulation for the treatment of Parkinson's disease,
essential tremor and dystonia. "We've seen very positive responses
in patients with Parkinson's disease. Studies of the DBS technique
show that this stimulation can significantly reduce tremor and other
symptoms in about three quarters of appropriately selected patients
with Parkinson's." says Brian N. Maddux, MD, PhD, Jeff's neurologist
at UHC and assistant professor at Case School of Medicine. "Patients
with a different movement disorder called dystonia can take three
months to respond to the electrical stimulation. We didn't know how
Jeff would respond. Within hours after the stimulator was turned on,
we observed the ceaseless movements become completely relaxed and he
was able to walk normally. We were awestruck."

Physicians at University Hospitals of Cleveland have submitted a
report of this case for consideration for publication in a peer-
reviewed journal. They hope to further explore the application of
DBS to other patients with Tourette syndrome. It is estimated that
approximately 200,000 Americans have Tourette syndrome, though
experts believe it is a movement disorder that often remains
undiagnosed.


###
For more information about the surgery, go to http://www.uhhs.com.
For more information about Tourette syndrome, go to http://www.tsa-
usa.org.

University Hospitals Health System (UHHS) is the region's premier
healthcare delivery system, serving patients at more than 150
locations throughout northern Ohio.

The System's 947-bed, tertiary medical center, University Hospitals
of Cleveland (UHC), is the primary affiliate of Case Western Reserve
University (CWRU). Together, they form the largest center for
biomedical research in the State of Ohio. The System provides the
major clinical base for translational researchers at the Case
Research Institute, a partnership between UHC and CWRU School of
Medicine, as well as a broad and well-characterized patient
population for clinical trials involving the most advanced
treatments. Included in UHC are Rainbow Babies & Children's
Hospital, among the nation's best children's hospitals; Ireland
Cancer Center, designated by the National Cancer Institute as a
Comprehensive Cancer Center (the nation's highest designation); and
MacDonald Women's Hospital, Ohio's only hospital for women.

Source
http://www.eurekalert.org/pub_releases/2004-04/uhoc-sen033104.php

`Sky's the Limit, Now'
Experimental Surgery Zaps Tics for Longtime Sufferer of Tourette
Syndrome

By Dr. Tim Johnson
ABCNEWS Medical Editor


C L E V E L A N D, April 1 — For nearly all of his 31 years, Jeff
Matovic lived his life in a body out of control.

Talking was often painfully difficult for him, and simple movements
nearly impossible. His greatest wish was a simple one.

"It would just be really nice to be still for, you know, a period of
time," Matovic said.

The quiet peace of sitting still was an unknown dream for Matovic,
who has Tourette syndrome, a disorder that affects 100,000
Americans, according to the National Tourette Syndrome Association.

Many people think of Tourette patients as people who uncontrollably
sputter out obscene language. But that particular symptom of the
disease, known as coprolalia, only affects 15 percent of Tourette
patients, and Matovic is not among them.

"Tourette syndrome is a disorder of tics," said Dr. Brian Maddux, a
neurologist from the University Hospitals of Cleveland. "There's
usually several such movements — including the production of sound —
so somebody may grunt, or cough or sniff, sometimes actually say
words."

For Matovic, just trying to say the simple sentence, "It's a sunny
day in Cleveland, Ohio," would send him into a fit of flailing and
grunting in an effort to get the words out. When he was asked to put
his arms out in front of him, it seemed an impossible task. But that
was before.

Under Control

Thanks to an experimental surgery, Matovic's once uncontrollable
body is now controlled to the point that he can operate a computer,
play video games and even challenge his stepchildren to a game of
basketball at their home in Lyndhurst, a suburb of Cleveland.

"My outlook on life in general is truly — the sky's the limit now,"
said Matovic, who, along with his doctors, spoke exclusively to Good
Morning America.

Jeff Matovic first showed symptoms of Tourette syndrome when he was
just 3 years old. Pictures showing the little boy smiling belie the
fact that his childhood was often frustrating and lonely.

"I wondered, why do I have to be home ticking, lying in bed, trying
to calm myself when everyone else is out having fun?"

Having fun wasn't his only challenge. Matovic's tics made finishing
high school and college relentlessly difficult.

"I mean, can you imagine trying to read something and you're
constantly doing this?" he said, arms moving. "And your eyes are
fluttering and you're losing your place every two seconds."

Much Trial and Error

He tried medication after medication, and they all helped control
his movements — but only for a while.

His wife, Deborah, says she watched her husband's abilities to move
and accomplish day-to-day activities disintegrate.

"Over the past year, when the medication stopped working — Jeff, he
just stopped being able to do almost anything," she said.

By last year, no pill was working. Jeff Matovic could not hold a
glass without breaking it, he couldn't work, he couldn't play with
his stepchildren and he described every day as sheer torture.

"And when it came to the kids — oh, man — it tore my heart out,
because it couldn't be," Deborah said, starting to cry. "He couldn't
go out and play basketball. He couldn't."

With no options left, Matovic began doing research on a procedure
called deep brain stimulation, or DBS.

It involves having two electrodes placed in the brain and attached
to a sort of pacemaker for several years. The procedure has been
used to control the symptoms of patients with tremors, Parkinson's
disease and other movement disorders.

So Matovic approached doctors at the University Hospitals. The only
problem was that deep brain stimulation had never been used before
on a Tourette patient in the United States.

"When Jeff came to see us for the first time — it wasn't clear
really that we knew what the target should be for Tourette," Maddux
said.

"We pored over what we could do, what we couldn't do — what I could
promise and what I couldn't promise," said Dr. Robert Maciunas, a
neurosurgeon at the hospital.

A Groundbreaking Experiment

The team in Cleveland agreed to try this groundbreaking experiment
on Matovic, knowing there were no guarantees. This past February,
using a sophisticated system for mapping the brain, surgeons
precisely inserted the electrodes, and later attached them to the
pacemakers, hoping it would fix the impulses causing his tics.

But the big question was — would it work? It did. Matovic can walk
easily down a hallway, and the sentence, "It's a sunny day in
Cleveland," is no longer a problem for him to say. The arm motions
are under control. Even his doctors were stunned at the operation's
success.

"We were basically dragging our jaws on the floor," Maddux said.

The procedure had been tried three times in Cleveland, and the
results have been good, but those surgeries were only done a few
years ago, so no one really knows how effective it is over the long
term. Still, doctors in Cleveland are hopeful because of the success
of DBS in treating other movement disorders.

In addition to the surprise over the operation's success, there were
plenty of tears.

"We were all just crying — everyone's mouth dropped — Dr. Maddox's
mouth just hit the floor," Jeff Matovic said. "Nobody expected this
result, especially this quickly."

"I was like, 'This isn't real, I'm dreaming, this isn't real,' and
he came up and put a big old hug around me and it was real," Deborah
Matovic said. "I didn't feel him shaking or quivering or anything
like that."

Hands that once couldn't hold a glass will be holding a brand new
baby in eight months. Deborah just found out she is pregnant.

"I'm looking forward to this with open arms and open heart — to be
able to bring a child into this world and really just be a part of
it like I've always envisioned," Matovic said.

Unlike Matovic, whose problems are primarily physical, many Tourette
patients suffer physical, neurological and psychological problems as
well. The Cleveland team said the procedure would only work for that
segment of Tourette patients who have primarily physical symptoms —
but that could still offer hope to many thousands of people. And
although he is the country's first Tourette patient to get this
procedure, Matovic is hoping he won't be the last.

"There is hope," he said. "The results that I have seen — the
feelings that I have felt — they're out there for other people too."

For more on the University Hospitals of Cleveland, go to
www.uhhs.com.To find out more about Tourette syndrome, go to the
National Tourette Syndrome Association's web site at www.tsa-
usa.org/.

Thea Trachtenberg produced this story for Good Morning America.

Source
http://abcnews.go.com/sections/GMA/DrJohnson/Tourette_syndrome_040401
-1.html


+++++++++++Sencond Story Same Topic++++++++++++

Surgeons explore new treatment for Tourette syndrome
Patient experiences significant resolution of symptoms following
brain surgery
NOTE: THIS RELEASE HAS BEEN UPDATED SINCE ITS ORIGINAL POSTING
CLEVELAND, April 1, 2004: A neurosurgical team at University
Hospitals of Cleveland (UHC) has, for the first time in North
America, applied a new surgical approach to the treatment of
Tourette syndrome, resulting in the immediate and nearly complete
resolution of symptoms for the patient, who has suffered from this
neurologic disorder since he was a child.

"We were genuinely amazed at the patient's response," says Robert J.
Maciunas, MD, neurosurgeon at UHC and professor at Case Western
Reserve University School of Medicine. He has used the technique
called deep brain stimulation (DBS) for the treatment of Parkinson's
disease and tremor, and was impressed with this patient's dramatic
reaction: the disappearance of the jerking motions, muscle tics and
grunting associated with his Tourette's. "This technique holds great
promise for patients suffering from this movement disorder, which
often is diagnosed in childhood or early adolescence and can be
completely debilitating."

Jeff Matovic, a Lyndhurst, Ohio, resident who grew up in Bay
Village, was six years old when he was diagnosed with Tourette
syndrome, a neurobehavioral disorder characterized by sudden,
repetitive muscle movements (motor tics) and vocalizations (vocal
tics). Though standard therapy with medication controlled his
movements for much of his boyhood, his condition severely worsened
with age.

"I had to drink with a sippy cup; otherwise, I would spill liquid
all over and even break glass or plastic cups with the severity of
the muscle spasms that were so forceful and unpredictable," says
Jeff, now age 31. "To grow up being made fun of, always feeling
different, and then, as an adult, unable to hold a job and support a
family, I was feeling devastated by my Tourette's. I had heard about
deep brain stimulation for other movement disorders. I knew that
brain surgery was risky, and the doctors could not guarantee any
positive outcome, but I wanted them to take a chance on me. And I'm
so grateful that they did."

Prior to brain surgery, physicians at University Hospitals Movement
Disorders Center mapped out regions of Jeff's brain, through MRI
(magnetic resonance imaging) scans and 3-D computer images. Their
goal was to locate the safest and most direct route to reach the
cells inside the thalamus portion of the brain, involved in
controlling Jeff's movements. By placing electrodes around those
cells to deliver continuous high-frequency electrical stimulation,
control messages are rebalanced throughout the movement centers in
the brain. The electrodes are connected from the brain through wires
under the skin (beneath the scalp, neck and upper chest) to an
implanted battery just beneath the collarbone. In Jeff's case, since
both sides of his body were affected by the movement disorder, he
has electrodes implanted on both sides of his brain and tiny battery
packs implanted on each side of his chest.

The doctors at University Hospitals of Cleveland are careful to
point out that not everyone with Tourette syndrome requires
treatment. The first line of treatment is medication, which can be
very effective. Surgical treatment is considered a last resort, and
it is not clear how effective deep brain stimulation will ultimately
prove for patients with this particular disorder.

In the United States, the Food and Drug Administration has approved
deep brain stimulation for the treatment of Parkinson's disease,
essential tremor and dystonia. "We've seen very positive responses
in patients with Parkinson's disease. Studies of the DBS technique
show that this stimulation can significantly reduce tremor and other
symptoms in about three quarters of appropriately selected patients
with Parkinson's." says Brian N. Maddux, MD, PhD, Jeff's neurologist
at UHC and assistant professor at Case School of Medicine. "Patients
with a different movement disorder called dystonia can take three
months to respond to the electrical stimulation. We didn't know how
Jeff would respond. Within hours after the stimulator was turned on,
we observed the ceaseless movements become completely relaxed and he
was able to walk normally. We were awestruck."

Physicians at University Hospitals of Cleveland have submitted a
report of this case for consideration for publication in a peer-
reviewed journal. They hope to further explore the application of
DBS to other patients with Tourette syndrome. It is estimated that
approximately 200,000 Americans have Tourette syndrome, though
experts believe it is a movement disorder that often remains
undiagnosed.


###
For more information about the surgery, go to http://www.uhhs.com.
For more information about Tourette syndrome, go to http://www.tsa-
usa.org.

University Hospitals Health System (UHHS) is the region's premier
healthcare delivery system, serving patients at more than 150
locations throughout northern Ohio.

The System's 947-bed, tertiary medical center, University Hospitals
of Cleveland (UHC), is the primary affiliate of Case Western Reserve
University (CWRU). Together, they form the largest center for
biomedical research in the State of Ohio. The System provides the
major clinical base for translational researchers at the Case
Research Institute, a partnership between UHC and CWRU School of
Medicine, as well as a broad and well-characterized patient
population for clinical trials involving the most advanced
treatments. Included in UHC are Rainbow Babies & Children's
Hospital, among the nation's best children's hospitals; Ireland
Cancer Center, designated by the National Cancer Institute as a
Comprehensive Cancer Center (the nation's highest designation); and
MacDonald Women's Hospital, Ohio's only hospital for women.

Source
http://www.eurekalert.org/pub_releases/2004-04/uhoc-sen033104.php



----------------------------------------------------------------
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@...

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

Thank you for being apart of Tourette Updates.

Mostly what we have discovered this month of news in regards to
Tourette Syndrome has been special events to local areas, movie, and
human interest stories.  If you are interested you may search the
latest with the following link.

If the link does not work correctly try to cut and past the entire
link in a new browser window.  Contact us if you need any assistance.

Link:

http://news.google.com/news?
hl=en&edition=us&q=tourette+syndrome&btnG=Search+News

If you have any relevant or interesting updates that we are not aware
of please forwad them as well as any other comments to us below.  Be
sure that the words Tourette Syndrome are in your subject line so
that your mail is not spam filtered.

Thank you,

Paul Marshall
Editor@...

http://www.tourettes-disorder.com

I get a lot of request by phone and e-mail for visitors looking for
Doctors in their area that treat or specialize in Tourette's
Disorder. I wanted to post this for your information and those that
come by searching for that criteria in the archives of the forum.

If you are looking for a Doctor, Physician, Neurologist, in your
area, we do not have a posted On-Line list neither does the Tourette
Syndrome Associations.

However there is a list available in your area on file with the TSA-
USA and they will be glad to send you a list in your area when you
contact them.

Here is their contact information:

Write them at:

Tourette Syndrome Association, Inc.
42-40 Bell Boulevard
Bayside, NY 11361-2820
Phone and fax numbers:

Call them at:
Tel: 718-224-2999 Fax: 718-224-9596

e-mail to: ts@t...
please include your regular mailing address.

WebSite: http://www.tsa-usa.org

______________________________

Also you should be sure to check around in your phone book and with
your health service provider for similar Dr.'s. Many times if you
contact your HMO or Health Care provider they will have tips and
resources for finding out similar information.

Thank you for being apart of the Tourette-Updates mailing list.

Paul Marshall PhD
Editor@...

As the new year begins, we have a very exciting opportunity to
benefit children with TS and need your help.  National TSA is
collaborating with HBO on a documentary for and about children with
TS which is slated for broadcast on HBO and/or HBO Family in 2005.

TSA's role as the co-sponsor is to do preliminary research to locate
possible candidates for referral to the HBO program director for
initial telephone interviews.  These telephone interviews may or may
not lead to face-to-face interviews.  We are looking for families
with children between the ages of 5 -13 who represent a range of
ethnic diversity.  Ideally, we will come up with a comparable number
of boys and girls.  Also we are seeking a broad regional
representation and possibly featuring a child from a community where
TS is less known/accepted.  Please note that although it is our goal
to identify possible candidates and to provide informational
resources to the producers, HBO will make the final decisions about
which children will be included in the program.

Generally, we are seeking youngsters to whom other young viewers can
relate readily, as well as those who are comfortable talking about
TS and are fairly articulate.  We want to feature a spectrum of TS
symptoms and co-morbid conditions. Children who have found ways to
benefit from a variety of coping mechanisms such as participation in
sports, playing musical instruments, the arts, computer skills,
chess or other games/hobbies are of particular interest.

To protect privacy, last names will not be used, and your location
can also be kept confidential if you wish. Parents need not
participate on camera.

The overall objective of this documentary is to educate, raise
awareness and increase social acceptance by the peers of all
children with TS.  TSA will own the production and promote
screenings nationwide in educational and other settings.

Please contact Tracy Colletti-Flynn, Manager, Public Relations and
Communications at national TSA at (718) 224-2999 x 236 or e-mail her
at tracy.flynn@... to discuss the possibility of a phone
interview between an HBO producer and you and your child.

We are looking forward to generating a lot of positive awareness via
this documentary and greatly appreciate your assistance.

Regards,
Tina


--

Tina Posterli

Chapter Services Manager

TOURETTE SYNDROME ASSOCIATION, INC.

(tel)718-224-2999

(fax)718-279-9596

website: http://tsa-usa.org

If you are a parent of a child from age 6 through 14, or know
someone in
> your chapter who is, please read on..........
>
> Peggy Harford is putting the final touches on the All Sports issue
of That
> Darn Tic. It is wonderful -- kids talking about what sports mean
to them
> and how everything from softball to trapeze work has given them
the self
> esteem they need to cope with TS tics.
>
> Now they need your assistance for the next issue which will focus
on the
> arts. They would  like poems, short stories, jokes, cartoons, comic
> strips, drawings, etc. They'll take a few essays too, but they'd
like to
> focus on creative writing so if you know a young person who'd like
to
> write his own fable, fantasy or sci fi story -- let them submit
it. This
> could be a great project for young people to work on during the
holiday
> break from school.
>
> This really is by and for kids, so the general rule is 6/7 to
13/14 years
> old. Because this is an art issue, they would accept a teen
writing for an
> audience that includes younger kids, but they need to keep the
focus on
> the elementary school/middle school aged kids.
> Please send submissions or direct your questions to Peggy Harford
at
> peggy.harford@... <mailto:peggy.harford@...>

Paul Marshall PhD
editor@...

Tourette Syndrome and Migraine May Go Hand-In-Hand

NEW YORK (Reuters Health) - Tourette syndrome is a fairly common
disorder that causes involuntary spasms and tics, sometimes with
vocal outbursts. To make matters worse, researchers have now shown,
patients with Tourette syndrome have a nearly four-fold higher
occurrence of migraine headache than the general population


Tourette syndrome, obsessive-compulsive disorder and migraine have
all been linked with disturbances in the brain's
chemical "neurotransmitters," especially involving the serotonin
system, Dr. Joseph Jankovic and colleagues note in an article in the
Archives of Neurology.


To further investigate the link between migraine headache and
Tourette syndrome, Dr. Jankovic's group at Baylor College of
Medicine in Houston assessed the family history of migraine in 100
patients with Tourette syndrome.


Twenty-five patients reported having migraine headaches. Migraines
were observed in 16 percent and 39 percent of pediatric and adult
patients with Tourette syndrome, respectively, significantly greater
than the corresponding rate of 6 percent and 11 percent reported in
the general pediatric and adult populations.


Twenty-four of the 25 patients with migraine also had obsessive-
compulsive traits. However, there was no significant difference in
the presence of obsessive-compulsive traits or attention deficit in
the Tourette syndrome patients with or without migraines.


Family members were also more likely to have migraines. In
fact, "Fifty-six percent of patients with Tourette syndrome had a
family member with migraine," Jankovic's team reports.


Based on these findings, the researchers suggest that "migraine
headache, if present also in family members with Tourette syndrome,
may be used as a clinical marker for this complex genetic disorder."


SOURCE: Archives of Neurology, November 2003.
http://story.news.yahoo.com/news?
tmpl=story&u=/nm/20031124/hl_nm/tourettes_migraines_dc_1

----------------------------------------------------------------
Other Info:

Prestwick Pharmaceuticals

Prestwick Pharmaceuticals (Washington, DC) is developing the drug
Xenazine to treat abnormal movements in Huntington's chorea and
other disorders such as Tourette's syndrome, which together affect
100,000 patients in the U.S. Xenazine was originally developed by
Roche as long ago as 1959 and is now in Phase III for Prestwick's
indications. The company also has other CNS interests, such as the
North American rights for one of Schering's (NYSE:SHR) Parkinson's
disease drugs in patch/transdermal form.

----------------------------------------------------------------
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@...

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

GAINESVILLE, Fla. (Ivanhoe Newswire) -- When tasks like washing,
arranging, checking, and hoarding take over a person's life, they
become out of control obsessions. It's called obsessive-compulsive
disorder, or OCD, and 1 million Americans struggle with it every
day. Here are two different treatments to keep the disorder in check.

Psychiatrist Nathan Shapira, M.D., Ph.D., of University of Florida,
is an expert on obsessive-compulsive disorder -- a common condition
that can be difficult to treat. He says, "Forty percent to 50
percent get almost no benefit from current treatments, and the other
half typically get partial benefit."

Jim Price knows. He's tried more than 20 drugs, and none have
worked. "I've taken almost all medications, all the tricyclics, the
SSRIs, the MAO inhibitors," he says.

One drug researchers are focusing on is topiramate. They hope adding
it to standard OCD treatments will help patients. "Topiramate has
been reported in case reports and some small trials to be helpful in
various anxiety disorders," Dr. Shapira says.

To help the depression that came with his OCD, Price used a
different drug -- tramadol. "It has not cured my depression," he
says, "But it has held it at a level much lower than what I had
before I started taking the tramadol."

Dr. Shapira says depression improves up to 60 percent with tramadol.
Still, he wants more for his patients. "They're still somewhat
disabled by their illness, although they're a lot better. Our hope
is these types of medications might help to really get the person
well as opposed to just better."

Tramadol is an FDA-approved medication for pain. Since the drug is
an opiate, there is some risk of addiction, but Dr. Shapira says
it's mild compared to the benefits. Topiramate is an FDA-approved
medication for epilepsy. The current study using topiramate for OCD
is being conducted nationwide.

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/.

----------------------------------------------------------------
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@...

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