The Official Parent's Sourcebook on Tourette Syndrome: A Revised and Updated Directory for the Internet Age

THE OFFICIAL PARENT’S SOURCEBOOK on OURETTE YNDROME J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITOR...

Author: Icon Health Publications

22 downloads 894 Views 1MB Size Report

This content was uploaded by our users and we assume good faith they have the permission to share this book. If you own the copyright to this book and it is wrongfully on our website, we offer a simple DMCA procedure to remove your content from our site. Start by pressing the button below!
Report copyright / DMCA form

DOWNLOAD PDF

THE OFFICIAL PARENT’S SOURCEBOOK

on

OURETTE YNDROME J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

ii

ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright Ó2002 by ICON Group International, Inc. Copyright Ó2002 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Tiffany LaRochelle Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher’s note: The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consultation with your child’s physician. All matters regarding your child’s health require medical supervision. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation, in close consultation with a qualified physician. The reader is advised to always check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960The Official Parent’s Sourcebook on Tourette Syndrome: A Revised and Updated Directory for the Internet Age/James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary and index. ISBN: 0-597-83122-X 1. Tourette Syndrome-Popular works. I. Title.

iii

Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem or as a substitute for consultation with licensed medical professionals. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, or the authors are not responsible for the content of any Web pages nor publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this sourcebook for parent use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications are copyrighted. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs or other materials, please contact us to request permission (e-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this sourcebook.

iv

Dedication To the healthcare professionals dedicating their time and efforts to the study of Tourette syndrome.

Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this sourcebook which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which directly or indirectly are dedicated to Tourette syndrome. All of the Official Parent’s Sourcebooks draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this sourcebook. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany LaRochelle for her excellent editorial support.

v

About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for the Official Parent’s Sourcebook series published by ICON Health Publications.

Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for the Official Parent’s Sourcebook series published by ICON Health Publications.

vi

About ICON Health Publications In addition to Tourette syndrome, Official Parent’s Sourcebooks are available for the following related topics: ·

The Official Patient's Sourcebook on Adrenoleukodystrophy

·

The Official Patient's Sourcebook on Alexander Disease

·

The Official Patient's Sourcebook on Alpers Disease

·

The Official Patient's Sourcebook on Batten Disease

·

The Official Patient's Sourcebook on Canavan Disease

·

The Official Patient's Sourcebook on Coffin Lowry Syndrome

·

The Official Patient's Sourcebook on Friedreich Ataxia

·

The Official Patient's Sourcebook on Incontinentia Pigmenti

·

The Official Patient's Sourcebook on Infantile Refsum Disease

·

The Official Patient's Sourcebook on Joubert Syndrome

·

The Official Patient's Sourcebook on Krabbé Disease

·

The Official Patient's Sourcebook on Mobius Syndrome

·

The Official Patient's Sourcebook on Moyamoya Disease

·

The Official Patient's Sourcebook on Neurofibromatoses

·

The Official Patient's Sourcebook on Rett Syndrome

·

The Official Patient's Sourcebook on Soto's Syndrome

·

The Official Patient's Sourcebook on Spinal Muscular Atrophy

·

The Official Patient's Sourcebook on Williams Syndrome

To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes & Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

Contents vii

Table of Contents INTRODUCTION...................................................................................... 1

Overview............................................................................................................... 1 Organization......................................................................................................... 3 Scope ..................................................................................................................... 3 Moving Forward................................................................................................... 4

PART I: THE ESSENTIALS ................................................. 7 CHAPTER 1. THE ESSENTIALS ON TOURETTE SYNDROME: GUIDELINES ............................................................................................................... 9

Overview............................................................................................................... 9 What Is Tourette Syndrome? ............................................................................. 10 What Are the Symptoms?................................................................................... 11 How Are Tics Classified? ................................................................................... 11 Can People with TS Control Their Tics? ........................................................... 12 What Causes TS?................................................................................................ 12 What Disorders Are Associated with TS?.......................................................... 12 How Is TS Diagnosed? ....................................................................................... 13 How Is TS Treated?............................................................................................ 13 Is TS Inherited? .................................................................................................. 14 What Is the Prognosis?....................................................................................... 15 What Is the Best Educational Setting for Children with TS? ............................ 15 What Research Is Being Done? .......................................................................... 16 Where Can I Go for More Information?............................................................. 17 More Guideline Sources ..................................................................................... 18 Vocabulary Builder............................................................................................. 22

CHAPTER 2. SEEKING GUIDANCE ....................................................... 27

Overview............................................................................................................. 27 Associations and Tourette Syndrome................................................................. 27 Finding More Associations................................................................................. 34 Finding Doctors.................................................................................................. 36 Finding a Neurologist......................................................................................... 37 Selecting Your Doctor ........................................................................................ 37 Working with Your Child’s Doctor.................................................................... 38 Broader Health-Related Resources ..................................................................... 39 Vocabulary Builder............................................................................................. 39

CHAPTER 3. CLINICAL TRIALS AND TOURETTE SYNDROME .............. 41

Overview............................................................................................................. 41 Recent Trials on Tourette Syndrome.................................................................. 44 Benefits and Risks............................................................................................... 58 Keeping Current on Clinical Trials.................................................................... 61 General References.............................................................................................. 62

viii Contents

Vocabulary Builder............................................................................................. 63

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL.................................................. 67 CHAPTER 4. STUDIES ON TOURETTE SYNDROME................................ 69

Overview............................................................................................................. 69 The Combined Health Information Database ..................................................... 69 Federally-Funded Research on Tourette Syndrome ........................................... 71 E-Journals: PubMed Central .............................................................................. 85 The National Library of Medicine: PubMed ...................................................... 85 Vocabulary Builder............................................................................................. 90

CHAPTER 5. PATENTS ON TOURETTE SYNDROME .............................. 95

Overview............................................................................................................. 95 Patents on Tourette Syndrome ........................................................................... 96 Patent Applications on Tourette Syndrome ....................................................... 97 Keeping Current ................................................................................................. 98 Vocabulary Builder............................................................................................. 98

CHAPTER 6. BOOKS ON TOURETTE SYNDROME .................................. 99

Overview............................................................................................................. 99 Book Summaries: Federal Agencies .................................................................... 99 Book Summaries: Online Booksellers ............................................................... 101 The National Library of Medicine Book Index ................................................. 102 Chapters on Tourette Syndrome....................................................................... 105 Directories......................................................................................................... 111 General Home References ................................................................................. 113 Vocabulary Builder........................................................................................... 115

CHAPTER 7. MULTIMEDIA ON TOURETTE SYNDROME ..................... 119

Overview........................................................................................................... 119 Bibliography: Multimedia on Tourette Syndrome ........................................... 119 Vocabulary Builder........................................................................................... 120

CHAPTER 8. PERIODICALS AND NEWS ON TOURETTE SYNDROME .. 121

Overview........................................................................................................... 121 News Services & Press Releases ....................................................................... 121 Newsletters on Tourette Syndrome .................................................................. 124 Newsletter Articles ........................................................................................... 124 Academic Periodicals covering Tourette Syndrome ......................................... 125 Vocabulary Builder........................................................................................... 127

CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES ................... 129

Overview........................................................................................................... 129 NIH Guidelines................................................................................................. 129 NIH Databases.................................................................................................. 130 Other Commercial Databases ........................................................................... 135 The Genome Project and Tourette Syndrome................................................... 135

Contents

ix

Specialized References....................................................................................... 140 Vocabulary Builder........................................................................................... 141

CHAPTER 10. DISSERTATIONS ON TOURETTE SYNDROME ............... 143

Overview........................................................................................................... 143 Dissertations on Tourette Syndrome................................................................ 143 Keeping Current ............................................................................................... 145 Vocabulary Builder........................................................................................... 145

PART III. APPENDICES .................................................. 147 APPENDIX A. RESEARCHING YOUR CHILD’S MEDICATIONS ........... 149

Overview........................................................................................................... 149 Your Child’s Medications: The Basics.............................................................. 150 Learning More about Your Child’s Medications ............................................. 151 Commercial Databases...................................................................................... 165 Contraindications and Interactions (Hidden Dangers) ................................... 166 A Final Warning .............................................................................................. 167 General References............................................................................................ 168 Vocabulary Builder........................................................................................... 169

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE ................... 173

Overview........................................................................................................... 173 What Is CAM? ................................................................................................. 174 What Are the Domains of Alternative Medicine?............................................ 174 Can Alternatives Affect My Child’s Treatment?............................................. 178 Finding CAM References on Tourette Syndrome ............................................ 178 Additional Web Resources................................................................................ 186 General References............................................................................................ 274 Vocabulary Builder........................................................................................... 275

APPENDIX C. RESEARCHING NUTRITION ......................................... 289

Overview........................................................................................................... 289 Food and Nutrition: General Principles........................................................... 290 Finding Studies on Tourette Syndrome ........................................................... 294 Federal Resources on Nutrition........................................................................ 298 Additional Web Resources................................................................................ 299 Vocabulary Builder........................................................................................... 319

APPENDIX D. FINDING MEDICAL LIBRARIES.................................... 323

Overview........................................................................................................... 323 Preparation ....................................................................................................... 323 Finding a Local Medical Library ...................................................................... 324 Medical Libraries Open to the Public............................................................... 324

APPENDIX E. YOUR CHILD’S RIGHTS AND INSURANCE ................... 331

Overview........................................................................................................... 331 Your Child’s Rights as a Patient ...................................................................... 331 Parent Responsibilities ..................................................................................... 335

x

Contents

Choosing an Insurance Plan............................................................................. 336 Medicaid ........................................................................................................... 338 NORD’s Medication Assistance Programs ..................................................... 338 Additional Resources ........................................................................................ 339

ONLINE GLOSSARIES.................................................... 340 Online Dictionary Directories.......................................................................... 341

TOURETTE SYNDROME GLOSSARY ........................ 343 General Dictionaries and Glossaries ................................................................ 374

INDEX................................................................................... 376

Introduction

1

INTRODUCTION Overview Dr. C. Everett Koop, former U.S. Surgeon General, once said, “The best prescription is knowledge.”1 The Agency for Healthcare Research and Quality (AHRQ) of the National Institutes of Health (NIH) echoes this view and recommends that all parents incorporate education into the treatment process. According to the AHRQ: Finding out more about your [child’s] condition is a good place to start. By contacting groups that support your [child’s] condition, visiting your local library, and searching on the Internet, you can find good information to help guide your decisions for your [child’s] treatment. Some information may be hard to find—especially if you don’t know where to look.2 As the AHRQ mentions, finding the right information is not an obvious task. Though many physicians and public officials had thought that the emergence of the Internet would do much to assist parents in obtaining reliable information, in March 2001 the National Institutes of Health issued the following warning: The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading.3 Quotation from http://www.drkoop.com. The Agency for Healthcare Research and Quality (AHRQ): http://www.ahcpr.gov/consumer/diaginfo.htm. 3 From the NIH, National Cancer Institute (NCI): http://cancertrials.nci.nih.gov/beyond/evaluating.html. 1 2

2

Tourette Syndrome

Since the late 1990s, physicians have seen a general increase in parent Internet usage rates. Parents frequently enter their children’s doctor’s offices with printed Web pages of home remedies in the guise of latest medical research. This scenario is so common that doctors often spend more time dispelling misleading information than guiding children through sound therapies. The Official Parent’s Sourcebook on Tourette Syndrome has been created for parents who have decided to make education and research an integral part of the treatment process. The pages that follow will tell you where and how to look for information covering virtually all topics related to Tourette syndrome, from the essentials to the most advanced areas of research. The title of this book includes the word “official.” This reflects the fact that the sourcebook draws from public, academic, government, and peerreviewed research. Selected readings from various agencies are reproduced to give you some of the latest official information available to date on Tourette syndrome. Given parents’ increasing sophistication in using the Internet, abundant references to reliable Internet-based resources are provided throughout this sourcebook. Where possible, guidance is provided on how to obtain free-ofcharge, primary research results as well as more detailed information via the Internet. E-book and electronic versions of this sourcebook are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). Hard copy users of this sourcebook can type cited Web addresses directly into their browsers to obtain access to the corresponding sites. Since we are working with ICON Health Publications, hard copy Sourcebooks are frequently updated and printed on demand to ensure that the information provided is current. In addition to extensive references accessible via the Internet, every chapter presents a “Vocabulary Builder.” Many health guides offer glossaries of technical or uncommon terms in an appendix. In editing this sourcebook, we have decided to place a smaller glossary within each chapter that covers terms used in that chapter. Given the technical nature of some chapters, you may need to revisit many sections. Building one’s vocabulary of medical terms in such a gradual manner has been shown to improve the learning process. We must emphasize that no sourcebook on Tourette syndrome should affirm that a specific diagnostic procedure or treatment discussed in a research study, patent, or doctoral dissertation is “correct” or your child’s best option. This sourcebook is no exception. Each child is unique. Deciding on

Introduction

3

appropriate options is always up to parents in consultation with their children’s physicians and healthcare providers.

Organization This sourcebook is organized into three parts. Part I explores basic techniques to researching Tourette syndrome (e.g. finding guidelines on diagnosis, treatments, and prognosis), followed by a number of topics, including information on how to get in touch with organizations, associations, or other parent networks dedicated to Tourette syndrome. It also gives you sources of information that can help you find a doctor in your local area specializing in treating Tourette syndrome. Collectively, the material presented in Part I is a complete primer on basic research topics for Tourette syndrome. Part II moves on to advanced research dedicated to Tourette syndrome. Part II is intended for those willing to invest many hours of hard work and study. It is here that we direct you to the latest scientific and applied research on Tourette syndrome. When possible, contact names, links via the Internet, and summaries are provided. It is in Part II where the vocabulary process becomes important as authors publishing advanced research frequently use highly specialized language. In general, every attempt is made to recommend “free-to-use” options. Part III provides appendices of useful background reading covering Tourette syndrome or related disorders. The appendices are dedicated to more pragmatic issues facing parents. Accessing materials via medical libraries may be the only option for some parents, so a guide is provided for finding local medical libraries which are open to the public. Part III, therefore, focuses on advice that goes beyond the biological and scientific issues facing children with Tourette syndrome and their families.

Scope While this sourcebook covers Tourette syndrome, doctors, research publications, and specialists may refer to your child’s condition using a variety of terms. Therefore, you should understand that Tourette syndrome is often considered a synonym or a condition closely related to the following: ·

Chronic Motor Tic

·

Chronic Multiple Tics

4

Tourette Syndrome

·

Gilles De La Tourette Syndrome

·

Gilles De La Tourette's Disease

·

Gilles De La Tourette's Syndrome

·

Habit Spasms

·

Maladie De Tics

·

Motor-verbal Tic Disorder

·

Paulitis

·

Tics

·

Tourette Syndrome

·

Tourette's Disorder

In addition to synonyms and related conditions, physicians may refer to Tourette syndrome using certain coding systems. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is the most commonly used system of classification for the world’s illnesses. Your physician may use this coding system as an administrative or tracking tool. The following classification is commonly used for Tourette syndrome:4 ·

307.23 gilles de la tourette disorder

·

307.23 gilles de la tourette's disorder

For the purposes of this sourcebook, we have attempted to be as inclusive as possible, looking for official information for all of the synonyms relevant to Tourette syndrome. You may find it useful to refer to synonyms when accessing databases or interacting with healthcare professionals and medical librarians.

Moving Forward Since the 1980s, the world has seen a proliferation of healthcare guides covering most illnesses. Some are written by parents, patients, or their family members. These generally take a layperson’s approach to understanding and coping with an illness or disorder. They can be uplifting, encouraging, and 4 This list is based on the official version of the World Health Organization’s 9th Revision, International Classification of Diseases (ICD-9). According to the National Technical Information Service, “ICD-9CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Health Care Financing Administration are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9-CM is the responsibility of the federal government.”

Introduction

5

highly supportive. Other guides are authored by physicians or other healthcare providers who have a more clinical outlook. Each of these two styles of guide has its purpose and can be quite useful. As editors, we have chosen a third route. We have chosen to expose you to as many sources of official and peer-reviewed information as practical, for the purpose of educating you about basic and advanced knowledge as recognized by medical science today. You can think of this sourcebook as your personal Internet age reference librarian. Why “Internet age”? When their child has been diagnosed with Tourette syndrome, parents will often log on to the Internet, type words into a search engine, and receive several Web site listings which are mostly irrelevant or redundant. Parents are left to wonder where the relevant information is, and how to obtain it. Since only the smallest fraction of information dealing with Tourette syndrome is even indexed in search engines, a non-systematic approach often leads to frustration and disappointment. With this sourcebook, we hope to direct you to the information you need that you would not likely find using popular Web directories. Beyond Web listings, in many cases we will reproduce brief summaries or abstracts of available reference materials. These abstracts often contain distilled information on topics of discussion. While we focus on the more scientific aspects of Tourette syndrome, there is, of course, the emotional side to consider. Later in the sourcebook, we provide a chapter dedicated to helping you find parent groups and associations that can provide additional support beyond research produced by medical science. We hope that the choices we have made give you and your child the most options in moving forward. In this way, we wish you the best in your efforts to incorporate this educational approach into your child’s treatment plan. The Editors

7

PART I: THE ESSENTIALS

ABOUT PART I Part I has been edited to give you access to what we feel are “the essentials” on Tourette syndrome. The essentials typically include a definition or description of the condition, a discussion of who it affects, the signs or symptoms, tests or diagnostic procedures, and treatments for disease. Your child’s doctor or healthcare provider may have already explained the essentials of Tourette syndrome to you or even given you a pamphlet or brochure describing the condition. Now you are searching for more in-depth information. As editors, we have decided, nevertheless, to include a discussion on where to find essential information that can complement what the doctor has already told you. In this section we recommend a process, not a particular Web site or reference book. The process ensures that, as you search the Web, you gain background information in such a way as to maximize your understanding.

Guidelines

9

CHAPTER 1. THE ESSENTIALS ON TOURETTE SYNDROME: GUIDELINES Overview Official agencies, as well as federally-funded institutions supported by national grants, frequently publish a variety of guidelines on Tourette syndrome. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. The great advantage of guidelines over other sources is that they are often written with the parent in mind. Since new guidelines on Tourette syndrome can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

The National Institutes of Health (NIH)5 The National Institutes of Health (NIH) is the first place to search for relatively current guidelines and fact sheets on Tourette syndrome. Originally founded in 1887, the NIH is one of the world’s foremost medical research centers and the federal focal point for medical research in the United States. At any given time, the NIH supports some 35,000 research grants at universities, medical schools, and other research and training institutions, both nationally and internationally. The rosters of those who have conducted research or who have received NIH support over the years include the world’s most illustrious scientists and physicians. Among them are 97 scientists who have won the Nobel Prize for achievement in medicine.

5

Adapted from the NIH: http://www.nih.gov/about/NIHoverview.html.

10 Tourette Syndrome

There is no guarantee that any one Institute will have a guideline on a specific medical condition, though the National Institutes of Health collectively publish over 600 guidelines for both common and rare disorders. The best way to access NIH guidelines is via the Internet. Although the NIH is organized into many different Institutes and Offices, the following is a list of key Web sites where you are most likely to find NIH clinical guidelines and publications dealing with Tourette syndrome and associated conditions: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines available at http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Neurological Disorders and Stroke (NINDS); http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

Among the above, the National Institute of Neurological Disorders and Stroke (NINDS) is particularly noteworthy. The mission of the NINDS is to reduce the burden of neurological disease—a burden borne by every age group, by every segment of society, by people all over the world.6 To support this mission, the NINDS conducts, fosters, coordinates, and guides research on the causes, prevention, diagnosis, and treatment of neurological disorders and stroke, and supports basic research in related scientific areas. The following patient guideline was recently published by the NINDS on Tourette syndrome.

What Is Tourette Syndrome?7 Tourette syndrome (TS) is an inherited, neurological disorder characterized by multiple involuntary movements and uncontrollable vocalizations called tics that come and go over years. In a few cases, such tics can include inappropriate words and phrases. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who first described an 86-year-old French noblewoman with the condition in 1885. 6 This paragraph has been adapted from the NINDS: http://www.ninds.nih.gov/about_ninds/mission.htm. “Adapted” signifies that a passage has been reproduced exactly or slightly edited for this book. 7 Adapted from The National Institute of Neurological Disorders and Stroke (NINDS): http://www.ninds.nih.gov/health_and_medical/pubs/tourette_syndrome.htm.

Guidelines 11

The symptoms of TS generally appear before the individual is 18 years old. TS can affect people of all ethnic groups; males are affected 3 to 4 times more often than females. It is estimated that 100,000 Americans have full-blown TS, and that perhaps as many as 1 in 200 show a partial expression of the disorder, such as chronic multiple tics or transient childhood tics. The natural course of TS varies from patient to patient. Although TS symptoms range from very mild to quite severe, the majority of cases fall in the mild category.

What Are the Symptoms? The first symptoms of TS are usually facial tics--commonly eye blinking. However, facial tics can also include nose twitching or grimaces. With time, other motor tics may appear such as head jerking, neck stretching, foot stamping, or body twisting and bending. TS patients may utter strange and unacceptable sounds, words, or phrases. It is not uncommon for a person with TS to continuously clear his or her throat, cough, sniff, grunt, yelp, bark, or shout. People with TS may involuntarily shout obscenities (coprolalia) or constantly repeat the words of other people (echolalia). They may touch other people excessively or repeat actions obsessively and unnecessarily. A few patients with severe TS demonstrate self-harming behaviors such as lip and cheek biting and head banging against hard objects. However, these behaviors are extremely rare. Tics alternately increase and decrease in severity, and periodically change in number, frequency, type, and location. Symptoms may subside for weeks or months at a time and later recur.

How Are Tics Classified? There are two categories of tics: simple and complex. Simple tics are sudden, brief movements that involve a limited number of muscle groups. They occur in a single or isolated fashion and are often repetitive. Some of the more common examples of simple tics include eye blinking, shoulder shrugging, facial grimacing, head jerking, yelping, and sniffing. Complex tics are distinct, coordinated patterns of successive movements involving several


muscle groups. Complex tics might include jumping, smelling objects, touching the nose, touching other people, coprolalia, echolalia, or selfharming behaviors.

Can People with TS Control Their Tics? People with TS can sometimes suppress their tics for a short time, but the effort is similar to that of holding back a sneeze. Eventually tension mounts to the point where the tic escapes. Tics worsen in stressful situations; however they improve when the person is relaxed or absorbed in an activity. In most cases tics decrease markedly during sleep.

What Causes TS? Although the basic cause of TS is unknown, current research suggests that there is an abnormality in the gene(s) affecting the brain’s metabolism of neurotransmitters such as dopamine, serotonin, and norepinephrine. Neurotransmitters are chemicals in the brain that carry signals from one nerve cell to another.

What Disorders Are Associated with TS? Not all people with TS have disorders other than tics. However, many people experience additional problems such as obsessive compulsive behavior, characterized by an intense need to act repeatedly, such as hand washing or checking that a door is locked; attention deficit-hyperactivity disorder, characterized by difficulty concentrating and staying on task; learning disabilities, which include reading, writing, and arithmetic difficulties; or sleep disorders, which include frequent awakenings or talking in one’s sleep. The wide range of behavioral symptoms that can accompany tics may, in fact, be more disabling than the tics themselves. Patients, families, and physicians need to determine which set of symptoms is most disabling so that appropriate medications and therapies can be selected.

Guidelines 13

How Is TS Diagnosed? Generally, TS is diagnosed by obtaining a description of the tics and evaluating family history. For a diagnosis of TS to be made, both motor and phonic tics must be present for at least 1 year. Neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS. However, TS is a clinical diagnosis. There are no blood tests or other laboratory tests that definitively diagnose the disorder. Studies show that correct diagnosis of TS is frequently delayed after the start of symptoms because many physicians may not be familiar with the disorder. The behavioral symptoms and tics are easily misinterpreted, often causing children with TS to be misunderstood at school, at home, and even in the doctor’s office. Parents, relatives, and peers who are unfamiliar with the disorder may incorrectly attribute the tics and other symptoms to psychological problems, thereby increasing the social isolation of those with the disorder. And because tics can wax and wane in severity and can also be suppressed, they are often absent during doctor visits, which further complicates making a diagnosis. In many cases, parents, relatives, friends, or even the patients themselves become aware of the disorder based on information they have heard or read in the popular media.

How Is TS Treated? Because symptoms do not impair most patients and development usually proceeds normally, the majority of people with TS require no medication. However, medications are available to help when symptoms interfere with functioning. Unfortunately, there is no one medication that is helpful to all persons with TS, nor does any medication completely eliminate symptoms; in addition, all medications have side effects. Instead, the available TS medications are only able to help reduce specific symptoms. Some patients who require medication to reduce the frequency and intensity of the tic symptoms may be treated with neuroleptic drugs such as haloperidol and pimozide. These medications are usually given in very small doses that are increased slowly until the best possible balance between symptoms and side effects is achieved.


Recently scientists have discovered that long-term use of neuroleptic drugs may cause an involuntary movement disorder called tardive dyskinesia. However, this condition usually disappears when medication is discontinued. Short-term side effects of haloperidol and pimozide include muscular rigidity, drooling, tremor, lack of facial expression, slow movement, and restlessness. These side effects can be reduced by drugs commonly used to treat Parkinson’s disease. Other side effects such as fatigue, depression, anxiety, weight gain, and difficulties in thinking clearly may be more troublesome. Clonidine, an antihypertensive drug, is also used in the treatment of tics. Studies show that it is more effective in reducing motor tics than reducing vocal tics. Fatigue, dry mouth, irritability, dizziness, headache, and insomnia are common side effects associated with clonidine use. Fluphenazine and clonazepam may also be prescribed to help control tic symptoms. Medications are also available to treat some of the associated behavioral disorders. Stimulants such as methyphenidate, pemoline, and dextroamphetamine, usually prescribed for attention deficit-hyperactivity disorders, although somewhat effective, have also been reported to increase tics; therefore their use is controversial. For obsessive compulsive behaviors that significantly disrupt daily functioning, fluoxetine, clomipramine, sertraline, and paroxetine may be prescribed. Other types of therapy may also be helpful. Although psychological problems do not cause TS, psychotherapy may help the person better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. Psychotherapy does not help suppress the patient’s tics. Relaxation techniques and biofeedback may be useful in alleviating stress which can lead to an increase in tic symptoms.

Is TS Inherited? Evidence from genetic studies suggests that TS is inherited in a dominant mode and the gene(s) involved can cause a variable range of symptoms in different family members. A person with TS has about a 50-50 chance of passing on the gene(s) to one of his or her offspring. However, that genetic predisposition may not necessarily result in full-blown TS; instead, it may express itself as a milder tic disorder or as obsessive compulsive behaviors or

Guidelines 15

possibly attention deficit-hyperactivity disorder with few or no tics at all. It is also possible that the gene-carrying offspring will not develop any TS symptoms. A higher than normal incidence of milder tic disorders and obsessive compulsive behaviors has been found in families of individuals with TS. Gender also plays an important role in TS gene expression. If the genecarrying offspring of a TS patient is male, then the risk of developing symptoms is 3 to 4 times higher. However, most people who inherit the gene(s) will not develop symptoms severe enough to warrant medical attention. In some cases of TS, inheritance cannot be determined. These cases are called sporadic and their cause is unknown.

What Is the Prognosis? There is no cure for TS; however, the condition in many individuals improves as they mature. Individuals with TS can expect to live a normal life span. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. TS does not impair intelligence. Tics tend to decrease with age, enabling some patients to discontinue using medication. In a few cases, complete remission occurs after adolescence. Although tic symptoms tend to decrease with age, it is possible that neuropsychiatric disorders such as depression, panic attacks, mood swings, and antisocial behaviors may increase.

What Is the Best Educational Setting for Children with TS? Although students with TS often function well in the regular classroom, it is estimated that many may have some kind of learning disability. When attention deficit-hyperactivity disorder, obsessive compulsive disorder, and frequent tics greatly interfere with academic performance or social adjustment, students should be placed in an educational setting that meets their individual needs. These students may require tutoring, smaller or special classes, and in some cases special schools. All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the


child’s symptoms interfere with his or her ability to write. Untimed testing reduces stress for students with TS.

What Research Is Being Done? Within the Federal Government, the leading supporter of research on TS and other neurological disorders is the National Institute of Neurological Disorders and Stroke (NINDS). The NINDS, a part of the National Institutes of Health (NIH), is responsible for supporting and conducting research on the brain and central nervous system. NINDS sponsors research on TS both in its laboratories at the NIH and through grants to major medical institutions across the country. The National Institute of Mental Health,the National Center for Research Resources, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders also support research of relevance to TS. Recent research has led to several notable advances in the understanding of TS. Already scientists have learned that TS is inherited from a dominant gene(s) that causes different symptoms from patient to patient, and that the disorder is more common than was previously thought. Genetic studies. Currently, investigators are conducting genetic linkage studies in large multigenerational families affected with TS in an effort to find the chromosomal location of the TS gene(s). Finding a genetic marker (a biochemical abnormality that all TS patients might share) for TS would be a major step toward understanding the genetic risk factors for TS. Once the marker is found, research efforts would then focus on locating the TS gene(s). Understanding the genetics of TS will directly benefit patients who are concerned about recurrence in their families and will ultimately help to clarify the development of the disorder. Localization of the TS gene will strengthen clinical diagnosis, improve genetic counseling, lead to the clarification of pathophysiology, and provide clues for more effective therapies. Neurotransmitter studies. Investigators continue to study certain neurotransmitters to increase our understanding of the syndrome, explore the role they play in the disease process, and provide more effective therapies.

Guidelines 17

Environmental studies. Other research projects currently under way include analyzing young unaffected children at high risk for TS in order to identify environmental factors such as life stresses or exposure to certain medications that may influence the expression of the disorder. Scientists are also conducting neuropsychological tests and neuroimaging studies of brain activity and structure to determine the extent to which specific environmental exposures may affect the emergence of tics and/or obsessive compulsive symptoms.

Where Can I Go for More Information? For more information about TS or other neurological disorders, or about the NINDS and its research programs, contact the contact the Institute’s Brain Resources and Information Network (BRAIN) at: BRAIN P.O. Box 5801 Bethesda, Maryland 20824 (301) 496-5751 (800) 352-9424 www.ninds.nih.gov The Tourette Syndrome Association, Inc., is a voluntary, nonprofit organization whose members include people with TS, their families and friends, and health care professionals. The Association funds research, provides services to patients and their families, and offers a variety of publications, including a newsletter, brochures, and fact sheets. For further information, contact: Tourette Syndrome Association, Inc. 42-40 Bell Boulevard Bayside, New York 11361-2820 (718) 224-2999 (800) 237-0717 www.tsa-usa.org/


More Guideline Sources The guideline above on Tourette syndrome is only one example of the kind of material that you can find online and free of charge. The remainder of this chapter will direct you to other sources which either publish or can help you find additional guidelines on topics related to Tourette syndrome. Many of the guidelines listed below address topics that may be of particular relevance to your child’s specific situation, while certain guidelines will apply to only some children with Tourette syndrome. Due to space limitations these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. Topic Pages: MEDLINEplus For parents wishing to go beyond guidelines published by specific Institutes of the NIH, the National Library of Medicine has created a vast and parentoriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages.” You can think of a health topic page as a guide to patient guides. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. If you do not find topics of interest when browsing health topic pages, then you can choose to use the advanced search utility of MEDLINEplus at http://www.nlm.nih.gov/medlineplus/advancedsearch.html. This utility is similar to the NIH Search Utility, with the exception that it only includes material linked within the MEDLINEplus system (mostly parent-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The Combined Health Information Database (CHID) CHID Online is a reference tool that maintains a database directory of thousands of journal articles and educational guidelines on Tourette syndrome and related conditions. One of the advantages of CHID over other sources is that it offers summaries that describe the guidelines available, including contact information and pricing. CHID’s general Web site is

Guidelines 19

http://chid.nih.gov/. To search this database, go to http://chid.nih.gov/detail/detail.html. In particular, you can use the advanced search options to look up pamphlets, reports, brochures, and information kits. The following was recently posted in this archive: ·

Q and A: Questions and Answers about Tourette Syndrome Source: Bayside, NY: Tourette Syndrome Association, Inc. 1994. 4 p. Contact: Available from Tourette Syndrome Association, Inc. 42-40 Bell Boulevard, Bayside, NY 11361-2874. (718) 224-2999; Fax (718) 279-9596. Price: Single copy free. Summary: This brochure provides answers to some common questions about Tourette Syndrome (TS), a neurological disorder characterized by involuntary, rapid, sudden movements or vocalizations that occur repeatedly. The brochure covers topics including the spectrum of symptoms of TS; the causes of TS; diagnostic considerations; the classification of TS tics; treatment options, notably medications to help control the symptoms of TS when they interfere with functioning; the need for early diagnosis and treatment of TS; behaviors that are often associated with TS, including attention deficit disorders, learning disabilities, difficulties with impulse control, sleep disorders, and compulsions or ritualistic behaviors; the special educational needs of students with TS; the genetic components of TS; the prognosis for TS over a person's lifetime; the incidence and history of TS; the current focus of research in this area; and the types of family services that exist. The brochure concludes with a description of the Tourette Syndrome Association (TSA), including the organization's goals and activities, and member benefits; a membership form is also included.

·

Tourette syndrome Source: Duarte, CA: City of Hope Tourette Syndrome Clinic, City of Hope Medical Center. ca. 1990. 7 pp. Contact: Available from City of Hope Medical Center, City of Hope Tourette Syndrome Clinic, 1500 East Duarte Road, Duarte, CA 91010. Telephone: (818) 359-8111. Summary: This brochure provides an overview of Tourette syndrome. It includes information on the symptoms of the condition and how it is diagnosed and treated. An annotated list of books on Tourette syndrome is also included.


·

Q & A: Questions and Answers About Tourette Syndrome Source: Bayside, NY: Tourette Syndrome Association, Inc. (TSA). 1994. 10 p. Contact: Available from Tourette Syndrome Association, Inc. (TSA). 42-40 Bell Boulevard, Bayside, NY 11361. (800) 237-0717 or (718) 224-2999; FAX (718) 279-9596. Price: Free. Summary: This brochure answers questions for persons who have Tourette syndrome (TS). It explains the condition, discusses cause, and covers diagnosis, symptoms, classification of TS, TS treatments, the importance of treating TS early, associated behaviors, special education needs, genetic inheritance, remission, number of persons in the U.S. who have it, history of TS, current research, and family services. An explanation of the goals of the Tourette Syndrome Association (TSA) and the advantages of TSA membership are also offered.

The National Guideline Clearinghouse™ The National Guideline Clearinghouse™ offers hundreds of evidence-based clinical practice guidelines published in the United States and other countries. You can search their site located at http://www.guideline.gov by using the keyword “Tourette syndrome” or synonyms. The following was recently posted: ·

Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. Source: American Academy of Child and Adolescent Psychiatry.; 2001 June 4; 96 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 2244&sSearch_string=Tourette+Syndrome

·

Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. Source: American Academy of Child and Adolescent Psychiatry.; 1997; 37 pages http://www.guideline.gov/FRAMESETS/guideline_fs.asp?guideline=00 0323&sSearch_string=Tourette+Syndrome

Guidelines 21

Healthfinder™ Healthfinder™ is an additional source sponsored by the U.S. Department of Health and Human Services which offers links to hundreds of other sites that contain healthcare information. This Web site is located at http://www.healthfinder.gov. Again, keyword searches can be used to find guidelines. The following was recently found in this database: ·

Tourette Syndrome (TS) Summary: A general overview of Tourette syndrome (TS) that includes a description of the disorder, treatment, prognosis and research information. Source: National Institute of Neurological Disorders and Stroke, National Institutes of Health http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=794

·

Tourette Syndrome Information Online Summary: Links to documents and online resources concerning Tourette syndrome, related topics and relevant medical treatments. Source: Educational Institution--Follow the Resource URL for More Information http://www.healthfinder.gov/scripts/recordpass.asp?RecordType=0&R ecordID=4100 The NIH Search Utility

After browsing the references listed at the beginning of this chapter, you may want to explore the NIH Search Utility. This allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEBSPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to Tourette syndrome. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and parents. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html.


PEDBASE Similar to NORD, PEDBASE covers relatively rare disorders, limited mainly to pediatric conditions. PEDBASE was designed by Dr. Alan Gandy. To access the database, which is more oriented to researchers than parents, you can view the current list of conditions covered at the following Web site: http://www.icondata.com/health/pedbase/pedlynx.htm.

Additional Web Sources A number of Web sites that often link to government sites are available to the public. These can also point you in the direction of essential information. The following is a representative sample: ·

AOL: http://search.aol.com/cat.adp?id=168&layer=&from=subcats

·

drkoop.comÒ: http://www.drkoop.com/conditions/ency/index.html

·

Family Village: http://www.familyvillage.wisc.edu/specific.htm

·

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

·

Med Help International: http://www.medhelp.org/HealthTopics/A.html

·

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

·

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

·

WebMDÒHealth: http://my.webmd.com/health_topics

Vocabulary Builder The material in this chapter may have contained a number of unfamiliar words. The following Vocabulary Builder introduces you to terms used in this chapter that have not been covered in the previous chapter: Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Antihypertensive: An agent that reduces high blood pressure. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include

Guidelines 23

increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Blinking: Brief closing of the eyelids by involuntary normal periodic closing, as a protective measure, or by voluntary action. [NIH] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Clomipramine: A tricyclic antidepressant similar to imipramine that selectively inhibits the uptake of serotonin in the brain. It is readily absorbed from the gastrointestinal tract and demethylated in the liver to form its primary active metabolite, desmethylclomipramine. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Facial: Of or pertaining to the face. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH]


Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurotransmitter: Any of a group of substances that are released on excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH] Pemoline: A central nervous system stimulant used in fatigue and depressive states and to treat hyperkinetic disorders in children. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Recurrence: The return of a sign, symptom, or disease after a remission. [NIH]

Guidelines 25

Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Tardive: Marked by lateness, late; said of a disease in which the characteristic lesion is late in appearing. [EU] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

Tremor: An involuntary trembling or quivering. [EU]

Seeking Guidance 27

CHAPTER 2. SEEKING GUIDANCE Overview Some parents are comforted by the knowledge that a number of organizations dedicate their resources to helping people with Tourette syndrome. These associations can become invaluable sources of information and advice. Many associations offer parent support, financial assistance, and other important services. Furthermore, healthcare research has shown that support groups often help people to better cope with their conditions.8 In addition to support groups, your child’s physician can be a valuable source of guidance and support. In this chapter, we direct you to resources that can help you find parent organizations and medical specialists. We begin by describing how to find associations and parent groups that can help you better understand and cope with your child’s condition. The chapter ends with a discussion on how to find a doctor that is right for your child.

Associations and Tourette Syndrome In addition to associations or groups that your child’s doctor might recommend, we suggest that you consider the following list (if there is a fee for an association, you may want to check with your child’s insurance provider to find out if the cost will be covered):

Churches, synagogues, and other houses of worship might also have groups that can offer you the social support you need. 8


·

Child Study Center Address: Child Study Center Yale University Medical School, 230 South Frontage Road, P.O. Box 207900, New Haven, CT 06520-7900 Telephone: (203) 785-2513 Toll-free: (888) 663-4637 Fax: (203) 785-7402 Web Site: http://info.med.yale.edu/chldstdy/welcome.htm Background: The Child Study Center is a clinical facility located at Yale University Medical School in New Haven, Connecticut. The Center, which is part of the Department of Child and Adolescent Psychiatry, is dedicated to the identification and treatment of a variety of childhood disorders including Heller Syndrome, Tourette Syndrome, Trichotillomania, Attention Deficit Hyperactivity Disorder, Obsessive Compulsive Disorder, Asperger's Syndrome, Autism, Pervasive Development Disorder, and other psychiatric disorders. The Center's goals include providing preventive services and working closely with other community programs to reduce the need for specialized services; providing early intervention; delivering appropriate care to children and their families in an effective fashion; and coordinating child psychiatric services with other medical and social services to assure continuity of care. The center holds support group meetings, offers phone support, and distributes reprints of medical articles related to childhood psychiatric disorders. Relevant area(s) of interest: Tourette Syndrome

·

Dana Alliance for Brain Initiatives Address: Dana Alliance for Brain Initiatives 745 Fifth Avenue, Suite 700, New York, NY 10151 Telephone: (212) 223-4040 Toll-free: (800) 950-6264 Fax: (212) 593-7623 Email: [email protected] Web Site: http://www.dana.org Background: The Dana Alliance for Brain Initiatives, a nonprofit organization supported by the Charles A. Dana Foundation, was established as an alliance of neuroscientists dedicated to providing information and promoting understanding concerning the personal and public benefits of brain research. (The Charles A. Dana Foundation is a private philanthropic foundation with grant programs in health and education.) Established in 1993, the Dana Alliance for Brain Initiatives currently consists of more than 175 neuroscientists. Alliance members

Seeking Guidance 29

have set 10 main objectives in brain research that are considered obtainable by the Year 2000. These objectives include the identification of the genes that are defective in familial Alzheimer's and Huntington's diseases; identification of genes responsible for hereditary forms of manic- depressive illness; and development of new drugs and other measures to alleviate the effects of multiple sclerosis, Alzheimer's disease, Parkinson's disease, motor neuron disease such as Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease), and epilepsy. Many of the 10 objectives have been met, and significant progress is being made on all 10 objectives. According to the Alliance, approximately one in five Americans is affected by a brain disease or disorder, ranging from learning disabilities to Parkinson's Disease from epilepsy to spinal cord injuries. The Dana Alliance for Brain Initiatives is dedicated to answering questions concerning brain-related research and providing information concerning new developments. The Alliance offers a variety of periodicals, newsletters, reports, reference works, and books. The Dana Alliance and the Dana Foundation also have a web site on the Internet that provides information on current activities and services, describes the Dana Alliance's objectives, offers information concerning available publications, and provides comprehensive dynamic linkage through the Dana BrainWeb. The Dana BrainWeb recommends several Internet sites as helpful resources for individuals concerned about brain diseases and disorders. The Dana Foundation and Alliance web site is located at http://www.dana.org. Relevant area(s) of interest: Tourette Syndrome ·

Harvard Brain Tissue Resource Center Address: Harvard Brain Tissue Resource Center McLean Hospital, 115 Mill Street, Belmont, MA 02178 Telephone: (617) 855-2400 Toll-free: (800) 272-4622 Fax: (617) 855-3199 Email: [email protected] Web Site: http://www.brainbank.mclean.org:8080 Background: The Harvard Brain Tissue Resource Center is a federally funded, not-for-profit organization, dedicated to serving as a national resource for the collection and distribution of postmortem brain tissues for medical research into the causes of neurological and psychiatric disorders. The Brain Bank is interested in the study of Huntington's, Alzheimer's, and Parkinson's diseases, progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS), Tourette and Rett syndromes, and autism, as well as schizophrenia and manic depressive illnesses. The


Center distributes brain tissue samples, at no charge, to qualified investigators in the United States who are involved in studying the neurobiology of these disorders. Relevant area(s) of interest: Rett Syndrome, Tourette Syndrome ·

March of Dimes Birth Defects Foundation Address: March of Dimes Birth Defects Foundation 1275 Mamaroneck Avenue, White Plains, NY 10605 Telephone: (914) 428-7100 Toll-free: (888) 663-4637 Fax: (914) 997-4763 Email: [email protected] Web Site: http://www.modimes.org Background: The March of Dimes Birth Defects Foundation is a national not-for- profit organization that was established in 1938. The mission of the Foundation is to improve the health of babies by preventing birth defects and infant mortality. Through the Campaign for Healthier Babies, the March of Dimes funds programs of research, community services, education, and advocacy. Educational programs that seek to prevent birth defects are important to the Foundation and to that end it produces a wide variety of printed informational materials and videos. The March of Dimes public health educational materials provide information encouraging health- enhancing behaviors that lead to a healthy pregnancy and a healthy baby. Relevant area(s) of interest: Adrenoleukodystrophy, Coffin Lowry Syndrome, Incontinentia Pigmenti, Joubert Syndrome, Moyamoya Disease, Rett Syndrome, Tourette Syndrome, Williams Syndrome

·

National Alliance for the Mentally Ill Address: National Alliance for the Mentally Ill 200 North Glebe Road, Suite 1015, Arlington, VA 22203-3754 Telephone: (703) 524-7600 Toll-free: (800) 950-6264 Fax: (703) 524-9094 Email: [email protected] Web Site: http://www.nami.org Background: The National Alliance for the Mentally Ill (NAMI) is a notfor-profit voluntary health organization dedicated to providing mutual support, education, advocacy, and research funding for people affected by mental illness, their families, and friends. The organization also serves

Seeking Guidance 31

those who have been diagnosed with schizophrenic depression and other related disorders. Established in 1979, this self-help organization refers individuals to nationwide support groups, services, and outreach programs. Educational materials produced by the organization include a database, directories, annual reports, informational brochures, pamphlets, a bimonthly newsletter entitled 'The Advocate,' and 'The Decade of the Brain,' NAMI's quarterly publication for presenting research, clinical practices and advances, and policy updates relevant to serious brain disorders. Relevant area(s) of interest: Tourette Syndrome ·

Nebraska Family Support Network Address: Nebraska Family Support Network 215 Centennial Mall South, Suite 220, Lincoln, NE 68508-1813 Telephone: (402) 477-2992 Toll-free: (800) 245-6081 Fax: (402) 477-3192 Email: None. Web Site: None Background: The Nebraska Family Support Network (NFSN), a voluntary not-for- profit advocacy organization, was established in 1988 by a group of parents who identified the need to develop support and referral services closer to home for families of children with mental illness, serious emotional disturbances, and behavioral disorders. The Network, which now consists of approximately 2,500 members, is dedicated to providing support to families of children with or at risk for a mental, emotional, or behavioral disorder; promoting an integrated 'system of care' for affected children and their families; and promoting awareness of the needs of affected children among the general public and health care professionals. The Nebraska Family Support Network works collaboratively with other family support organizations across the state for the purposes of information sharing, resource exchange, advocacy, service development, and policy/legislation review. The Network also offers a 24-hour toll- free telephone support line for statewide access for parents and professionals; serves as a referral mechanism for families to link with appropriate support groups in or near their communities; and offers networking services to affected families, enabling them to exchange mutual support, information, and resources. In addition, the Network provides advocacy services upon requests from families, physicians, or special educators; develops programs to educate families and professionals about the needs of children and adolescents with emotional, behavioral, or mental disorders; and conducts regular


workshops to help parents become more effective participants in their children's treatment when working with Medicaid or Medicaid Managed Care providers. The Nebraska Family Support Network also has a lending library with print and video resource materials and publishes a quarterly newsletter for families and professionals that regularly includes commentary, support group locations, behavioral and mental health information updates, and legislative/regulatory updates concerning changes that may affect affected families' access to required services. Relevant area(s) of interest: Tourette Syndrome ·

Tourette Syndrome Association, Inc Address: Tourette Syndrome Association, Inc. 42-40 Bell Boulevard, Bayside, NY 11361-2861 Telephone: (718) 224-2999 Toll-free: (888) 486-8738 Fax: (718) 279-9596 Email: [email protected] Web Site: http://TSA.mgh.harvard.edu/ Background: The Tourette Syndrome Association, Inc. (TSA) is a national nonprofit organization dedicated to serving the needs of individuals affected by Tourette Syndrome and their families. Tourette Syndrome (TS) is a hereditary neurologic movement disorder characterized by repetitive motor and vocal tics. Symptoms may include involuntary movement of the extremities, shoulders, and face accompanied by uncontrollable sounds and/or inappropriate words. Symptoms tend to be variable and follow a chronic waxing and waning course. Founded in 1972 and currently consisting of 50 chapters and approximately 8,000 members, TSA's mission is to identify the cause, find a cure, and control the effects of Tourette Syndrome. To this end, TSA facilitates a research grant award program and is guided by both a volunteer national Medical Advisory Board and a Scientific Advisory Board. The Association produces a variety of educational materials including brochures, a quarterly newsletter, and videotapes. In addition, TSA maintains a crisis hotline, provides physician referral listings, and engages in patient advocacy. The Tourette Syndrome Association maintains a web site at http://www.TSA.mgh.harvard.edu. Relevant area(s) of interest: Tourette Syndrome

·

Tourette Syndrome Foundation of Canada Address: Tourette Syndrome Foundation of Canada 194 Jarvis Street, Suite 206, Toronto, Ontario, M5B 1M6, Canada

Seeking Guidance 33

Telephone: (416) 861-8398 Toll-free: (800) 361-3120 Fax: (416) 861-2472 Email: [email protected] Web Site: http://www.tourette.ca Background: The Tourette Syndrome Foundation of Canada (TSFC) is a national voluntary health organization dedicated to providing support and information to Canadian families affected by Tourette Syndrome. Tourette Syndrome (TS) is a hereditary neurologic movement disorder characterized by repetitive motor and vocal tics. Symptoms may include involuntary movements of the extremities, shoulders, and face accompanied by uncontrollable sounds and/or inappropriate words. Symptoms tend to be variable and follow a chronic waxing and waning course. TSFC's mission is to help families affected by Tourette Syndrome by gathering and distributing information about the disorder; promoting local self-help and professional services; and stimulating and funding research into the cause, treatment, and potential cure of TS. Founded in 1976 and consisting of 26 chapters, TSFC organizes workshops and symposiums to increase the knowledge and sensitivity of health care professionals; provides periodic forums for scientists, clinicians, and others working in the field of Tourette Syndrome; develops and maintains lists of physicians who diagnose and treat TS; and supports the Brain Bank Program and collaborates with other agencies dealing with neurological disorders. The Foundation publishes a tri-annual newsletter entitled 'The Green Leaflet' and provides brochures, pamphlets, reports, and audiovisual aids. Relevant area(s) of interest: Chronic Motor Tic, Chronic Multiple Tics, Gilles de la Tourette Syndrome, Habit Spasms, Maladie de Tics, Tics, Tourette Syndrome ·

WE MOVE (Worldwide Education and Awareness for Movement Disorders) Address: WE MOVE (Worldwide Education and Awareness for Movement Disorders) Mt. Sinai Medical Center, One Gustave L. Levy Place Box 1052, New York, NY 10029 Telephone: (212) 241-8567 Toll-free: (800) 437-6682 Fax: (212) 987-7363 Email: [email protected] Web Site: http://www.wemove.org Background: WE MOVE (Worldwide Education and Awareness for Movement Disorders) is an international educational program endorsed


by the Movement Disorder Society. It is dedicated to promoting awareness of neurological movement disorders for the purpose of early diagnosis, appropriate treatment, and patient support. The primary focus of the program is to educate the health care community about movement disorders. To that end, the organization sponsors education programs and produces teaching materials designed for medical professionals including neurologists, family practitioners, physical therapists, speech pathologists, and other health care workers. WE MOVE serves as a communication link between physicians, affected individuals, and support groups around the world. The program also publishes the 'International Guide to Patient Support Organizations' and a brochure entitled 'Educator's Resource Materials.' In addition, the organization maintains a web site at http://www.mssm.edu/neurology/html/wemove.html. Relevant area(s) of interest: Tics, Tourette Syndrome

Finding More Associations There are a number of directories that list additional medical associations that you may find useful. While not all of these directories will provide different information than what is listed above, by consulting all of them, you will have nearly exhausted all sources for parent associations. The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about Tourette syndrome. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797.

DIRLINE A comprehensive source of information on associations is the DIRLINE database maintained by the National Library of Medicine. The database comprises some 10,000 records of organizations, research centers, and government institutes and associations which primarily focus on health and biomedicine. DIRLINE is available via the Internet at the following Web site: http://dirline.nlm.nih.gov. Simply type in “Tourette syndrome” (or a

Seeking Guidance 35

synonym) or the name of a topic, and the site will list information contained in the database on all relevant organizations.

The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “Tourette syndrome”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” By making these selections and typing in “Tourette syndrome” (or synonyms) into the “For these words:” box, you will only receive results on organizations dealing with Tourette syndrome. You should check back periodically with this database since it is updated every 3 months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by specific medical conditions. You can access this database at the following Web site: http://www.rarediseases.org/cgi-bin/nord/searchpage. Select the option called “Organizational Database (ODB)” and type “Tourette syndrome” (or a synonym) in the search box.

Online Support Groups In addition to support groups, commercial Internet service providers offer forums and chat rooms to discuss different illnesses and conditions. WebMDÒ, for example, offers such a service at their Web site: http://boards.webmd.com/roundtable. These online communities can help you connect with a network of people whose concerns are similar to yours. Online support groups are places where people can talk informally. If you read about a novel approach, consult with your child’s doctor or other healthcare providers, as the treatments or discoveries you hear about may not be scientifically proven to be safe and effective.


Finding Doctors All parents must go through the process of selecting a physician for their children with Tourette syndrome. While this process will vary, the Agency for Healthcare Research and Quality makes a number of suggestions, including the following:9 ·

If your child is in a managed care plan, check the plan’s list of doctors first.

·

Ask doctors or other health professionals who work with doctors, such as hospital nurses, for referrals.

·

Call a hospital’s doctor referral service, but keep in mind that these services usually refer you to doctors on staff at that particular hospital. The services do not have information on the quality of care that these doctors provide.

·

Some local medical societies offer lists of member doctors. Again, these lists do not have information on the quality of care that these doctors provide.

Additional steps you can take to locate doctors include the following: ·

Check with the associations listed earlier in this chapter.

·

Information on doctors in some states is available on the Internet at http://www.docboard.org. This Web site is run by “Administrators in Medicine,” a group of state medical board directors.

·

The American Board of Medical Specialties can tell you if your child’s doctor is board certified. “Certified” means that the doctor has completed a training program in a specialty and has passed an exam, or “board,” to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care doctors may also be certified as specialists. The AMBS Web site is located at 10 http://www.abms.org/newsearch.asp. You can also contact the ABMS by phone at 1-866-ASK-ABMS.

·

You can call the American Medical Association (AMA) at 800-665-2882 for information on training, specialties, and board certification for many licensed doctors in the United States. This information also can be found in “Physician Select” at the AMA’s Web site: http://www.amaassn.org/aps/amahg.htm.

This section is adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm. While board certification is a good measure of a doctor’s knowledge, it is possible to receive quality care from doctors who are not board certified. 9

10

Seeking Guidance 37

If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare medical conditions. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Finding a Neurologist The American Academy of Neurology allows you to search for member neurologists by name or location. To use this service, go to http://www.aan.com/, select “Find a Neurologist” from the toolbar. Enter your search criteria, and click “Search.” To find out more information on a particular neurologist, click on the physician’s name. If the previous sources did not meet your needs, you may want to log on to the Web site of the National Organization for Rare Disorders (NORD) at http://www.rarediseases.org/. NORD maintains a database of doctors with expertise in various rare diseases. The Metabolic Information Network (MIN), 800-945-2188, also maintains a database of physicians with expertise in various metabolic diseases.

Selecting Your Doctor11 When you have compiled a list of prospective doctors, call each of their offices. First, ask if the doctor accepts your child’s health insurance plan and if he or she is taking new patients. If the doctor is not covered by your child’s plan, ask yourself if you are prepared to pay the extra costs. The next step is to schedule a visit with your first choice. During the first visit you will have the opportunity to evaluate your child’s doctor and to find out if your child feels comfortable with him or her.

11 This

section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.


Working with Your Child’s Doctor12 Research has shown that parents who have good relationships with their children’s doctors tend to be more satisfied with their children’s care. Here are some tips to help you and your child’s doctor become partners: ·

You know important things about your child’s symptoms and health history. Tell the doctor what you think he or she needs to know.

·

Always bring any medications your child is currently taking with you to the appointment, or you can bring a list of your child’s medications including dosage and frequency information. Talk about any allergies or reactions your child has had to medications.

·

Tell your doctor about any natural or alternative medicines your child is taking.

·

Bring other medical information, such as x-ray films, test results, and medical records.

·

Ask questions. If you don’t, the doctor will assume that you understood everything that was said.

·

Write down your questions before the doctor’s visit. List the most important ones first to make sure that they are addressed.

·

Ask the doctor to draw pictures if you think that this will help you and your child understand.

·

Take notes. Some doctors do not mind if you bring a tape recorder to help you remember things, but always ask first.

·

Take information home. Ask for written instructions. Your child’s doctor may also have brochures and audio and videotapes on Tourette syndrome.

By following these steps, you will enhance the relationship you and your child have with the physician.

This section has been adapted from the AHRQ: www.ahrq.gov/consumer/qntascii/qntdr.htm.

12

Seeking Guidance 39

Broader Health-Related Resources In addition to the references above, the NIH has set up guidance Web sites that can help parents find healthcare professionals. These include:13 ·

Caregivers: http://www.nlm.nih.gov/medlineplus/caregivers.html

·

Choosing a Doctor or Healthcare Service: http://www.nlm.nih.gov/medlineplus/choosingadoctororhealthcareserv ice.html

·

Hospitals and Health Facilities: http://www.nlm.nih.gov/medlineplus/healthfacilities.html

Vocabulary Builder The following vocabulary builder provides definitions of words used in this chapter that have not been defined in previous chapters: Manic: Affected with mania. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Trichotillomania: Compulsion to pull out one's hair. [NIH]

You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html.

13

Clinical Trials 41

CHAPTER 3. CLINICAL TRIALS AND TOURETTE SYNDROME Overview Very few medical conditions have a single treatment. The basic treatment guidelines that your child’s physician has discussed with you, or those that you have found using the techniques discussed in Chapter 1, may provide you with all that you will require. For some patients, current treatments can be enhanced with new or innovative techniques currently under investigation. In this chapter, we will describe how clinical trials work and show you how to keep informed of trials concerning Tourette syndrome.

What Is a Clinical Trial?14 Clinical trials involve the participation of people in medical research. Most medical research begins with studies in test tubes and on animals. Treatments that show promise in these early studies may then be tried with people. The only sure way to find out whether a new treatment is safe, effective, and better than other treatments for Tourette syndrome is to try it on patients in a clinical trial.

The discussion in this chapter has been adapted from the NIH and the NEI: www.nei.nih.gov/netrials/ctivr.htm.

14


What Kinds of Clinical Trials Are There? Clinical trials are carried out in three phases: ·

Phase I. Researchers first conduct Phase I trials with small numbers of patients and healthy volunteers. If the new treatment is a medication, researchers also try to determine how much of it can be given safely.

·

Phase II. Researchers conduct Phase II trials in small numbers of patients to find out the effect of a new treatment on Tourette syndrome.

·

Phase III. Finally, researchers conduct Phase III trials to find out how new treatments for Tourette syndrome compare with standard treatments already being used. Phase III trials also help to determine if new treatments have any side effects. These trials--which may involve hundreds, perhaps thousands, of people--can also compare new treatments with no treatment. How Is a Clinical Trial Conducted?

Various organizations support clinical trials at medical centers, hospitals, universities, and doctors’ offices across the United States. The “principal investigator” is the researcher in charge of the study at each facility participating in the clinical trial. Most clinical trial researchers are medical doctors, academic researchers, and specialists. The “clinic coordinator” knows all about how the study works and makes all the arrangements for your child’s visits. All doctors and researchers who take part in the study on Tourette syndrome carefully follow a detailed treatment plan called a protocol. This plan fully explains how the doctors will treat your child in the study. The “protocol” ensures that all patients are treated in the same way, no matter where they receive care. Clinical trials are controlled. This means that researchers compare the effects of the new treatment with those of the standard treatment. In some cases, when no standard treatment exists, the new treatment is compared with no treatment. Patients who receive the new treatment are in the treatment group. Patients who receive a standard treatment or no treatment are in the “control” group. In some clinical trials, patients in the treatment group get a new medication while those in the control group get a placebo. A placebo is a harmless substance, a “dummy” pill, that has no effect on Tourette syndrome. In other clinical trials, where a new surgery or device (not a medicine) is being tested, patients in the control group may receive a “sham

Clinical Trials 43

treatment.” This treatment, like a placebo, has no effect on Tourette syndrome and will not harm your child. Researchers assign patients “randomly” to the treatment or control group. This is like flipping a coin to decide which patients are in each group. If you choose to have your child participate in a clinical trial, you will not know which group he or she will be appointed to. The chance of any patient getting the new treatment is about 50 percent. You cannot request that your child receive the new treatment instead of the placebo or “sham” treatment. Often, you will not know until the study is over whether your child has been in the treatment group or the control group. This is called a “masked” study. In some trials, neither doctors nor patients know who is getting which treatment. This is called a “double masked” study. These types of trials help to ensure that the perceptions of the participants or doctors will not affect the study results. Natural History Studies Unlike clinical trials in which patient volunteers may receive new treatments, natural history studies provide important information to researchers on how Tourette syndrome develops over time. A natural history study follows patient volunteers to see how factors such as age, sex, race, or family history might make some people more or less at risk for Tourette syndrome. A natural history study may also tell researchers if diet, lifestyle, or occupation affects how a medical condition develops and progresses. Results from these studies provide information that helps answer questions such as: How fast will a medical condition usually progress? How bad will the condition become? Will treatment be needed? What Is Expected of Your Child in a Clinical Trial? Not everyone can take part in a clinical trial for a specific medical condition. Each study enrolls patients with certain features or eligibility criteria. These criteria may include the type and stage of the condition, as well as, the age and previous treatment history of the patient. You or your child’s doctor can contact the sponsoring organization to find out more about specific clinical trials and their eligibility criteria. If you would like your child to participate in a clinical trial, your child’s doctor must contact one of the trial’s investigators and provide details about his or her diagnosis and medical history.


When participating in a clinical trial, your child may be required to have a number of medical tests. Your child may also need to take medications and/or undergo surgery. Depending upon the treatment and the examination procedure, your child may be required to receive inpatient hospital care. He or she may have to return to the medical facility for followup examinations. These exams help find out how well the treatment is working. Follow-up studies can take months or years. However, the success of the clinical trial often depends on learning what happens to patients over a long period of time. Only patients who continue to return for follow-up examinations can provide this important long-term information.

Recent Trials on Tourette Syndrome The National Institutes of Health and other organizations sponsor trials on various medical conditions. Because funding for research goes to the medical areas that show promising research opportunities, it is not possible for the NIH or others to sponsor clinical trials for every medical condition at all times. The following lists recent trials dedicated to Tourette syndrome.15 If the trial listed by the NIH is still recruiting, your child may be eligible. If it is no longer recruiting or has been completed, then you can contact the sponsors to learn more about the study and, if published, the results. Further information on the trial is available at the Web site indicated. Please note that some trials may no longer be recruiting patients or are otherwise closed. Before contacting sponsors of a clinical trial, consult with your child’s physician who can help you determine if your child might benefit from participation. ·

Brain Activation in Vocal and Motor Tics Condition(s): Tourette's Syndrome; Chronic Motor Tic Disorder; Chronic Motor Vocal Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will investigate the brain areas that are activated by vocal and motor tics in patients with Tourette's syndrome and other tic disorders. Tics are involuntary repetitive movements similar to voluntary movements. They may be simple, involving only a few muscles or simple sounds, or complex, involving several groups of muscles in orchestrated bouts. This study will involve only simple motor tics, such as eye blinking, nose wrinkling, facial grimacing and

15

These are listed at www.ClinicalTrials.gov.

Clinical Trials 45

abdominal tensing, and simple vocal tics, such as throat clearing, sniffing and snorting. Healthy normal volunteers and patients between 14 and 65 years of age with simple motor or vocal tics may be eligible for this study. Participants will have a brief medical history and physical examination and magnetic resonance imaging (MRI) of the brain. MRI uses a magnetic field and radio waves to produce images. For the procedure, the subject lies on a table that is moved into a cylindrical chamber containing a strong magnet. Earplugs are worn to muffle the loud thumping sounds made by electrical switching of the radio frequency circuits and protect against temporary hearing impairment. During the scan, normal volunteers will be asked to make simple movements or sounds designed to imitate tics, such as raising eyebrows, blinking or coughing. Patients with tic disorders will have two parts to the scanning session. First they will relax and allow tics to occur spontaneously, then they will be asked to imitate a specific tic when there is no urge to tic. Patients and healthy subjects will have electromyography (EMG) to record the timing of the voluntary movements and tics. For this procedure, several pairs of small, saucer-like electrodes are attached to the skin with a gel or paste. Electric signals from the electrodes are amplified and recorded on a computer. A microphone may be placed near patients to record any vocal tics. A video camera may also be used to record the tics. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00026000;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Brain Tissue Collection for the Neuropathology Section of the Clinical Brain Disorders Branch of the National Institute of Mental Health Condition(s): Bipolar Disorder; Huntington Disease; Schizophrenia; Tourette Syndrome; Dementia Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This study will actively request relatives of deceased patients to donate the brain of the patient for use in furthering the knowledge and understanding of certain neurological and psychiatric disorders. This study will allow the NIMH to participate along with other pathology departments of the Washington D.C. and metropolitan area as


well as local medical examiner's offices in collecting donated brain tissue. This study will not directly benefit the deceased or the families of the deceased, but information gathered from donated tissue may lead to better treatments and potential cures for neurologic and psychiatric disorders in the future. Study Type: Observational Contact(s): Maryland; National Institute of Mental Health (NIMH), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Joel E. Kleinman, M.D. 3014027909 [email protected] Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001260;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Central Mechanisms in Speech Motor Control Studied with H215O PET Condition(s): Communication Disorder; Healthy; Stuttering; Tourette Syndrome; Voice Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute on Deafness and Other Communication Disorders (NIDCD) Purpose - Excerpt: Positron Emission Tomography (PET) is a technique used to investigate the functional activity of the brain. The PET technique allows doctors to study the normal biochemical and metabolic processes of the central nervous system of normal individuals and patients with neurologic illnesses without physical / structural damage to the brain. Radioactive water H215O in PET scans permits good visualization of areas of the brain related to speech. Most of the PET scan studies conducted have concentrated on learning about how language is formed and decoded. Few studies have been conducted on speech production. This study aims to use radioactive water (H215O) and Positron Emission Tomography (PET scan) to measure blood flow to different areas of the brain in order to better understand the mechanisms involved in speech motor control. When a region of the brain is active, it uses more fuel in the form of oxygen and sugar (glucose). As the brain uses more fuel it produces more waste products, carbon dioxide and water. Blood carries fuel to the brain and waste products away from the brain. As brain activity increases blood flow to and from the area of activity increases also. Knowing these facts, researchers can use radioactive chemicals (H215O) and PET scans to observe what areas of the brain are receiving more blood flow. Researchers will ask patients to perform tasks that will affect speech, voice, and language. At the same time patients will

Clinical Trials 47

undergo a PET scan. The tasks are designed to help researchers observe the blood flow to brain areas associated with voicebox (laryngeal) functions, movement of muscles in the jaw, tongue, and mouth, and other aspects of motor speech. Special studies will be conducted to evaluate how certain therapies and tasks can draw out symptoms in illnesses in which speech and language are affected. Results of these tests will be used in other studies to evaluate the neurologic mechanisms of diseases like Tourette's syndrome and parkinson's disease. Study Type: Observational Contact(s): Maryland; National Institute on Deafness and Other Communication Disorders (NIDCD), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001308;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Developmental Phenomenology of Obsessive Compulsive Disorder and Tourette Syndrome in Children and Adolescents Condition(s): Tourette Syndrome; Obsessive Compulsive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); Yale University Purpose - Excerpt: Objectives: I. Characterize the natural history, associated features, and severity of symptoms of obsessive compulsive disorder and Tourette syndrome in children and adolescents. II. Identify factors that influence the clinical course and prognosis of these patients. Study Type: Observational Contact(s): Connecticut; Yale University School of Medicine, New Haven, Connecticut, 06520-8035, United States; Recruiting; James F. Leckman 203-785-7971. Study chairs or principal investigators: James F. Leckman, Study Chair; Yale University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004324;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F


·

Evaluation and Follow-up of Patients with Obsessive-Compulsive Disorder and Related Conditions Condition(s): Anorexia Nervosa; Obsessive Compulsive Disorder; Tourette Syndrome; Trichotillomania Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: This study will follow the progress of patients with obsessive-compulsive disorder (OCD) and related conditions, such as Tourette's syndrome, trichotillomania (hair pulling), anorexia nervosa, and others. The purpose is to better understand the course of these disorders and evaluate treatments. Patients 18 years or older with OCD and related conditions will be evaluated for this study with a medical and psychiatric history, questionnaires and neurological testing. Those enrolled will be seen about every 4 to 12 weeks for evaluation through rating scales of symptoms (e.g., anxiety and depression) and ability to function in daily activities, personality tests, blood and urine tests, memory tests, brain scans and other clinical exams. Evaluations may be through interviews or paper and pencil or computer-assisted tests. Some patients may be invited to participate in other studies to test new medications. All patients may, if they wish, participate in a monthly OCD support group. At the end of the study, participants will be referred to community support or treatment centers, as appropriate. Study Type: Observational Contact(s): Maryland; National Institute of Mental Health (NIMH), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800-411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004550;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F

·

Genetics of Obsessive-Compulsive Disorder: A Collaborative Study Condition(s): Obsessive Compulsive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Obsessive-compulsive disorder (OCD) affects approximately 2 to 3 in every 100 people. People with OCD have recurrent thoughts, feelings, and behaviors even against their attempt to stop. This can often cause an overwhelming sense of anxiety. The symptoms can cause so much distress that people with OCD have a

Clinical Trials 49

difficult time functioning on a daily basis. Obsessive compulsive disorder is a heritable condition. The mode of inheritance is poorly understood, but researchers believe it is likely complex, involving multiple sites (loci) on genes. The primary goal of this research project is to detect and localize the genes that increase or decrease susceptibility to obsessive compulsive disorder. The data gathered from this study will be combined with other similar research studies being conducted in other institutions. By identifying genes that alter the risk of OCD, researchers can better understand how the condition develops, and ultimately improve the treatment of patients with OCD. Study Type: Observational Contact(s): Maryland; National Institute of Mental Health (NIMH), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Diane Kazuba 3014968977 [email protected] Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001548;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

I-123 Brain Studies of Serotonin Metabolism in Psychiatric Patients and Normal Volunteers Condition(s): Healthy; Mental Disorder; Obsessive Compulsive Disorder; Schizophrenia; Tourette Syndrome Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Abnormalities in the re-uptake of dopamine and serotonin have been described in various neuropsychiatric disorders and substance abuse. [I-123] Beta-CIT is a recently developed radioligand for SPECT imaging of dopamine and serotonin transporters. [I-123]Beta-CIT SPECT has been used at the SPECT-lab of the Clinical Brain Disorders Branch in over fifty subjects without adverse events. Due to the trace concentrations used, a pharmacological effect of Beta-CIT is unlikely and has not been observed. The purpose of this study is to use Beta-CIT and SPECT to study the expression of dopamine and serotonin transporters in vivo in normal controls and various patient populations to address hypothesized abnormalities of the transporters in different disorders and to understand the effects of genetic variations in the genes of these transporters on their in vivo expression. Study Type: Observational


Contact(s): Maryland; National Institute of Mental Health (NIMH), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Julie Gorey, DNMT 3014356364 [email protected] Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00001771;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Magnetic Resonance Spectroscopy to Evaluate Tourette's Syndrome Condition(s): Tourette Syndrome Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will use magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) of the brain to try to gain a better understanding of the disease process in Tourette's syndrome, a neuropsychiatric disorder characterized by motor and vocal tics. Tourette's syndrome is also associated with behavioral and emotional disturbances, including symptoms of attention deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). MRI and MRS show chemical substances in the brain. Findings in normal volunteers will be compared with those of patients. Healthy volunteers and patients with Tourette's syndrome 14 years of age and older may be eligible for this study. Volunteers will be screened with a medical history and physical and neurological examinations. Patients will be screened through NINDS protocol 93-N-0202. Participants will undergo MRI and MRS. MRI uses a strong magnetic field and radio waves to visualize brain anatomy and chemistry. For this study, the subject lies on a stretcher, which is moved into a strong magnetic field (the MRI scanner). Earplugs are worn to muffle loud thumping noises caused by the electrical switching of the radio frequency circuits. During the study, the subject lies still during each scan, for 1 to 8 minutes at a time. Total scanning time varies from 20 minutes to 2 hours, with most examinations lasting between 45 and 90 minutes. The subject can speak through an intercom with the staff member performing the study at all times during the procedure. Up to 5 studies may be performed. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222 [email protected]; TTY 1-866-411-1010

Clinical Trials 51

Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00030953;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Plasma Exchange for Immune-Mediated Neuropsychiatric Symptoms in Children and Adolescents Condition(s): Obsessive Compulsive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: Clinical observations and systematic study have demonstrated that a sub-group of children with obsessive-compulsive disorder (OCD) and/or tic disorders experience symptom exacerbations following infections with Group A beta-hemolytic streptococci (GABHS). This sub-group of children has been designated by the acronym PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections). The purpose of this investigation is to examine neurobiological and immunological correlates of response to treatment with an immunomodulatory treatment, plasma exchange (PEX), in this sub-group. A recent double-blind randomized study compared PEX with intravenous immunoglobulin (IVIG) and sham IVIG (placebo) for treatment of tics, obsessive-compulsive symptoms in children with PANDAS. The results showed the PEX was superior to the placebo condition on all measures, with average improvements of 49% (tics) to 58% (obsessive-compulsive symptoms). The effectiveness of PEX led to its choice as the treatment modality in this investigation, which will examine a variety of biological and behavioral variables before and after immunomodulatory treatment, in order to determine predictors of treatment response, as well as to identify possible mediators of PEX's therapeutic effect. The subjects of the investigation are 15 children and adolescents (ages 5-14 years) in the PANDAS sub-group with severe tic disorders and/or obsessive-compulsive disorder. Each child enrolled in the study will receive a series of 5 plasma exchange treatments over a 912 day hospitalization at the Clinical Center. Evaluations will be done at baseline and one month post-term to determine predictors of treatment response, as evaluations will include neurological and physical examination, psychiatric evaluation, structured assessments of symptom severity, laboratory studies (including a variety of immunologic markers), nuclear magnetic resonance imaging (NMRI), lumbar puncture, neuropsychological testing, and transcranial magnetic stimulation (TMS). In addition, medical and psychiatric histories and genetic samples will be obtained from all first-degree relatives of the probands, in order to


examine familial patterns of psychopathology and possible genetic vulnerabilities to immunologic and neuropsychiatric symptomatology. Phase(s): Phase III Study Type: Interventional Contact(s): Maryland; National Institute of Mental Health (NIMH), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Susan E. Swedo, M.D. 3014965323 [email protected] Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00005109;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Study of GABA-A receptors in the Generation of Tics in Patients with Tourette's Syndrome Condition(s): Tourette Syndrome Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will investigate how the brain generates tics in patients with Tourette's syndrome and which areas of the brain are primarily affected. Tourette's syndrome is a neuropsychiatric disorder characterized by motor and vocal tics, and is associated with behavioral and emotional disturbances, including symptoms of attention deficit hyperactivity disorder and obsessive-compulsive disorder. This study will examine whether tic generation is related to changes in brain cell receptors for a chemical messenger called gamma-aminobutyric acid (GABA). Healthy normal volunteers and patients with Tourette's syndrome between 21 and 65 years of age may be eligible for this study. Candidates will be screened with a medical history and physical and neurological examinations. Participants will undergo positron emission tomography (PET) scanning to measure brain blood flow. For this procedure, the subject receives an injection of H215O, a radioactive substance similar to water. A special camera detects the radiation emitted by the H215O, allowing measurement of the blood flow. Subjects will receive up to five injections of H215O during the scanning. They will also be injected with another radioactive chemical, (11C) flumazenil, which binds to GABA receptors, to measure the density and distribution of these receptors. This will reveal which areas of the brain in patients with Tourette's syndrome have abnormal binding of flumazenil compared with the brains of healthy control subjects. During the PET procedure, the subject lies on a table in the PET scanner. A small catheter (plastic tube) is

Clinical Trials 53

placed in an arm vein for injecting the radioactive tracers, and a mask is placed on the face to help keep the head still during scanning. The mask has large openings for eyes, nose and mouth, so that it does not interfere with talking or breathing. The entire test takes about 3 hours. On a separate day, participants will also undergo magnetic resonance imaging (MRI), a diagnostic test that uses a magnetic field and radio waves to produce images of the brain. For this procedure, the subject lies still on a stretcher that is moved into the scanner (a narrow cylinder containing the magnet). Earplugs are worn to muffle loud noises caused by electrical switching of radio frequency circuits used in the scanning process. The scan lasts about 45 to 60 minutes. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00034398;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Study of the Neurobiology of Tourette Syndrome and Related Disorders Condition(s): Tourette Syndrome; Obsessive Compulsive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Center for Research Resources (NCRR); Yale University Purpose - Excerpt: Objectives: I. Investigate the pathobiology of Tourette syndrome and related disorders by measuring various compounds of interest in cerebrospinal fluid, plasma, and urine of patients with Tourette syndrome, obsessive compulsive disorder, and/or chronic tics. II. Determine the pattern of familial aggregation of Tourette syndrome and obsessive compulsive disorder by systematic assessment of all firstdegree family members of patients selected for cerebrospinal fluid studies. III. Establish the neurochemical and neuropeptide profile associated with the range of expression of the putative Tourette gene expression in adult and adolescent patients. Study Type: Observational Contact(s): Connecticut; Yale University School of Medicine, New Haven, Connecticut, 06520-8035, United States; Recruiting; James F. Leckman


203-785-7971. Study chairs or principal investigators: James F. Leckman, Study Chair; Yale University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004325;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Study of Tics in Patients with Tourette's Syndrome and Chronic Motor Tic Disorder Condition(s): Tourette Syndrome; Tic Disorders Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Neurological Disorders and Stroke (NINDS) Purpose - Excerpt: This study will investigate which areas of the brain are primarily involved in and responsible for tics in patients with Tourette's syndrome and chronic motor disorder. Tourette's syndrome is a neuropsychiatric disorder characterized by motor and vocal tics and is associated with behavioral and emotional disturbances, including symptoms of attention deficit hyperactivity disorder and obsessivecompulsive disorder. Chronic motor disorder has the same characteristics as Tourette's syndrome, except that patients do not have vocal tics. Healthy normal volunteers and patients with Tourette's syndrome or chronic motor tic disorder between 18 and 65 years of age may be eligible for this study. Candidates will be screened with a medical history and physical and neurological examinations. Participants will undergo positron emission tomography (PET) scanning to study tics under three conditions- spontaneous tics, suppression of tics, and sleep-to determine which areas of the brain are responsible for generation of tics. For this procedure, the subject is injected with H215O, a radioactive substance similar to water. A special camera detects the radiation emitted by the H215O, allowing measurement of brain blood flow. Subjects will receive up to 20 injections of H215O during the scanning. Participants will be asked not to sleep the entire night before the test. Before the scan, both patients and volunteers will have EEG electrodes placed on their heads to record the electrical activity of their brains. Patients will also have EMG electrodes placed in areas of the body where tics occur. A small catheter (plastic tube) will be placed in an arm vein for injecting the radioactive tracers, and a mask will be placed on the face to help keep the head still during scanning. The mask has large openings for eyes, nose and mouth, so that it does not interfere with talking or breathing. The entire test takes about 4 hours. During this time, the subject will sleep for 1.5 hours either at the beginning or end of the scan. For the other 2.5 hours, scans will be

Clinical Trials 55

done every 10 minutes for 1 minute under the different conditions of tic suppression or release of tics. On a separate day, participants will also undergo magnetic resonance imaging (MRI), a diagnostic test that uses a magnetic field and radio waves to produce images of the brain. For this procedure, the subject lies still on a stretcher that is moved into the scanner (a narrow cylinder containing the magnet). Earplugs are worn to muffle loud noises caused by electrical switching of radio frequency circuits used in the scanning process. The scan lasts about 45 to 60 minutes. Study Type: Observational Contact(s): Maryland; National Institute of Neurological Disorders and Stroke (NINDS), 9000 Rockville Pike Bethesda, Maryland, 20892, United States; Recruiting; Patient Recruitment and Public Liaison Office 1-800411-1222 [email protected]; TTY 1-866-411-1010 Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00033995;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Treatment of Obsessive-Compulsive Disorder Condition(s): Obsessive-Compulsive Disorder Study Status: This study is currently recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH) Purpose - Excerpt: The purpose of this study is to find the best treatment for Tourette's Syndrome (TS)-spectrum obsessive-compulsive disorder (OCD), which includes symptoms of TS, e.g., repeated and involuntary body movements (tics). There are 3 parts to this study: In Part 1, patients are placed into 1 of 2 groups based on type of OCD, determined by medical history and family member interviews. In Part 2, patients are treated with fluvoxamine (FVX) for 8 weeks. If patients do not respond to FVX alone, either haloperidol or an inactive placebo will be added to the FVX regimen; patients will take this drug combination for 4 weeks. In Part 3, if patients show improvement with the medications in Part 2, they are given a protein drink or inactive placebo. Patients will be monitored throughout the trial. You may be eligible for this study if you: Are 16 - 70 years old. Have obsessive-compulsive disorder (OCD). Study Type: Interventional Contact(s): Wayne Goodman, MD 1-877-788-3994 [email protected] Candy L. Hill, MS 352-392-2831 [email protected]; Florida; Psychiatric Specialty Clinic, Shands Hospital at the University of Florida, Gainesville, Florida, 32608, United


States; Recruiting; University of Florida Behavioral Health Mandarin Clinic, Jacksonville, Florida, 32257, United States; Recruiting. Study chairs or principal investigators: Wayne Goodman, MD, Principal Investigator Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00000373;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Randomized Study of Pergolide in Children with Tourette Syndrome Condition(s): Tourette Syndrome Study Status: This study is no longer recruiting patients. Sponsor(s): National Institute of Mental Health (NIMH); FDA Office of Orphan Products Development; Medical University of South Carolina Purpose - Excerpt: Objectives: I. Evaluate the presumed mechanism of action of low dose pergolide to act acutely through the dopaminergic autoreceptor or postsynaptically at D2 sites in children 7 to 17 with tourette syndrome (GTS). II. Compare tolerability and safety of pergolide in these patients to standard neuroleptic therapy via naturalist assessment after 3-6 months of treatment using matched historical controls on neuroleptics. III. Determine efficacy of pergolide for tic control in these patients. Study Type: Interventional Contact(s): Floyd R. Sallee 513-636-4414. Study chairs or principal investigators: Floyd R. Sallee, Study Chair; Medical University of South Carolina Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004433;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F

·

Phase II Double Blind Placebo Controlled Trial of Risperidone in Tourette Syndrome Condition(s): Tourette Syndrome Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); Yale University Purpose - Excerpt: Objectives: I. Conduct a randomized, double blind, placebo controlled, parallel study of the atypical neuroleptic risperidone (RIS) in the treatment of children and adults with moderate to severe Tourette Syndrome. II. Evaluate further the safety of RIS in this population.

Clinical Trials 57

Phase(s): Phase II Study Type: Interventional Contact(s): Bradley S. Peterson 203-785-2511. Study chairs or principal investigators: Bradley S. Peterson, Study Chair; Yale University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004393;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F ·

Phase II Pilot Controlled Study of Short vs Longer Term Pimozide (Orap) Therapy in Tourette Syndrome Condition(s): Tourette Syndrome Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); University of Rochester Purpose - Excerpt: Objectives: I. Determine whether the time period between randomization and endpoint is longer in the short term pimozide therapy or longer term therapy in patients with Tourette syndrome. II. Determine whether tic severity, medication side effects, academic performance and psychosocial functioning are better in the short term pimozide therapy or longer term pimozide therapy. Phase(s): Phase II Study Type: Interventional Contact(s):. Study chairs or principal investigators: Roger Kurlan, Study Chair; University of Rochester Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004652;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F

·

Phase III Randomized, Double-Blind, Placebo-Controlled Study of Guanfacine for Tourette Syndrome and Attention Deficit Hyperactivity Disorder Condition(s): Tourette Syndrome Study Status: This study is completed. Sponsor(s): National Center for Research Resources (NCRR); Yale University Purpose - Excerpt: Objectives: I. Evaluate the safety and efficacy of the alpha-2 adrenergic agonist guanfacine in children and adolescents with


Tourette syndrome or other chronic tic disorder, and attention deficit hyperactivity disorder. Phase(s): Phase III Study Type: Interventional Contact(s): Lawrence Scahill 203-785-5880. Study chairs or principal investigators: Lawrence Scahill, Study Chair; Yale University Web Site: http://clinicaltrials.gov/ct/gui/show/NCT00004376;jsessionid=FCDDC 54F45C935B09FE2FCAB6886E91F

Benefits and Risks16 What Are the Benefits of Participating in a Clinical Trial? If you are considering a clinical trial, it is important to realize that your child’s participation can bring many benefits: ·

A new treatment could be more effective than the current treatment for Tourette syndrome. Although only half of the participants in a clinical trial receive the experimental treatment, if the new treatment is proved to be more effective and safer than the current treatment, then those patients who did not receive the new treatment during the clinical trial may be among the first to benefit from it when the study is over.

·

If the treatment is effective, then it may improve your child’s health.

·

Clinical trial patients receive the highest quality of medical care. Experts watch them closely during the study and may continue to follow them after the study is over.

·

People who take part in trials contribute to scientific discoveries that may help others with Tourette syndrome. In cases where certain medical conditions run in families, your child’s participation may lead to better care or prevention for you and other family members.

This section has been adapted from ClinicalTrials.gov, a service of the National Institutes of Health: http://www.clinicaltrials.gov/ct/gui/c/a1r/info/whatis?JServSessionIdzone_ct=9jmun6f2 91. 16

Clinical Trials 59

The Informed Consent Once you agree to have your child take part in a clinical trial, you will be asked to sign an “informed consent.” This document explains a clinical trial’s risks and benefits, the researcher’s expectations of you and your child, and your child’s rights as a patient.

What Are the Risks? Clinical trials may involve risks as well as benefits. Whether or not a new treatment will work cannot be known ahead of time. There is always a chance that a new treatment may not work better than a standard treatment. There is also the possibility that it may be harmful. The treatment your child receives may cause side effects that are serious enough to require medical attention.

How Is Your Child’s Safety Protected? Clinical trials can raise fears of the unknown. Understanding the safeguards that protect your child can ease some of these fears. Before a clinical trial begins, researchers must get approval from their hospital’s Institutional Review Board (IRB), an advisory group that makes sure a clinical trial is designed to protect your child’s safety. During a clinical trial, doctors will closely watch your child to see if the treatment is working and if he or she is experiencing any side effects. All the results are carefully recorded and reviewed. In many cases, experts from the Data and Safety Monitoring Committee carefully monitor each clinical trial and can recommend that a study be stopped at any time. Your child will only be asked to participate in a clinical trial as a volunteer with your informed consent. What Are Your Child’s Rights in a Clinical Trial? If your child is eligible for a clinical trial, you will be given information to help you decide whether or not you want him or her to participate. You and your child have the right to: ·

Information on all known risks and benefits of the treatments in the study.

·

Know how the researchers plan to carry out the study, for how long, and where.


·

Know what is expected of your child.

·

Know any costs involved for you or your child’s insurance provider.

·

Know before any of your child’s medical or personal information is shared with other researchers involved in the clinical trial.

·

Talk openly with doctors and ask any questions.

After your child joins a clinical trial, you and your child have the right to: ·

Leave the study at any time. Participation is strictly voluntary.

·

Receive any new information about the new treatment.

·

Continue to ask questions and get answers.

·

Maintain your child’s privacy. Your child’s name will not appear in any reports based on the study.

·

Know whether your child participated in the treatment group or the control group (once the study has been completed).

What about Costs? In some clinical trials, the research facility pays for treatment costs and other associated expenses. You or your child’s insurance provider may have to pay for costs that are considered standard care. These things may include inpatient hospital care, laboratory and other tests, and medical procedures. You also may need to pay for travel between your home and the clinic. You should find out about costs before committing your child to participation in the trial. If your child has health insurance, find out exactly what it will cover. If your child does not have health insurance, or if your child’s insurance policy will not cover care, talk to the clinic staff about other options for covering the costs. What Questions Should You Ask before Your Child Participates in a Clinical Trial? Questions you should ask when deciding whether or not to enroll your child in a clinical trial include the following: ·

What is the purpose of the clinical trial?

·

What are the standard treatments for Tourette syndrome? Why do researchers think the new treatment may be better? What is likely to happen to my child with or without the new treatment?

Clinical Trials 61

·

What tests and treatments will my child need? Will my child need surgery? Medication? Hospitalization?

·

How long will the treatment last? How often will my child have to come back for follow-up exams?

·

What are the treatment’s possible benefits to my child’s condition? What are the short- and long-term risks? What are the possible side effects?

·

Will the treatment be uncomfortable? Will it make my child sick? If so, for how long?

·

How will my child’s health be monitored?

·

Where will my child need to go for the clinical trial?

·

How much will it cost to participate in the study? What costs are covered by the study? How much will my child’s health insurance cover?

·

Who will be in charge of my child’s care?

·

Will taking part in the study affect my child’s daily life?

·

How does my child feel about taking part in a clinical trial? Will other family members benefit from my child’s contributions to new medical knowledge?

Keeping Current on Clinical Trials Various government agencies maintain databases on trials. The U.S. National Institutes of Health, through the National Library of Medicine, has developed ClinicalTrials.gov to provide the public and physicians with current information about clinical research across the broadest number of medical conditions. The site was launched in February 2000 and currently contains approximately 5,700 clinical studies in over 59,000 locations worldwide, with most studies being conducted in the United States. ClinicalTrials.gov receives about 2 million hits per month and hosts approximately 5,400 visitors daily. To access this database, simply go to their Web site (www.clinicaltrials.gov) and search by “Tourette syndrome” (or synonyms).


While ClinicalTrials.gov is the most comprehensive listing of NIH-supported clinical trials available, not all trials are in the database. The database is updated regularly, so clinical trials are continually being added. The following is a list of specialty databases affiliated with the National Institutes of Health that offer additional information on trials: ·

For clinical studies at the Warren Grant Magnuson Clinical Center located in Bethesda, Maryland, visit their Web site: http://clinicalstudies.info.nih.gov/

·

For clinical studies conducted at the Bayview Campus in Baltimore, Maryland, visit their Web site: http://www.jhbmc.jhu.edu/studies/index.html

·

For trials on neurological disorders and stroke, visit and search the Web site sponsored by the National Institute of Neurological Disorders and Stroke of the NIH: http://www.ninds.nih.gov/funding/funding_opportunities.htm#Clinica l_Trials

General References The following references describe clinical trials and experimental medical research. They have been selected to ensure that they are likely to be available from your local or online bookseller or university medical library. These references are usually written for healthcare professionals, so you may consider consulting with a librarian or bookseller who might recommend a particular reference. The following includes some of the most readily available references (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

A Guide to Patient Recruitment : Today’s Best Practices & Proven Strategies by Diana L. Anderson; Paperback - 350 pages (2001), CenterWatch, Inc.; ISBN: 1930624115; http://www.amazon.com/exec/obidos/ASIN/1930624115/icongroupinterna

·

A Step-By-Step Guide to Clinical Trials by Marilyn Mulay, R.N., M.S., OCN; Spiral-bound - 143 pages Spiral edition (2001), Jones & Bartlett Pub; ISBN: 0763715697; http://www.amazon.com/exec/obidos/ASIN/0763715697/icongroupinterna

·

The CenterWatch Directory of Drugs in Clinical Trials by CenterWatch; Paperback - 656 pages (2000), CenterWatch, Inc.; ISBN: 0967302935; http://www.amazon.com/exec/obidos/ASIN/0967302935/icongroupinterna

·

The Complete Guide to Informed Consent in Clinical Trials by Terry Hartnett (Editor); Paperback - 164 pages (2000), PharmSource Information

Clinical Trials 63

Services, Inc.; ISBN: 0970153309; http://www.amazon.com/exec/obidos/ASIN/0970153309/icongroupinterna ·

Dictionary for Clinical Trials by Simon Day; Paperback - 228 pages (1999), John Wiley & Sons; ISBN: 0471985961; http://www.amazon.com/exec/obidos/ASIN/0471985961/icongroupinterna

·

Extending Medicare Reimbursement in Clinical Trials by Institute of Medicine Staff (Editor), et al; Paperback 1st edition (2000), National Academy Press; ISBN: 0309068886; http://www.amazon.com/exec/obidos/ASIN/0309068886/icongroupinterna

·

Handbook of Clinical Trials by Marcus Flather (Editor); Paperback (2001), Remedica Pub Ltd; ISBN: 1901346293; http://www.amazon.com/exec/obidos/ASIN/1901346293/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Abdominal: Pertaining to the abdomen. [EU] Abrupt: Sudden and unexpected. [EU] Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Anorexia: Lack or loss of the appetite for food. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language,


abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Guanfacine: A centrally acting antihypertensive agent. The drug lowers both systolic and diastolic blood pressure by activating the central nervous system alpha-2 adrenoreceptors, which results in reduced sympathetic outflow leading to reduced vascular tone. Its adverse reactions include dry mouth, sedation, and constipation. [NIH] Intravenous: Within a vein or veins. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and the pelvis. [EU] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Pergolide: A long-acting dopamine agonist which is effective in the treatment of Parkinson's disease and hyperprolactinemia. It has also been observed to have antihypertensive effects. [NIH]

Clinical Trials 65

Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH] Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]

67

PART II: ADDITIONAL RESOURCES AND ADVANCED MATERIAL

ABOUT PART II In Part II, we introduce you to additional resources and advanced research on Tourette syndrome. All too often, parents who conduct their own research are overwhelmed by the difficulty in finding and organizing information. The purpose of the following chapters is to provide you an organized and structured format to help you find additional information resources on Tourette syndrome. In Part II, as in Part I, our objective is not to interpret the latest advances on Tourette syndrome or render an opinion. Rather, our goal is to give you access to original research and to increase your awareness of sources you may not have already considered. In this way, you will come across the advanced materials often referred to in pamphlets, books, or other general works. Once again, some of this material is technical in nature, so consultation with a professional familiar with Tourette syndrome is suggested.

Studies 69

CHAPTER 4. STUDIES ON TOURETTE SYNDROME Overview Every year, academic studies are published on Tourette syndrome or related conditions. Broadly speaking, there are two types of studies. The first are peer reviewed. Generally, the content of these studies has been reviewed by scientists or physicians. Peer-reviewed studies are typically published in scientific journals and are usually available at medical libraries. The second type of studies is non-peer reviewed. These works include summary articles that do not use or report scientific results. These often appear in the popular press, newsletters, or similar periodicals. In this chapter, we will show you how to locate peer-reviewed references and studies on Tourette syndrome. We will begin by discussing research that has been summarized and is free to view by the public via the Internet. We then show you how to generate a bibliography on Tourette syndrome and teach you how to keep current on new studies as they are published or undertaken by the scientific community.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and Tourette syndrome, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the


format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type in “Tourette syndrome” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is a sample of what you can expect from this type of search: ·

Recognition and Management of Tourette's Syndrome and Tic Disorders Source: American Family Physician. 59(8): 2263-2272. April 15, 1999. Summary: This article reviews the recognition and management of Tourette's syndrome and tic disorders, conditions that primary care physicians are likely to encounter. Up to 20 percent of children have at least a transient tic disorder at some point. Once believed to be rare, Tourette's syndrome is now known to be a more common disorder that represents the most complex and severe manifestation of the spectrum of tic disorders. Tourette's syndrome is characterized by both motor and vocal tics, with onset in childhood. Tourette's syndrome is a chronic familial disorder with a fluctuating course; the long term outcome is generally favorable. Although the exact underlying pathology has yet to be determined, evidence indicates a disorder localized to the frontal subcortical neural pathways. Tourette's syndrome is commonly associated with attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder, behavior problems, and learning disabilities. These comorbid conditions make the management of Tourette's syndrome more challenging. Management of Tourette's syndrome should include timely and accurate diagnosis, education, and behavior or pharmacologic interventions. The use of neuroleptic medications and dopamine D2 antagonist drugs can be effective, but may be associated with significant side effects. 3 figures. 5 tables. 32 references.

·

Adoptees from Overseas: Post-Institutionalized Children Present with Host of Communication Disorders Source: ADVANCE for Speech-Language Pathologists and Audiologists. 9(6): 12-13. February 8, 1999. Contact: Available from Merion Publications, Inc. 650 Park Avenue, Box 61556, King of Prussia, PA 19406-0956. (800) 355-5627, ext. 279. E-mail: [email protected]. Website: www.advanceweb.com.

Studies 71

Summary: Diagnosing specific communication disorders in children adopted from institutions in Eastern Europe and the former Soviet Union is a complex process. This article addresses this issue, noting that many of these children present with a host of deficits, ranging from developmental delays and psychological disturbances to medical problems. Even very young children adopted from institutions tend to have some language problems and delays, as children develop receptive communication capabilities long before they express themselves by speaking. The author discusses the role of early intervention, the role of the native language, diagnostic strategies, the presence of attention deficit hyperactivity disorder, the impact of institutional life on language development, and the presence of certain disorders including Tourette syndrome, fetal alcohol syndrome, and traumatic brain injury (TBI). The article concludes with the contact information for the clinician interviewed, as well as the address and telephone number of the Parent Network for the Post Institutionalized Child.

Federally-Funded Research on Tourette Syndrome The U.S. Government supports a variety of research studies relating to Tourette syndrome and associated conditions. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.17 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally-funded biomedical research projects conducted at universities, hospitals, and other institutions. Visit the CRISP Web site at http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket. You can perform targeted searches by various criteria including geography, date, as well as topics related to Tourette syndrome and related conditions. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally-funded studies use animals or simulated models to explore Tourette syndrome and related conditions. In some cases, therefore, it may be difficult to understand how some basic or fundamental research could eventually translate into medical practice. The following sample is typical of

17 Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).


the type of information found when searching the CRISP database for Tourette syndrome: ·

Project Title: Parent Training for Children with Tourette Syndrome Principal Investigator & Institution: Scahill, Lawrence D.; Associate Professor; None; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2001; Project Start 1-MAY-2001; Project End 0-APR2003 Summary: This proposal requests funding to conduct a two-year pilot study on the effectiveness of Parent Management Training (PMT) in 32 children with Tourette syndrome and explosive, noncompliant behavior. Although Tourette syndrome (TS) is defined by chronic motor and phonic tics, clinically-identified children with TS often have comorbid obsessive-- compulsive symptoms (OCS), Attention Deficit Hyperactivity Disorder (ADHD) and/or noncompliant behavior. Parents describe these more complex cases as stubborn, irritable, argumentative, emotionally brittle, easily frustrated and prone to tantrums. Whether these problems are part of TS, secondary to TS or an unrelated comorbid behavioral profile is unknown. For children with this behavior profile, however, the care- taking demands can be extraordinary. Because the tics of TS are involuntary, parents may question the child's capacity to control this noncompliant and explosive behavior. This uncertainty threatens parental competence and may lead to inconsistent and insufficient parental control. The purpose of this PMT program is to improve the explosive and noncompliant behavior in children with TS by enhancing parental management of the disruptive and explosive behavior. PMT has been successfully applied to children with disruptive behavior problems in ADHD, but has not been applied to children with TS. The study will be conducted at the Yale Child Study Center in collaboration with the Tic Disorder Clinic, the ongoing Program Project in Tourette syndrome (P01MH49351) and the Research Unit in Pediatric Psychopharmacology (N01MH7009). Three successive waves of children and their families (10 to 12 per wave) will be recruited and then randomly assigned to the 12session PMT program developed by Barkley and colleagues (1997) or twelve weeks of standard treatment in the clinic. The primary outcome measures will include Oppositional Defiant Scale and the Clinician's Global Improvement score assessed at midpoint (6-week mark) and endpoint (11-week mark) by a clinician who is blind to treatment assignment. The same clinician will evaluate the durability of PMT in this population at six weeks and twelve weeks posttreatment. Children who were randomly assigned to standard treatment will be invited to participate in the PMT program and will also be independently assessed

Studies 73

at six and twelve weeks. This design will permit two sets of analysis: short-term efficacy (change from baseline in randomly assigned groups after the 11-session intervention); durability of PMT (evidence of sustained benefit up to 12 weeks post-treatment). Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Population Genetic Mapping of Tourette Syndrome Principal Investigator & Institution: Freimer, Nelson B.; Professor and Director; Langley Porter Psychiat Inst; University of California San Francisco 500 Parnassus Ave San Francisco, Ca 94122 Timing: Fiscal Year 2000; Project Start 0-APR-1998; Project End 1-AUG2000 Summary: (Adapted from investigator's abstract): This is a proposal to identify the chromosomal location of genes responsible for Tourette Syndrome (TS), an inherited disorder characterized by motor and vocal tics. They plan studies of two genetically homogeneous populations that have expanded rapidly over the past few hundred years: that of the Central Valley of Costa Rica (CR) and that of Ashkenazi Jews in the United States. TS patients in these populations may have inherited a susceptibility to this disorder from one or a few common ancestors. TS genes will be mapped by searching for genomic regions that TS patients share identical by descent (IBD) from such ancestors; these regions will include the TS genes, and may differ between the two populations. They will search for IBD regions by randomly sampling only affected individuals and their parents from these isolated populations. The study sample will consist of individuals moderately to severely affected with TS, about 100 from CR and about 200 Ashkenazim. Diagnostic assessment will include interviews of patients and family members and review of medical records; final diagnoses will be assigned through a 'best estimate' consensus process conducted by experts in diagnosing TS. Genealogies will be obtained for all subjects, who will be included in the study only if most of their ancestors were from the target populations. The samples will be genotyped using markers distributed throughout the genome. Evaluation of IBD in each genome region will be accomplished using association tests. Their computer simulation power studies show a high probability of detecting TS loci in each study population, even if TS is etiologically heterogeneous within each population. Once TS genes are localized, fine-mapping studies will begin, leading to positional cloning efforts. Also, clinical questions relevant to understanding the cause and course of TS will be addressed using the patients sampled for the PGM studies. They have completed preliminary studies to show the feasibility of the sampling, diagnostic, and genotyping approaches described in this


proposal. The sampling will be facilitated by ongoing collaborations in CR and new collaborations with several TS centers in the U.S. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Clonidine in ADHD Principal Investigator & Institution: Sallee, Floyd R.; Professor; Children's Hospital Med Ctr (Cincinnati) 3333 Burnet Ave Cincinnati, Oh 45229 Timing: Fiscal Year 2000; Project Start 8-AUG-2000; Project End 1-JUL2004 Summary: Attention Deficit, Hyperactivity disorder (ADHD) is a common mental health disorder of significant morbidity for which approximately 100,000 children yearly are treated with clonidine (CLON) in the US, either as an alternative to psychostimulants, or as combination therapy. Adequate ADHD efficacy and safety data are lacking and CLON is not FDA approved for ADHD. Rationales for combination with methylphenidate (MPH) are that it may be synergistic, may extend the stimulant effect, and/or that CLON may address certain core symptoms not treated by stimulants alone. No data support these rationales, yet the combination is increasingly being prescribed despite reports of serious adverse events linked to combination therapy. CLON has yet to be comprehensively studied in primary ADHD, but an NINDS sponsored evaluation of the safety and efficacy of CLON alone and in combination with MPH is currently being conducted in children with Tourette Syndrome with comorbid ADHD (TACT). TACT subjects however may be predominantly "inattentive" subtype, in contrast to combined type, most commonly seen in primary ADHD. TACT data also cannot be extrapolated to primary ADHD because treatment with CLON in TACT is dually targeted to the treatment of both tics and ADHD such that dosing interval and potentially safety findings (if adverse events are dose related) may not be readily applied to primary ADHD. Efficacy and safety data from TACT therefore may be inadequate for primary ADHD treatment, for which the majority of CLON is prescribed. The clinical trial machinery and expertise of the TACT team however is uniquely positioned to study CLON in primary ADHD. Advantages would be: 1) reduced cost by using TACT existing infrastructure; 2) an opportunity to pool safety data across studies such that low frequency adverse events may be detected; 3) to compare therapeutic outcomes in primary ADHD to ADHD with comorbid Tourette Syndrome to determine if CLON has differential effects in "inattentive subtype" versus "hyperactive/impulsive" or combined subtypes; and 4) to determine if chronic treatment with MPH can contribute to the development of tic disorder. We propose a multicenter, controlled study of CLON, MPH,

Studies 75

and CLON plus MPH for children with primary ADHD. The study will A) determine the safety and efficacy of CLON for the treatment of ADHD in children; B) evaluate the safety and efficacy of combined CLON+MPH for treatment of ADHD compared to standard MPH therapy; C) provide a lyr extension for all subjects to follow-up tic development during course of the study. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Developmental Phenomenology of OCD and Tourette's Syndrome in Children Principal Investigator & Institution: Leckman, James F.; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2000 Summary: The phenomenology and natural history of obsessive compulsive disorder (OCD) and Tourette syndrome (TS) in children and adolescents is being characterized, and factors that influence the clinical course and prognosis of these disorders are being determined. This is an ongoing study. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

·

Project Title: Dopamine Synaptic Mechanisms in Tourette's Syndrome Principal Investigator & Institution: Albin, Roger L.; Associate Professor; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2001; Project Start 1-DEC-1979; Project End 1-JUL2006 Summary: Tourette syndrome (TS) is a common neuropsychiatric disorder with onset in childhood. Some data suggests that TS is part of a spectrum ranging from tics to Obsessive-Compulsive Disorder. The clinical pharmacology of TS implicates abnormalities of dopaminergic neurotransmission, possibly involving the nigrostriatal dopaminergic projection, in the pathophysiology of TS. Our prior data indicates normal density of dorsal striatal dopaminergic innervation. We hypothesize that TS is marked by abnormal regulation of striatal dopamine neurotransmission. We will use PET methods to study striatal dopaminergic function in TS and control subjects to determine the existence of functional abnormalities in TS striatal dopaminergic synapses. We will compare binding of one striatal dopamine terminal marker, [[11C]dihydrotetrabenazine, that is not regulated by alterations in synaptic dopamine flux, with another dopamine terminal marker that is regulated by synaptic dopamine flux, [11C]methylphenidate. We will search for specific alterations in striatal dopamine synaptic physiology by


direct measurement of the stimulant releasable pool of striatal dopamine with amphetamine challenge- [11C]raclopride PET and estimates of synaptic striatal dopamine concentrations with [11C]raclopride PET after alpha-methyl-tyrosine depletion of dopamine. Discovery of an alteration in striatal dopamine synaptic physiology would lead to more mechanistic hypotheses regarding the nature of the abnormality in TS. The major alternative hypotheses is a subregional difference in dopaminergic innervation of the ventral striatum. We have preliminary data suggesting the presence of a focal abnormality of ventral striatal dopaminergic innervation in TS. We will collect additional imaging data evaluate the validity of this finding. Failure to uncover abnormalities in striatal dopamine synapse function or subregional difference sin innervation will direct attention away from the striatal dopaminergic synapse. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Frontostriatal Development and Cognitive Control Principal Investigator & Institution: Casey, Betty J.; Associate Professor; Psychiatry; Weill Medical College of Cornell Univ of Cornell University New York, Ny 10021 Timing: Fiscal Year 2001; Project Start 1-MAY-2001; Project End 0-APR2006 Summary: One key feature of cognitive and behavioral development is the gradual ability to override one behavior in favor of another or to suppress attention to irrelevant information in favor of more relevant information. The proposed studies examine the normal development of this ability and its neural basis. Behavioral paradigms will be used that parametrically manipulate the degree of interfering, irrelevant information, thereby increasing the demands for overriding an attentional or behavioral response (i.e., cognitive control). The investigators will examine the structural and functional connectivity of brain systems including the prefrontal cortex and basal ganglia, assumed to play a role in cognitive control. They propose to use the following methods to address this issue: 1) structural magnetic resonance imaging (MRI) to examine morphometric changes in relevant brain structures; 2) diffusion tensor imaging to examine the extent of myelination of frontostriatal circuitry; and 3) functional MRI in conjunction with well defined cognitive paradigms to examine the functional development of neural systems involved in cognitive control. The investigators will use a cross lag design exploiting both cross-sectional and longitudinal information across the ages of 4 to 30. Further, to understand the neuromodulatory role of dopamine in this developmental process, known polymorphisms in genes that contribute to the neuromodulatory

Studies 77

effects of dopamine will be examined via gene association studies. A number of such polymorphisms have been identified that occur relatively frequently in the general population. The investigators will collect DNA samples from the cheek cells of subjects. This DNA will be typed for variation at a particular gene and then correlated with behavioral performance using simple population-based statistical tests. The method is simple, noninvasive, reliable, fast and inexpensive relative to the neuroimaging studies. They will determine if measures of genetic variation predict performance on tasks of cognitive control or relate to measures of structural and functional brain development. This work promises to have significant implications at the behavioral, biological, and ultimately at the genetic level for developmental disorders that have as a core deficit, a problem overriding or suppressing inappropriate thoughts and behaviors like Attention Deficit-Hyperactivity Disorder, Obsessive Compulsive Disorder and Tourette syndrome. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Genetic Analysis of Paroxysmal Dystonic Choreoathetosis Principal Investigator & Institution: Fink, John K.; Associate Professor; Neurology; University of Michigan at Ann Arbor Ann Arbor, Mi 48109 Timing: Fiscal Year 2000; Project Start 1-JAN-1998; Project End 1-DEC2000 Summary: (modified from the principal investigator's application): Involuntary movement disorders are a major cause of disability. The principal investigator proposes to study paroxysmal dystonic choreoathetosis (PDC), an inherited disorder characterized by attacks of involuntary movements that occur spontaneously at rest and often following caffeine or alcohol consumption. The cause of PDC is unknown and treatments are generally unsatisfactory. The overall goal of this investigation is to understand the cause and treatment of PDC. Understanding the molecular genetic cause of PDC will provide insight into PCD's pathophysiology and hopefully, into the cause and treatments of common movement disorders, including other paroxysmal dyskinesia, idiopathic dystonia, Tourette syndrome, Parkinson's disease, neurolepticinduced tardive dyskinesia and extrapyramidal cerebral palsy. Moveover, understanding the molecular basis of PDC will suggest mechanisms by which alcohol and caffeine provoke PDC attacks. This insight will advance our understanding of the complex neurophysiologic effects of alcohol and caffeine. As Preliminary Data, he reports discovery of a genetic locus for PDC on chromosome 2q33-35. The PDC locus spans 6cM. The principal investigator and his group are collaborating with Dr Thomas Bird and Dr Wendy Raskind (University of Washington, Seattle)


to analyze an unrelated PDC kindred that is also linked to this locus. Many important candidate genes are near the PDC locus including a cluster of ion channel genes. Four other paroxysmal neurologic disorders are due to mutations in ion channel genes. Since PDC is a paroxysmal, they propose that PDC is also due to an ion channel gene mutation. They propose to evaluate currently known genes on chromosome 2q33-35 and search for mutations in neurologically relevant genes that are physically mapped to the locus. As Preliminary Data, they report progress evaluating sodium hydrogen anion exchanger (AE3) gene; AE3 is completely linked with PDC. The principal investigator determined AE3's genomic organization and is now evaluating AE3 for mutations in PDC patients. Also as Preliminary Data, the principal investigator describes a nearly complete YAC contig that spans the PDC locus. He hopes to close the gaps in this contig. If he excludes known candidate genes, he will identify novel genes expressed from this contig. The proposed investigation will find the PDC gene and its mutations. Future proposals will study the physiologic consequences of this mutation. Understanding the molecular basis of PDC will help elucidate the causes of their inherited and acquired movement disorders including those listed above and provide insight into the physiology of alcohol and caffeine, which induce PDC attacks. This proposal deals exclusively with identification of the abnormal gene responsible for PDC. Previously criticized studies related to the PET scanning were removed from the present application. The Specific Aims, as related to the genetic analysis, of this application are the same as in original application, except the Aim 2, which is new and relates to the evaluation chromosome 2q33-35 Expressed Sequence Tagged Sites (ESTS). The Specific Aims, their rationale and methodology are described in a satisfactory fashion. The principal investigator has made progress since the time that first application has been submitted. He reduced the PDC gene locus from 6cM to 5cM. He excluded one candidate gene. He has made significant progress toward sequencing another candidate gene, anion exchanger (AE3) gene. AE3 gene is completely linked to the PDC locus in three of the four families and partially linked in the fourth family. AE3 gene is expressed in the brain, so its complete analysis in PDC should be important. In addition the principal investigator gained experience in isolating YACs from endogenous yeast chromosome DNA and isolated many YACs that constitute the nearly complete YAC contig spanning the PDC locus. There is no major criticism in relation to methodology and the design of the proposal. The concern relates to the fact that there are currently only four PDC available families, and it is uncertain whether more families will be identified. Therefore, only 3 years of funding is recommended in order to be able to evaluate progress.

Studies 79

Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Disorders

Molecular

Approaches

to

Childhood

Psychiatric

Principal Investigator & Institution: State, Matthew W.; Child Study Center; Yale University New Haven, Ct 06520 Timing: Fiscal Year 2002; Project Start 1-MAY-2002; Project End 0-APR2007 Summary: This application presents a career development award proposal spanning the fields of child psychiatry, molecular cytogenetics and molecular genetics. The near-term objective of this submission is to develop an independent program in patient-oriented research that focuses on identifying genes that contribute to serious psychiatric disorders. The ultimate aim of the applicant is to contribute to the translation of advances in genetics into improvements in diagnosis, treatment and prevention of childhood developmental and neuropsychiatric illnesses. After completing clinical training in adult and child psychiatry, the applicant participated in a three-year NIMH funded patient-oriented research fellowship at the Yale Child Study Center (YCSC). During this time, he simultaneously pursued an expertise in molecular genetics by enrolling in the Ph.D. program in the Department of Genetics at Yale. Dr. State was appointed Assistant Professor in the Child Study Center (Department of Child Psychiatry) in July of 2000. He currently divides his time between attending in the Tourette syndrome (TS) and Obsessive Compulsive Disorder (OCD) clinics and conducting research in the laboratory. This career award will provide vital support for his efforts to bridge clinical and basic science research. It will facilitate his continued patient-oriented research training, allow him to develop further expertise in relevant areas of molecular genetics and molecular cytogenetics, and provide the opportunity to achieve full scientific independence. The research plan presented below centers on the identification and characterization of genes that reside within a small region around a chromosomal inversion breakpoint found in a patient with a Tourette syndrome/Obsessive Compulsive Disorder (TS/OCD) phenotype. The developmental expression pattern of these genes will be assessed and the transcripts will be prioritized for further study with respect to their role in the TS/OCD spectrum of disorders. The proposal also plans for the development of a repository of cytogenetic abnormalities in well- characterized patients with TS/OCD phenotypes. The overarching objective of the award proposal, comprising both the career development and research plans, is to identify candidate genes in childhood neuropsychiatric disorders as a prelude to further


investigations within the Child Study Center and the Children's Clinical Research Center (CCRC) that will focus on the relevance of these genes for the diagnosis, treatment, and natural history of TS/OCD. To help reach his long-term career objectives, the applicant has arranged for an outstanding group of mentors and advisors to provide guidance with respect to the design and conduct of his research, assistance in mastering the organizational challenges of running a successful research program, and training in the ethical issues attending research. He has formulated a plan for additional didactics and intensive workshops that will deepen his understanding of clinical statistical methodology, population genetics, gene expression analysis, genomics, and bioinformatics. Finally, his overall career development plan is made possible by the existence at Yale of a multidisciplinary team conducting translational research into the pathogenesis and treatment of childhood neuropsychiatnc disorders including TS/OCD, as well as the availability of the Children's Clinical Research Center (CCRC) which serves as a key resource in the conduct of this ongoing research. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Monoamine and Related Regulatory Systems in Tourette's Principal Investigator & Institution: Ciliax, Brian J.; Neurology; Emory University 1380 S Oxford Rd Atlanta, Ga 30322 Timing: Fiscal Year 2000; Project Start 0-SEP-2000; Project End 1-AUG2004 Summary: (Verbatim from the Applicant's Abstract) A prominent theory of the pathophysiology of Tourette Syndrome (TS) is based on abnormal function of monoaminergic (e.g. dopaminergic, serotonergic, and noradrenergic) pathways in basal ganglia. The abnormality may lie within the neurochemistry of the "primary" monoaminergic systems themselves or that of "secondary" systems (e.g.) gonadal steroid receptors or oxytoxin and vasopressin pathways that project to basal ganglia), which regulate the basal ganglia or their monoamine afferents. Monoamines have been implicated in TS by metabolic abnormalities, increased dopamine transporter binding, and effective treatment with dopamine receptor blockers. However, gonadal steroids and their peptidergic effector systems also may be involved, since male to female ratios are disproportionate, changes in steroid hormone levels alter tic severity, and androgen antagonist were efficacious in preliminary trials. Moreover, steroid hormones and oxytocin and vasopressin pathways have distinct sex differences, have distinct ontogenic events that could account for the chldhood onet of TS, and regulate monoaminergic circuits

Studies 81

and related locomotor and limbic behaviors. The goal of this research proposal is to determine if there are neurochemical alterations in either of these primary and secondary circuits that could cause the pathophysiology of TS. The specific neurochemicals to be studied will be the plasma membrane transporters for dopamine (DAT), sertonin (SERT), and norepinephrine (NET), and the vesicular monoamine transporter (VMAT2), gonadal steroid receptors (androgen (AR) and estrogen (ER)), and receptors for oxytocin (OT-R), and vasopressin (V1a). The specific techniques to be used include immunocytoghemistry quantitative immunoautoradiography, quantitative immunoautoradiography, quantitative counting methods, and quantitative radioligand binding autoradiography in postmortem TS brain tissue. Our transporter analysis will focus on the respective monoaminergic neurons in brainstem and their terminal fields in basal ganaglia, whereas the steroid receptor and neuropeptide receptor analyses will focus on parvocellular oxytocin and vasopressin neurons in paraventricular nucleus of hypothalamus and bed nucleus of stria terminalis/medial amygdala complex, and their terminal fields in brainstem monoamine cell groups and basal ganglia. The findings of this study will help elucidate the neurochemical changes that occur in TS and might suggest novel therapeutic strategies. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Neurobiology of Disease in Children Conferences Principal Investigator & Institution: Maria, Bernard L.; Pediatrics; University of Florida Gainesville, Fl 32611 Timing: Fiscal Year 2001; Project Start 5-APR-2001; Project End 1-AUG2001 Summary: This grant application describes for symposia titled "Neurobiology of Disease in Children", to be held in conjunction with the 2001 to 2005 annual Child Neurology Society (CNS) meetings. Each of the conditions selected as symposia topics- leukodystrophy, tuberous sclerosis complex, neurofibromatosis, Rett syndrome, and Tourette syndrome- are significant to the child neurology community. The symposia directors are Dr. Hugo Moser (leukodystrophy) Dr. Steven Roach (tuberous sclerosis complex), Dr. Bruce Korf (neurofibromatosis), Dr. Alan Percy (Rett syndrome), and Dr. Harvey Singer (Tourette syndrome). CNS members will constitute the largest segment of the projected 100 to 150 attendees. The symposia will bring together clinicians, scientists, caregivers, and National Institutes of Health (NIH) program officers to determine how research findings can be translated to enhance clinical understanding and affect clinical practice. Moreover, symposia attendees will identify the clinical and basic research needed to


advance diagnostic accuracy and develop safe and effective therapies for these disorders. In 1998, the NIH funded a symposium on Joubert syndrome held as a satellite meeting of the annual CNS conference that will serve as a model for the proposed scientific sessions. The overall aims are (1) to review scientific advances and determine their relevance to current and future clinical practice in child neurology; (2) to coordinate efforts among various clinical and basic science disciplines lay organizations, and NIH to review current research initiatives and define future directions; and (3) to disseminate symposia proceedings to ensure that clinical and basic science disciplines are informed about scientific advances, current research initiatives, and future directions. We believe the "Neurobiology of Disease in Children" symposia will contribute to advancing the field of child neurology by facilitating the exchange of information and coordination of research efforts across disciplines and organizations. The project will help further develop a symposium model that may be applied to a broader range of conditions that affect the child's nervous system. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: The Role of Norepinephrine in Hyperactivity Disorders Principal Investigator & Institution: Bruno, Kristy J.; Neuroscience and Anatomy; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2001; Project Start 5-AUG-2001 Summary: (provided by applicant): Hyperactivity is associated with several human neurological disorders, such as attention deficit hyperactivity disorder (ADHD) and Tourette syndrome (TS). The coloboma mouse represents a model of spontaneous hyperactivity. Coloboma mice have a heterozygous, semidominant deletion mutation on mouse chromosome 2 that spans the Snap gene and causes a 50% reduction in SNAP-25 (synaptosomal-associated protein). SNAP-25 is a presynaptic docking protein that regulates exocytotic neurotransmitter release. Therefore, it is likely that presynaptic mechanisms are responsible for the hyperactivity of coloboma mice. In fact, presynaptic dopamine (DA) regulation is thought to play a major role in hyperactivity disorders. Dopaminergic abnormalities in patients who have such disorders have been studied intensively for several decades. However, it is becoming increasingly clear that norepinephrine (NE) also plays a role. The majority of drugs efficacious in the treatment of ADHD modify both DA and NE neurotransmission. Indeed, administration of clonidine, an a2-adrenergic receptor agonist that inhibits NE release, ameliorates symptoms in some ADHD and TS patients. Studies of

Studies 83

coloboma mice also implicate NE in hyperactive behavior. Coloboma mice have high levels of NE in the striatum and nucleus accumbens, brain regions implicated in movement and attention, respectively. Destruction of noradrenergic terminals with neurotoxin DSP-4 decreases locomotor activity of coloboma mice. Thus, coloboma mice may be extremely useful for determining the role of NE in the regulation of hyperactivity. We hypothesize that aberrant neurotransmission of NE contributes to the hyperactivity of these mice. The specific aims of this proposal are 1) to determine if noradrenergic challenge will ameliorate the coloboma phenotype, and 2) to determine the effect of drug challenge on neurotransmitter release. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: TIC: Tourette Intervention for Children Principal Investigator & Institution: Holtz, Kristen D.; Vice President of Child and Family Healt; Danya International, Inc. 8737 Colesville Rd, Ste 1200 Silver Spring, Md 20910 Timing: Fiscal Year 2001; Project Start 6-SEP-2001; Project End 1-AUG2003 Summary: In Phase I of this SBIR project, Danya International, Inc., in collaboration with a team of experts, developed a video-based intervention package to educate school-aged children about Tourette Syndrome (TS). This intervention package, entitled "You've Got A Friend," provides information, prosocial messages, and interactional strategies to foster acceptance and social integration for children with TS. Building on the success of Phase I, Phase II will include three tasks that will expand the intervention package. First, we will develop a video for older children with Tourette Syndrome. The video will be developed in collaboration with a team of teens with TS who will provide extensive input on the content, design and presentation of the video. Second, a supporting website for the intervention package will be programmed, which will contain information for teachers, parents and children with and without TS. Finally, a full-scale, nationwide empirical evaluation of the effectiveness of the intervention package will be conducted. This evaluation will explore whether or not presentation of the video intervention in the classroom of a child with TS has an impact on the social adjustment of that child, as reported through three informants: the teacher, the parent and the child himself. All of the intervention materials will also be translated, filmed, and printed in Spanish. Proposed Commercial Application: The TIC intervention package will be marketed as an educational tool to newly diagnosed children, their teachers, peers, and parents.


Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket ·

Project Title: Transmitter Release in a Model of Hyperactivity Principal Investigator & Institution: Hess, Ellen J.; Associate Professor; Neuroscience and Anatomy; Pennsylvania State Univ Hershey Med Ctr 500 University Dr Hershey, Pa 17033 Timing: Fiscal Year 2000; Project Start 1-JUN-1997; Project End 0-JUN2000 Summary: The applicant has recently identified the mouse mutant coloboma as a novel animal model of hyperactivity with locomotor activity exceeding 3 times control mice. She has demonstrated that the hyperactivity expressed by coloboma mice is the result of a deletion of the Snap gene. This gene encodes SNAP-25, a neuron-specific protein found in presynaptic nerve terminals that plays a major role in transmitter release. SNAP-25 is a component of the machinery essential for docking and holding synaptic vesicles at the presynaptic membrane in readiness for Ca2+ triggered transmitter exocytosis. Thus, it is though likely that defects in transmitter release cause by a reduction in SNAP- 25 expression results in the expression of hyperactivity. In fact, there appears to be a dopaminergic component to the hyperactivity as the applicant has also identified gross behavioral abnormalities in response to dopamimetics. It is hypothesized that abnormalities in vesicular function result in an increased concentration of cytosolic dopamine leading the unregulated nonexocytotic dopamine release ultimately expressed as hyperactivity. This proposal focuses on Ca2+ mediated transmitter release and dopaminergin function in coloboma mice to isolate the synaptic events giving rise to hyperactivity. The specific aims are: 1) To define abnormalities in vesicular neurotransmitter release. Individual release events will be recorded and drug-induced alterations in release assessed. 2) To assess the contribution of catecholaminergic neurotransmission to the generation of locomotor hyperactivity in coloboma mice. This contribution will be tested through a transgenic rescue experiment by replacing SNAP-25 in only catecholaminergic cells. 3) To identify neurochemical defects in vivo underlying hyperactivity in coloboma mice. These experiments will integrate the cellular defects identified in vitro with a functional analysis in vivo. 4) To determine the cellular mechanisms involved in hyperactivity using classical behavior pharmacology. Using drugs known to affect presynaptic dopamine terminals, including storage, synthesis and release, we will establish a direct link between dopamine terminal dysfunction and hyperactivity via this in vivo assay. The mouse mutant coloboma represents an unprecedented model in which to study the contributions of a single

Studies 85

known gene to a complex multifactorial phenotype in humans which includes disorders such as attention deficit hyperactivity disorder and Tourette syndrome. Website: http://commons.cit.nih.gov/crisp3/CRISP.Generate_Ticket

E-Journals: PubMed Central18 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).19 Access to this growing archive of e-journals is free and unrestricted.20 To search, go to http://www.pubmedcentral.nih.gov/index.html#search, and type “Tourette syndrome” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for Tourette syndrome in the PubMed Central database: ·

Haplotype of Multiple Polymorphisms Resolved by Enzymatic Amplification of Single DNA Molecules by G Ruano, KK Kidd, and JC Stephens; 1990 August 15 http://www.pubmedcentral.nih.gov/articlerender.fcgi?rendertype=abst ract&artid=54520

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine. The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to the public.21 If the publisher has a Web site that Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html. 19 With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 20 The value of PubMed Central, in addition to its role as an archive, lies the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 21 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web 18


offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with Tourette syndrome, simply go to the PubMed Web site at www.ncbi.nlm.nih.gov/pubmed. Type “Tourette syndrome” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for “Tourette syndrome” (hyperlinks lead to article summaries): ·

A behavioural intervention for Gilles de la Tourette syndrome in a severely mentally handicapped girl. Author(s): Zarkowska E, Crawley B, Locke J. Source: J Ment Defic Res. 1989 June; 33 ( Pt 3): 245-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2666670&dopt=Abstract

·

A brief behavior therapy protocol for Tourette syndrome. Author(s): Carr JE, Bailey JS. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1996 March; 27(1): 33-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8814519&dopt=Abstract

·

An evaluation of behavioral treatments for Tourette syndrome. Author(s): Peterson AL, Azrin NH. Source: Behaviour Research and Therapy. 1992 March; 30(2): 167-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1567346&dopt=Abstract

·

Cannabinoids: possible role in patho-physiology and therapy of Gilles de la Tourette syndrome. Author(s): Muller-Vahl KR, Kolbe H, Schneider U, Emrich HM. Source: Acta Psychiatrica Scandinavica. 1998 December; 98(6): 502-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9879795&dopt=Abstract

sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

Studies 87

·

Influence of treatment of Tourette syndrome with delta9tetrahydrocannabinol (delta9-THC) on neuropsychological performance. Author(s): Muller-Vahl KR, Koblenz A, Jobges M, Kolbe H, Emrich HM, Schneider U. Source: Pharmacopsychiatry. 2001 January; 34(1): 19-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11229617&dopt=Abstract

·

Relaxation therapy in Tourette syndrome: a pilot study. Author(s): Bergin A, Waranch HR, Brown J, Carson K, Singer HS. Source: Pediatric Neurology. 1998 February; 18(2): 136-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9535299&dopt=Abstract

·

Relaxation-imagery (self-hypnosis) in Tourette syndrome: experience with four children. Author(s): Kohen DP, Botts P. Source: Am J Clin Hypn. 1987 April; 29(4): 227-37. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3296729&dopt=Abstract

·

Tourette syndrome. Author(s): Carey M, Carbonari C. Source: Nurs News (Meriden). 1979 May; 52(9): 2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=286980&dopt=Abstract

·

Tourette syndrome: pieces of the puzzle. Author(s): Leckman JF, Cohen DJ, Goetz CG, Jankovic J. Source: Adv Neurol. 2001; 85: 369-90. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11530445&dopt=Abstract

·

"Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics. Author(s): Schapiro NA. Source: Pediatric Nursing. 2002 May-June; 28(3): 243-6, 249-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12087644&dopt=Abstract


·

156 cases of Gilles de la Tourette's syndrome treated by acupuncture. Author(s): Wu L, Li H, Kang L. Source: J Tradit Chin Med. 1996 September; 16(3): 211-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9389122&dopt=Abstract

·

A four-step hypnotherapy model for Gilles de la Tourette's syndrome. Author(s): Culbertson FM. Source: Am J Clin Hypn. 1989 April; 31(4): 252-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2653022&dopt=Abstract

·

A new hypnobehavioral method for the treatment of children with Tourette's disorder. Author(s): Young MH, Montano RJ. Source: Am J Clin Hypn. 1988 October; 31(2): 97-106. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3228065&dopt=Abstract

·

A simple and a complex tic (Gilles de la Tourette's syndrome): their response to EEG sensorimotor rhythm biofeedback training. Author(s): Tansey MA. Source: International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology. 1986 July; 4(2): 91-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3460976&dopt=Abstract

·

A treatment model for motor tics based on a specific tension-reduction technique. Author(s): Evers RA, van de Wetering BJ. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1994 September; 25(3): 255-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7852608&dopt=Abstract

·

Cortical evoked potentials in Gilles de la Tourette's syndrome--a single case study. Author(s): Surwillo WW.

Studies 89

Source: Psychiatry Research. 1981 February; 4(1): 31-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6938999&dopt=Abstract ·

Effects of massed practice and cue-controlled relaxation on tic frequency in Gilles de la Tourette's syndrome. Author(s): Turpin G, Powell GE. Source: Behaviour Research and Therapy. 1984; 22(2): 165-78. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6370223&dopt=Abstract

·

Gilles de la Tourette's syndrome--an overview of development and treatment of a case, using hypnotherapy, haloperidol, and psychotherapy. Author(s): Clements RO. Source: Am J Clin Hypn. 1972 January; 14(3): 167-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4526606&dopt=Abstract

·

Occurrence of tics in Asperger's syndrome and autistic disorder. Author(s): Ringman JM, Jankovic J. Source: Journal of Child Neurology. 2000 June; 15(6): 394-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10868783&dopt=Abstract

·

Pharmacological options for the treatment of Tourette's disorder. Author(s): Jimenez-Jimenez FJ, Garcia-Ruiz PJ. Source: Drugs. 2001; 61(15): 2207-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11772131&dopt=Abstract

·

Stress management and Gilles de la Tourette's syndrome. Author(s): Michultka DM, Blanchard EB, Rosenblum EL. Source: Biofeedback Self Regul. 1989 June; 14(2): 115-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2571359&dopt=Abstract

·

The treatment of tics. Author(s): Singer HS.


Source: Curr Neurol Neurosci Rep. 2001 March; 1(2): 195-202. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11898516&dopt=Abstract ·

Tics through Tourette's syndrome. Author(s): Carter JH. Source: J Neurosci Nurs. 1991 June; 23(3): 145-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1678768&dopt=Abstract

·

Tonic, phasic and cortical arousal in Gilles de la Tourette's syndrome. Author(s): Bock RD, Goldberger L. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1985 June; 48(6): 535-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3859582&dopt=Abstract

Vocabulary Builder Aberrant: Wandering or deviating from the usual or normal course. [EU] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cholinergic: Resembling acetylcholine in pharmacological stimulated by or releasing acetylcholine or a related compound. [EU]

action;

Coloboma: Congenital anomaly in which some of the structures of the eye are absent due to incomplete fusion of the fetal intraocular fissure during gestation. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cytogenetics: A branch of genetics which deals with the cytological and

Studies 91

molecular behavior of genes and chromosomes during cell division. [NIH] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Dystonia: Disordered tonicity of muscle. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely organized connective tissue located outside the central nervous system. [NIH] Gonadal: Pertaining to a gonad. [EU] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Jews: An ethnic group with certain cultural and religious traditions. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU]


Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] Molecular: Of, pertaining to, or composed of molecules: a very small mass of matter. [EU] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH]

Studies 93

Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU]

Patents 95

CHAPTER 5. PATENTS ON TOURETTE SYNDROME Overview You can learn about innovations relating to Tourette syndrome by reading recent patents and patent applications. Patents can be physical innovations (e.g. chemicals, pharmaceuticals, medical equipment) or processes (e.g. treatments or diagnostic procedures). The United States Patent and Trademark Office defines a patent as a grant of a property right to the inventor, issued by the Patent and Trademark Office.22 Patents, therefore, are intellectual property. For the United States, the term of a new patent is 20 years from the date when the patent application was filed. If the inventor wishes to receive economic benefits, it is likely that the invention will become commercially available within 20 years of the initial filing. It is important to understand, therefore, that an inventor’s patent does not indicate that a product or service is or will be commercially available. The patent implies only that the inventor has “the right to exclude others from making, using, offering for sale, or selling” the invention in the United States. While this relates to U.S. patents, similar rules govern foreign patents. In this chapter, we show you how to locate information on patents and their inventors. If you find a patent that is particularly interesting to you, contact the inventor or the assignee for further information.

22Adapted

from The U. S. Patent and Trademark Office: http://www.uspto.gov/web/offices/pac/doc/general/whatis.htm.


Patents on Tourette Syndrome By performing a patent search focusing on Tourette syndrome, you can obtain information such as the title of the invention, the names of the inventor(s), the assignee(s) or the company that owns or controls the patent, a short abstract that summarizes the patent, and a few excerpts from the description of the patent. The abstract of a patent tends to be more technical in nature, while the description is often written for the public. Full patent descriptions contain much more information than is presented here (e.g. claims, references, figures, diagrams, etc.). We will tell you how to obtain this information later in the chapter. The following is an example of the type of information that you can expect to obtain from a patent search on Tourette syndrome: ·

Method for the diagnosis of Tourette syndrome and associated disorders Inventor(s): Comings; David E. (Duarte, CA) Assignee(s): City of Hope (Duarte, CA) Patent Number: 5,260,196 Date filed: June 14, 1991 Abstract: Differences in the rate of kynurenine formation in the lysates of red blood cells of a patient suspected of having Tourette syndrome, Tourette syndrome associated disorders or Tourette spectrum disorders and of a control are used for the diagnosis of such disorders. Excerpt(s): Tourette syndrome (TS) is a common, hereditary, neurobehavioral disorder characterized by motor and vocal tics. In addition to the tics the applicant has shown that TS is associated with a wide range of other behavioral disorders in both the patients and their relatives. These include attention deficit disorder (ADD) with or without hyperactivity, autism (a trait of three sets of symptoms: (1) a profound failure to develop social relationships; (2) defective speech and language; and (3) ritualistic or compulsive behavior), obsessive-compulsive behaviors, unipolar or bipolar affective disorder, phobias, panic attacks, premenstrual syndrome (PMS), generalized anxiety disorder, pervasive developmental disorder, dyslexia, learning disabilities, dysgraphia, mental retardation, specific math disabilities, specific reading disabilities, specific spelling disabilities, borderline personality disorder, migraine headaches, exhibitionism, stuttering, delayed speech, schizophreniform disorder, schizoid disorder, drug or alcohol addiction or abuse, bulimia, compulsive eating with obesity, physical or sexual abuse of spouse or children, somatiform disorders including spastic colon, (irritable bowel

Patents 97

syndrome), chronic fatigue syndrome, sleep disturbances, sleep apnea, sudden infant death syndrome (SIDS), narcolepsy, insomnia, short temper, and temper tantrums. ... This invention includes any test that assays or determines the functional integrity of tryptophan oxygenase (tryptophan 2,3-dioxygenase, TD02 or indoleamine 2,3-dioxygenase, ID02) in relationship to Tourette syndrome and TS associated behaviors, or TS spectrum disorders, whether that test is to determine changes in the nucleotide sequence of any part of the gene, the expression of TD02-ID02 messenger RNA, the expression or activity of the TD02-ID02 protein or enzyme, or electrophoretic variants of the TD02-ID02 protein or enzyme in any tissue or bodily fluid. ... Diagnostic tests are provided for, among other things, Tourette syndrome (TS), and TS associated behaviors including chronic motor and vocal tics, attention deficit disorder (ADD) with or without hyperactivity, autism, obsessive-compulsive behaviors, depression or mania (unipolar or bipolar affective disorder) disorder, phobias, panic attacks, premenstrual syndrome (PMS), generalized anxiety disorder, pervasive developmental disorder, dyslexia, learning disabilities, mental retardation, dysgraphia, specific math disabilities, specific reading disabilities, specific spelling disabilities, borderline personality disorder, migraine headaches, exhibitionism, stuttering, delayed speech, schizophreniform disorder, schizoid disorder, drug or alcohol addiction or abuse, bulimia, compulsive eating with obesity, physical or sexual abuse of spouse or children, somatiform disorders including spastic colon, (irritable bowel syndrome), chronic fatigue syndrome, sleep disturbances, sleep apnea, sudden infant death syndrome (SIDS), narcolepsy, insomnia, short temper, and temper tantrums. Web site: http://www.delphion.com/details?pn=US05260196__

Patent Applications on Tourette Syndrome As of December 2000, U.S. patent applications are open to public viewing.23 Applications are patent requests which have yet to be granted (the process to achieve a patent can take several years).

23

This has been a common practice outside the United States prior to December 2000.


Keeping Current In order to stay informed about patents and patent applications dealing with Tourette syndrome, you can access the U.S. Patent Office archive via the Internet at no cost to you. This archive is available at the following Web address: http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” You will see two broad options: (1) Patent Grants, and (2) Patent Applications. To see a list of granted patents, perform the following steps: Under “Patent Grants,” click “Quick Search.” Then, type “Tourette syndrome” (or synonyms) into the “Term 1” box. After clicking on the search button, scroll down to see the various patents which have been granted to date on Tourette syndrome. You can also use this procedure to view pending patent applications concerning Tourette syndrome. Simply go back to http://www.uspto.gov/main/patents.htm. Under “Services,” click on “Search Patents.” Select “Quick Search” under “Patent Applications.” Then proceed with the steps listed above.

Vocabulary Builder Apnea: A transient absence of spontaneous respiration. [NIH] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Spastic: 1. of the nature of or characterized by spasms. 2. hypertonic, so that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU]

Books 99

CHAPTER 6. BOOKS ON TOURETTE SYNDROME Overview This chapter provides bibliographic book references relating to Tourette syndrome. You have many options to locate books on Tourette syndrome. The simplest method is to go to your local bookseller and inquire about titles that they have in stock or can special order for you. Some parents, however, prefer online sources (e.g. www.amazon.com and www.bn.com). In addition to online booksellers, excellent sources for book titles on Tourette syndrome include the Combined Health Information Database and the National Library of Medicine. Once you have found a title that interests you, visit your local public or medical library to see if it is available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go to http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “Tourette syndrome” (or synonyms) into the “For these words:” box. You will only receive results on books. You should check back periodically with this database which is updated every 3 months. The following is a typical result when searching for books on Tourette syndrome: ·

A-Z Reference Book of Syndromes and Inherited Disorders Source: London, England: Chapman and Hall. 1996. 394 p.


Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. Price: $42.95 plus shipping and handling. ISBN: 0412641208. Summary: This book provides a practical reference for both caregivers and those with a syndrome or inherited disorder. The author describes the disorders and problems of both children and adults, and considers the day-to-day management of conditions. The book is written in nontechnical language while still providing enough detail for medical, nursing, and midwifery professionals. The syndromes and disorders are listed alphabetically by name. Those specifically related to deafness, communication, and speech and language include achondroplasia, Alport's syndrome, Apert's syndrome, Asperger's syndrome, Batten's disease, Beckwith-Wiedeman syndrome, CHARGE syndrome, Cockayne syndrome, Cornelia de Lange syndrome, Crouzon's syndrome, Down's syndrome, Duchenne muscular dystrophy, Edward's syndrome, EhlersDanlos syndrome, Fabry disease, fetal alcohol syndrome, Fragile X syndrome, Gilles de la Tourette syndrome, Goldenhar syndrome, Hunter's syndrome, Hurler's syndrome, Klinefelter's syndrome, LEOPARD syndrome, Moebius syndrome, Morquio's syndrome, neurofibromatosis, Niemann-Pick disease, Noonan's syndrome, osteogenesis imperfecta, Pierre-Robin syndrome, Prader-Willi syndrome, Rett's syndrome, Reye's syndrome, San Filippo syndrome, SmithMagenis syndrome, Stickler syndrome, Tay-Sachs disease, Treacher Collins syndrome, Turner's syndrome, Usher's syndrome, Waardenburg's syndrome, and William's syndrome. For each syndrome, the author lists alternative names, incidence, causation (etiology), characteristics or symptoms, management implications (treatment options), prognosis, and self-help groups to contact. Most groups listed are in England. The book concludes with three appendices that provide a discussion of genetics, a listing of regional genetics centers (in England), and a glossary of terms. A subject index is also included. (AA-M). ·

Children With Tourette Syndrome: A Parents' Guide Source: Rockville, MD: Woodbine House, Inc. 1992. 350 p. Contact: Available from Woodbine House, Inc. 5615 Fishers Lane, Rockville, MD 20852. (800) 843-7323. Price: $14.95 plus shipping and handling. ISBN: 0933149441. Summary: This handbook, written for parents of children and teenagers with Tourette Syndrome, offers up-to-date, concrete information and advice for dealing with this neurological disorder. The authors offer

Books 101

families a foundation for understanding this complex disorder and for developing strategies that can help their child become a productive, happy adult. Topics covered include medical, educational, legal, family life, daily care, and emotional issues. The authors discuss treatments, including those for related conditions such as attention deficit disorder (ADD) and obsessive compulsive disorder (OCD); behavior management techniques; tips on handling the reactions of others; parent advocacy; coping with feelings of guilt and resentment; and getting help for a child at school. Coprolalia and language development are also discussed. Tables listing developmental milestones in language and other areas are included. Parent statements appear at the end of each chapter; experienced parents share feelings and practical insights that can be especially helpful to new parents. The book concludes with a detailed listing of organizations (including state-by-state resources), a reading list, a subject index, and a glossary. (AA-M). ·

Disability etiquette: Tips on interacting with people with disabilities Source: Buffalo, NY: Eastern Paralyzed Veterans Association. [1998]. 51 pp. Contact: Available from Eastern Paralyzed Veterans Association, 75-20 Astoria Boulevard, Jackson Heights, NY 11370. Telephone: (718) 803-3782 / fax: (718) 803-0414 / e-mail: [email protected] / Web site: http://www.epva.org. Available from the Web site at no charge. Summary: This illustrated booklet is for anyone-with or without a disability- who wants to interact more effectively with people with disabilities. Topics include sensitivity in offering assistance, physical contact, general conversation, and the Americans with Disabilities Act. Chapters offer tips unique to the type of disability encountered; blind/visually impaired; deaf/hard of hearing; speech disabilities; short stature; cerebral palsy; Tourette syndrome; multiple chemical sensitivity; epilepsy; HIV and AIDS; psychiatric disabilities; cognitive disabilities; and emergency evacuation procedures. Additional information is provided about print, Web, and other special resources.

Book Summaries: Online Booksellers Commercial Internet-based booksellers, such as Amazon.com and Barnes & Noble.com, offer summaries which have been supplied by each title’s publisher. Some summaries also include customer reviews. Your local bookseller may have access to in-house and commercial databases that index


all published books (e.g. Books in PrintÒ). The following have been recently listed with online booksellers as relating to Tourette syndrome (sorted alphabetically by title; follow the hyperlink to view more details at Amazon.com): ·

Tourette's Syndrome--Tics, Obsessions, Compulsions: Developmental Psychopathology and Clinical Care by James F. Leckman, Donald J. Cohen (2001); ISBN: 0471113751 http://www.amazon.com/exec/obidos/tg/detail/0471113751/icongroupinterna

·

Tourette Syndrome: The Facts by Mary M. Robertson, Simon BaronCohen (1998); ISBN: 019852398X; http://www.amazon.com/exec/obidos/tg/detail/-/019852398X/ icongroupinterna

The National Library of Medicine Book Index The National Library of Medicine at the National Institutes of Health has a massive database of books published on healthcare and biomedicine. Go to the following Internet site, http://locatorplus.gov/, and then select “Search LOCATORplus.” Once you are in the search area, simply type “Tourette syndrome” (or synonyms) into the search box, and select “books only.” From there, results can be sorted by publication date, author, or relevance. The following was recently catalogued by the National Library of Medicine:24 ·

Brain disorders sourcebook: basic consumer health information about strokes, epilepsy, amyotrophic lateral sclerosis (ALS. Author: Lou Gehrig's disease) Parkinson's disease, brain tumors, cerebral palsy, headache, Tourette syndrome, and more; along with statisti; Year: 1999; Detroit, MI: Omnigraphics, c1999; ISBN: 0780802292 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0780802292/icongroupin terna

In addition to LOCATORPlus, in collaboration with authors and publishers, the National Center for Biotechnology Information (NCBI) is adapting biomedical books for the Web. The books may be accessed in two ways: (1) by searching directly using any search term or phrase (in the same way as the bibliographic database PubMed), or (2) by following the links to PubMed abstracts. Each PubMed abstract has a “Books” button that displays a facsimile of the abstract in which some phrases are hypertext links. These phrases are also found in the books available at NCBI. Click on hyperlinked results in the list of books in which the phrase is found. Currently, the majority of the links are between the books and PubMed. In the future, more links will be created between the books and other types of information, such as gene and protein sequences and macromolecular structures. See http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books.

24

Books 103

·

Cursing brain?: the histories of Tourette syndrome. Author: Howard I. Kushner; Year: 1999; Cambridge, Mass.: Harvard University Press, 1999; ISBN: 0674180224 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0674180224/icongroupin terna

·

Gilles de la Tourette syndrome. Author: Arthur K. Shapiro ... [et al.]; Year: 1988; New York: Raven Press, c1988; ISBN: 0881673404 http://www.amazon.com/exec/obidos/ASIN/0881673404/icongroupin terna

·

Gilles de la Tourette syndrome. Author: editors, Arnold J. Friedhoff, Thomas N. Chase; Year: 1982; New York: Raven Press, c1982; ISBN: 0890047618 http://www.amazon.com/exec/obidos/ASIN/0890047618/icongroupin terna

·

Handbook of Tourette's syndrome and related tic and behavioral disorders. Author: edited by Roger Kurlan; Year: 1993; New York: M. Dekker, c1993; ISBN: 0824787870 (alk. paper) http://www.amazon.com/exec/obidos/ASIN/0824787870/icongroupin terna

·

Mind of its own: Tourette's syndrome: a story and a guide. Author: Ruth Dowling Bruun, Bertel Bruun; Year: 1994; New York: Oxford University Press, 1994; ISBN: 0195065875 (alk. paper): http://www.amazon.com/exec/obidos/ASIN/0195065875/icongroupin terna

·

Search for the Tourette syndrome and human behavior genes. Author: by David E. Comings; Year: 1996; Duarte, CA: Hope Press, c1996; ISBN: 1878267361 (hb) http://www.amazon.com/exec/obidos/ASIN/1878267361/icongroupin terna

·

Tics, Tourette syndrome and other movement disorders: a pediatrician's guide. Author: by Arthur K. Shapiro and Elaine S. Shapiro; Year: 1980; Bayside, N.Y.: Tourette Syndrome Association, c1980

·

Tourette syndrome: genetics, neurobiology, and treatment. Author: editors, Thomas N. Chase, Arnold J. Friedhoff, Donald J. Cohen; Year: 1992; New York: Raven Press, c1992; ISBN: 0881679224 http://www.amazon.com/exec/obidos/ASIN/0881679224/icongroupin terna

·

Tourette syndrome and human behavior. Author: David E. Comings; Year: 1990; Duarte, Calif.: Hope Press, c1990; ISBN: 1878267272 http://www.amazon.com/exec/obidos/ASIN/1878267272/icongroupin terna


·

Tourette syndrome. Author: editors, Donald J. Cohen, Joseph Jankovic, Christopher G. Goetz; Year: 2001; Philadelphia: Lippincott Williams ; Wilkins, c2001; ISBN: 0781724058 http://www.amazon.com/exec/obidos/ASIN/0781724058/icongroupin terna

·

Tourette syndrome. Author: Mary M. Robertson and Simon BaronCohen; Year: 1998; Oxford; New York: Oxford University Press, 1998; ISBN: 019852398X http://www.amazon.com/exec/obidos/ASIN/019852398X/icongroupi nterna

·

Tourette's and attention deficit hyperactivity disorder: toughing it out at home and at school. Author: managing editor, Joan Murphy; consulting editors, Barbara J. Golden... [et al.]; Year: 1995; [Baton Rouge, LA]: Baton Rouge Tourette's Support Group, c1995; ISBN: 0962519413 http://www.amazon.com/exec/obidos/ASIN/0962519413/icongroupin terna

·

Tourette's syndrome and tic disorders: clinical understanding and treatment. Author: edited by Donald J. Cohen, Ruth D. Bruun, James F. Leckman; Year: 1988; New York: Wiley, c1988; ISBN: 0471629243 http://www.amazon.com/exec/obidos/ASIN/0471629243/icongroupin terna

·

Tourette's syndrome--tics, obsessions, compulsions: developmental psychopathology and clinical care. Author: James F. Leckman and Donald J. Cohen; Year: 1999; New York: John Wiley ; Sons, c1999; ISBN: 0471160377 (cloth: alk. paper) http://www.amazon.com/exec/obidos/ASIN/0471160377/icongroupin terna

·

Understanding Tourette syndrome, obsessive compulsive disorder, and related problems: a developmental and catastrophe theory perspective. Author: John M. Berecz; Year: 1992; New York: Springer Pub. Co., c1992; ISBN: 082617390X http://www.amazon.com/exec/obidos/ASIN/082617390X/icongroupi nterna

·

Unwelcome companion: an insider's view of Tourette syndrome. Author: Rick Fowler; Year: 1995; Cashiers, NC: Silver Run Publications, 1995; ISBN: 0964637618 http://www.amazon.com/exec/obidos/ASIN/0964637618/icongroupin terna

Books 105

Chapters on Tourette Syndrome Frequently, Tourette syndrome will be discussed within a book, perhaps within a specific chapter. In order to find chapters that are specifically dealing with Tourette syndrome, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and Tourette syndrome using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” By making these selections and typing in “Tourette syndrome” (or synonyms) into the “For these words:” box, you will only receive results on chapters in books. The following is a typical result when searching for book chapters on Tourette syndrome: ·

Does Asperger Syndrome Aggregate in Families? Source: in Klin, A.; Volkmar, F.R.; Sparrow, S.S., eds. Asperger Syndrome. New York, NY: Guilford Press. 2000. p. 159-171. Contact: Available from Guilford Publications. 72 Spring Street, New York, NY 10012. (800) 365-7006. Fax (212) 966-6708. E-mail: [email protected]. Website: www.guilford.com. Price: $45.00 plus shipping and handling. ISBN: 1572305347. Summary: This chapter on Asperger syndrome (AS) and its clustering in families is from a comprehensive text on this autistic spectrum disorder. The authors introduce this chapter with a brief discussion of definitions and a review of the need to estimate the population prevalence of AS. The authors then review the studies that address AS from a genetic perspective and conclude by suggesting hypotheses for testing in future research. Topics include the co occurrence in families of autism, Asperger syndrome, and the broader autism phenotype; other disorders reported in AS families, including major affective disorder, selective mutism, and Tourette syndrome; possible genetic mechanisms; and genetic counseling considerations. The authors conclude that although they are scant and weak, the available data suggest that AS and autism may co segregate and may be genetically related to one another. However, well designed family studies of AS and its association with autism and other disorders are sorely needed, both to establish diagnostic boundaries and to determine which disorders co segregate and which are transmitted independently. 1 table. 38 references.


·

Voice Source: in Roeser, R.J.; Pearson, D.W.; Tobey, E.A. Speech-Language Pathology Desk Reference. New York, NY: Thieme Medical Publishers, Inc. 1998. p. 321-383. Contact: Available from Thieme Medical Publishers, Inc. 333 Seventh Avenue, New York, NY 10001. (800) 782-3488. Fax (212) 947-0108. E-mail: [email protected]. Website: www.thieme.com. Price: $45.00 plus shipping and handling. ISBN: 0865776972. Summary: This chapter on voice and voice disorders is from a reference book for speech language pathologists. The book includes twelve chapters, each consisting predominantly of charts and figures that cover the topic under consideration. Topics covered in this chapter include amyotrophic lateral sclerosis (ALS) and its impact on the voice, apraxia of speech, artificial larynges, ataxic dysarthria, breathy whispered voice, cervical dystonia, cleft lip and palate classifications, congenital disorders of the larynx, cranial nerve assessment techniques, dystonia, exhalation, fundamental and formant frequencies, Tourette syndrome, laryngoscopy, muscles used in voice, laryngeal dimensions, laryngeal anatomy and physiology, myasthenia gravis, palate and face development during embryonic and fetal stages, Parkinson's disease, voice attributes, the classification of voice disorders, terminology of voice pathology, hoarseness, the neurophysiology of the voice, voice therapy, and a voice rating scale. The book includes a series of 22 color plates, most of which depict the vocal cords. 32 figures. 37 tables.

·

Motor Clumsiness Source: in Attwood, T. Asperger's Syndrome: A Guide for Parents and Professionals. London, England: Jessica Kingsley Publishers. 1998. p. 103111. Contact: Available from Future Horizons. 721 West Abram Street, Arlington, TX 76013. (800) 489-0727. Fax (817) 277-2270. Website: www.futurehorizons-autism.com. Price: $19.95 plus shipping and handling. ISBN: 1853025771. Summary: Asperger's syndrome is characterized by a lack of social skills, limited ability to have a reciprocal conversation, and an intense interest in a particular subject. This chapter on motor clumsiness is from a book for parents and professionals written to assist in the identification and treatment of children and adults with Asperger's syndrome. The book provides a description and analysis of the unusual characteristics of the syndrome, and practical strategies to reduce those that are most conspicuous or debilitating. Included are numerous quotations from

Books 107

people with Asperger's syndrome. In this chapter, the author notes that clumsiness is not unique to Asperger's syndrome, however, research suggests that between 50 and 90 percent of children and adults with Asperger's have problems with motor coordination. The author discusses which abilities are affected and offers strategies to improve particular skills in the areas of locomotion, ball skills, balance, manual dexterity, handwriting, rapid movements, lax joints, rhythm, and imitation of movements. The author also reviews recognized disorders of movement, including Tourette syndrome, catatonia and Parkinsonian features, and cerebellar dysfunction. 1 table. ·

Neurologic Disorders Affecting the Voice in Performance Source: in Sataloff, R.T., ed. Professional Voice: The Science and Art of Clinical Care. 2nd ed. San Diego, CA: Singular Publishing Group, Inc. 1997. p. 479-498. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. Price: $325.00 plus shipping and handling. ISBN: 1565937287. Summary: This chapter, from a book on the clinical care of the professional voice, discusses neurologic disorders affecting the voice in performance. The complex functions necessary for normal voice function require coordinated interactions among multiple body systems. Neurologic dysfunction that impairs control of these interactions commonly causes voice dysfunction. The authors note that it is not unusual for voice disorders to be the presenting complaint in patients with neurologic disease. Topics include neurolaryngology, neuroanatomy and neurophysiology of phonation, neurological dysfunction and voice, vocal cord paralysis, dysarthria (imperfect articulation in speech), vocal tremor, Parkinson disease, postpolio syndrome, stuttering, myasthenia gravis, and other neurological conditions affecting voice performance, including amyotrophic lateral sclerosis, multiple sclerosis, Huntington's chorea, Gilles de la Tourette syndrome, cerebrovascular accident (stroke), quadriplegia, facial paralysis in singers and actors, headache, and dizziness. The authors conclude that familiarity with the latest concepts in neurolaryngology, clinical voice disorders, and a close working relationship between laryngologists and neurologists may optimize treatment. 5 figures. 31 references.


·

Gilles de la Tourette Syndrome Source: in Gilbert, P. A-Z Reference Book of Syndromes and Inherited Disorders. 2nd ed. London, England: Chapman and Hall. p. 134-136. Contact: Available from Singular Publishing Group, Inc. 401 West 'A' Street, Suite 325, San Diego, CA 92101-7904. (800) 521-8545 or (619) 2386777. Fax (800) 774-8398 or (619) 238-6789. E-mail: [email protected]. Website: www.singpub.com. Price: $42.95 plus shipping and handling. ISBN: 0412641208. Summary: This chapter on Gilles de la Tourette syndrome is from a practical reference book that describes inherited disorders and syndromes in both children and adults. Tourette syndrome features motor and vocal tics, obsessive behavior, and reduced attention span. Vocal tics can include coughing, sneezing, sucking, throat-clearing, sniffing, and other unusual noises. At times, the involuntary shouting of inappropriate words or phrases, including obscenities, can make life extremely difficult for parents and companions of the affected child. Topics include alternative names for the condition, incidence, history, causation, characteristics, management implications, prognosis, and selfhelp groups. Education for these children may be necessary in a small unit, where a variety of difficult behavior patterns can be contained. The chapter concludes with a list of support groups and organizations that can be found in England.

·

Student with a Genetic Disorder: Educational Implications for Special Education Teachers and for Physical Therapists, Occupational Therapists, and Speech Pathologists Source: Springfield, IL: Charles C Thomas Publisher. 1993. 380 p. Contact: Available from Charles C Thomas Publisher. 2600 South First Street, Springfield, IL 62794-9265. (212) 789-8980; Fax (217) 789-9130. Price: $75.95 plus shipping and handling (cloth); $39.95 plus shipping and handling (paper). ISBN: 0398058393. Summary: This textbook is designed to acquaint special education teachers, therapists, child development specialists, and other health professionals with general genetic concepts and the physical characteristics, learning profiles, and health and related problems of children with certain specific genetic conditions. In addition, the authors suggest educational and therapy interventions for these children in classrooms and child development programs. Eight chapters cover basic genetic principles; how genetic syndromes are inherited; the characteristics of a genetic syndrome; the child in the school, including special education laws, attitudinal barriers, adaptive equipment, and

Books 109

barrier-free schools; what to expect from therapists; and referrals for genetic counseling. The bulk of the book is presented in the final chapter, which discusses individual genetic disorders, including blood disorders; bone and joint disorders; chromosome disorders; connective tissue disorders; metabolic and exocrine disorders; multiple malformations, including Cornelia de Lange Syndrome; muscle disorders; neurologic disorders, including Neurofibromatosis and Tourette Syndrome; sensory disorders, including Usher Syndrome and Waardenburg Syndrome; skull and face deformities, including Apert Syndrome, Crouzon Syndrome, and Treacher Collins Syndrome; storage diseases; and teratogens. The text also includes a resources list, glossary, and author and subject indices. ·

Approach to the Patient Who May Have Epilepsy Source: in Handbook of Pediatric Epilepsy. Murphy, J.V.; Dehkharghani, F.; eds. New York, NY, Marcel Dekker, Inc., pp. 1-15, 1993. Contact: Marcel Dekker, Inc., 270 Madison Avenue, New York, NY 10016. Summary: Approach to the Patient Who May Have Epilepsy, a chapter in Handbook of Pediatric Epilepsy, defines a seizure as an involuntary event accompanied by a sudden, rapid, and abnormal discharge of cortical neurons, or a paroxysmal change in the recorded electroencephalogram (EEG) concurrent with the event. Epilepsy is recurrent unprovoked seizures. The diagnosis of epilepsy is made on the basis of a description of an atypical event, knowledge that the described event is characteristic of a seizure, and a history that the event is recurrent. Seizures may be preceded by an aura and followed temporarily by such postictal changes as lethargy, hemiparesis, vomiting, or headache. The state of alertness during the seizure indicates whether the seizure is generalized or partial. Recurrent events that occur in childhood that can simulate seizures include paroxysmal vertigo, breathholding spells, cardiogenic syncope, periodic behaviors in a child with an abnormal EEG, paroxysmal kinesigenic choreoathetosis, shuddering attacks, night terrors, Tourette syndrome, pseudoseizures, migraine, and rages. Differential diagnosis is made with an accurate clinical description of the event, awareness of disorders that mimic epilepsy, and, if necessary, a video-EEG. Decisions about activities for children with epilepsy should be made on an individual basis. Parents should consider the people who need to know that the child has epilepsy. Requirements for driving licenses vary by state. Anticonvulsant regimens should be limited to twice a day or less, if possible. Young adults with epilepsy should avoid excessive consumption of alcohol. Patients should be referred to a neurologist when (1) seizures are intractable to the initial


anticonvulsants, (2) there is an unusual seizure disorder with which the primary practitioner is not familiar, (3) apparent intolerance of recommended anticonvulsants, (4) continuing anxiety or concerns of the family, or (5) to obtain information about current recommendations for the duration of therapy. 1 table, 53 references. ·

Neurological Disorders Source: in Scully, C. and Cawson, R.A. Medical Problems in Dentistry. 4th ed. Woburn, MA: Butterworth-Heinemann. 1998. p. 336-373. Contact: Available from Butterworth-Heinemann. 225 Wildwood Avenue, Woburn, MA 01801-2041. (800) 366-2665 or (781) 904-2500. Fax (800) 446-6520 or (781) 933-6333. E-mail: [email protected]. Website: www.bh.com. Price: $110.00. ISBN: 0723610568. Summary: Dental staff should be able to recognize abnormalities involving the cranial nerves, especially the trigeminal, facial, glossopharyngeal, vagal and hypoglossal nerves. This chapter on neurologic disorders is from a text that covers the general medical and surgical conditions relevant to the oral health care sciences. Topics include congenital neurological disorders, including cerebral palsy (CP), neural tube defects (spina bifida), syringomyelia, Huntington's chorea, and Friedreich's ataxia; acquired neurological disorders, including the examination and lesions of the cranial nerves, facial sensory loss (facial pain is covered in a separate chapter), facial paralysis, Bell's palsy, trigeminal motor neuropathy, abnormal facial movements (dystonias, dyskinesias, facial tics, Tourette syndrome), multiple cranial nerve palsies, blindness and visual impairment, deafness and hearing impairment, Meniere's disease, autonomic dysfunction, epilepsy, syncope (fainting), raised intracranial pressure, hypoxic encephalopathy, infections of the nervous system (including HIV and syphilis), cerebrovascular accidents (stroke), Parkinson's disease, multiple sclerosis, Guillain-Barre syndrome (infective or idiopathic polyneuritis), motor neurone disease, mercury intoxication, tumors of the central nervous system (CNS), myasthenia gravis, patients with respiratory paralysis, and peripheral neuropathies. For each condition, the authors discuss general aspects, diagnosis and management issues, dental aspects, and patient care strategies. The chapter includes a summary of the points covered. 1 appendix. 4 figures. 15 tables. 52 references.

Books 111

Directories In addition to the references and resources discussed earlier in this chapter, a number of directories relating to Tourette syndrome have been published that consolidate information across various sources. These too might be useful in gaining access to additional guidance on Tourette syndrome. The Combined Health Information Database lists the following, which you may wish to consult in your local medical library:25 ·

Brain Connections: Your Source Guide to Information on Brain Diseases and Disorders. 5th ed Source: New York, NY: Dana Alliance for Brain Initiatives. 2000. 49 p. Contact: Available from Dana Press. Charles A. Dana Foundation, 745 Fifth Avenue, Suite 700, New York, NY 10151. Fax (212) 593-7623. Website: www.dana.org. Price: Single copy free. Summary: This guide lists organizations that assist people with a brainrelated disorder or disease as well as those organizations that assist caregivers and health care providers in these areas. The guide lists more than 275 organizations alphabetically by disease or disorder. Listings of particular relevance to communication disorders include: acoustic neuroma, aphasia, ataxia, attention deficit hyperactivity disorder, autism, deafness and hearing loss, disability and rehabilitation, dizziness, dyslexia, dystonia, head injury, learning disabilities, neurofibromatosis, smell and taste (chemosensory) disorders, spasmodic dysphonia, stuttering, tinnitus, Tourette syndrome, and vestibular disorders. Emphasis is placed on organizations that have a national focus, however, many of these groups sponsor local chapters or affiliates and make referrals to local medical professionals and organizations. For each organization listed, the guide notes mailing address, telephone numbers, e-mail and web sites; also provided are symbols which indicate that the organization offers support groups, referrals to doctors, referrals to other sources of information, regional chapters, availability of literature, availability of speakers, and volunteer opportunities. The guide also describes the publishing body, the Dana Alliance for Brain Initiatives,

You will need to limit your search to “Directories” and Tourette syndrome using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find directories, use the drop boxes at the bottom of the search page where “You may refine your search by”. For publication date, select “All Years”, select language and the format option “Directory”. By making these selections and typing in “Tourette syndrome” (or synonyms) into the “For these words:” box, you will only receive results on directories dealing with Tourette syndrome. You should check back periodically with this database as it is updated every three months.

25


and provides a list of ways in which readers can support and further brain research. ·

Parent Resources: Agencies, Organizations, Support Groups Source: in DeFeo, A.B., ed. Parent Articles 2. San Antonio, TX: Communication Skill Builders. 1995. p. 213-234. Contact: Available from Communication Skill Builders. Customer Service, 555 Academic Court, San Antonio, TX 78204-2498. (800) 211-8378; Fax (800) 232-1223. Price: $55.00 plus shipping and handling. Order Number 076-163-0732. Summary: This appendix section is from a parent education skill builders textbook. The appendix lists agencies, organizations, and support groups that parents might want to contact as they work with developing communication skills in and with their child. National information and advocacy groups are listed, including groups for consumer information, education, financial aid, home care, legal assistance, nonoral communication, orthotics and prosthetics, psychiatry, psychology, rare disorders, rehabilitation, residential placement, self-help, severe disabilities, sibling support, social workers, and telephone usage for persons with disabilities. Also listed are national organizations for specific disabilities and conditions, including acoustic neuroma, autism, birth defects, chronic dizziness and balance disorders, cleft palate and craniofacial disorders, developmental disabilities, Down's syndrome, dyslexia, dystonia, genetic conditions, head injuries, hearing impairments, learning disabilities, mental retardation, neurofibromatosis, neurological disorders, stuttering, Tourette syndrome, and voice disorders and laryngectomies. The address and telephone number for each organization are noted.

·

Self-Help Sourcebook: Finding and Forming Mutual Aid Self-Help Groups. 4th ed Source: Denville, NJ: American Self-Help Clearinghouse. 1992. 226 p. Contact: Available from American Self-Help Clearinghouse. Attn: Sourcebook, St. Clares-Riverside Medical Center, 25 Pocono Road, Denville, NJ 07834. Voice (201) 625-7101; TTY (201) 625-9053. Price: $9.00 book rate; $10.00 first class mail. ISBN: 0963432206. Summary: This sourcebook lists self-help groups in a wide variety of topic areas, including addictions and dependencies, bereavement, disabilities, health, mental health, parenting and family, physical and/or emotional abuse, and miscellaneous categories. Topics relevant to deafness and communication disorders include acoustic neuroma,

Books 113

alternative/augmentative communication, autism, cleft palate and cleft lip, cochlear implants, developmental disabilities, developmentally delayed children, Down syndrome, dystonia, ear anomalies, elective mutism, hearing impairment, inner ear problems, laryngectomy, latedeafened adults, learning disabilities, Meniere's disease, neck-head-oral cancer, parents of children with hearing impairment, speech dysfunction, speech impairments, stuttering, tinnitus, Tourette syndrome, and Usher's syndrome. In addition to basic information about the self-help groups, the sourcebook lists self-help clearinghouses, toll-free helplines, resources for rare disorders, resources for genetic disorders, housing and neighborhood resources and resources for the homeless, how-to ideas for developing self-help groups, and using a home computer for mutual help. The book includes a bibliography and key word index. ·

International Guide to Patient Support Organizations Source: New York, NY: Worldwide Education and Awareness for Movement Disorders (WE MOVE). 1994. 17 p. Contact: Available from Worldwide Education and Awareness for Movement Disorders (WE MOVE). Mt. Sinai Medical Center, One Gustave L. Levy Place, Box 1052, New York, NY 10029-6574. (800) 4376682, (212) 241-8567; FAX (212) 987-7363. Price: Free. Summary: This directory lists, by country, the names and addresses of non-profit organizations located throughout the world that promote awareness of the following movement disorders: ataxia, dystonia, Huntington's disease, myoclonus, multiple-system atrophy (Shy-Drager syndrome), Parkinson's disease, progressive supranuclear palsy, restless legs syndrome, Rett syndrome, spasticity, tardive dyskinesia, tics or Tourette syndrome, tremor, and Wilson's disease. A cross-reference by country also is included.

General Home References In addition to references for Tourette syndrome, you may want a general home medical guide that spans all aspects of home healthcare. The following list is a recent sample of such guides (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Adams & Victor’s Principles Of Neurology by Maurice Victor, et al; Hardcover - 1692 pages; 7th edition (December 19, 2000), McGraw-Hill


Professional Publishing; ISBN: 0070674973; http://www.amazon.com/exec/obidos/ASIN/0070674973/icongroupinterna · American Academy of Pediatrics Guide to Your Child’s Symptoms : The Official, Complete Home Reference, Birth Through Adolescence by Donald Schiff (Editor), et al; Paperback - 256 pages (January 1997), Villard Books; ISBN: 0375752579; http://www.amazon.com/exec/obidos/ASIN/0375752579/icongroupinterna · The Children’s Hospital Guide to Your Child’s Health and Development by Alan D. Woolf (Editor), et al; Hardcover - 796 pages, 1st edition (January 15, 2001), Perseus Books; ISBN: 073820241X; http://www.amazon.com/exec/obidos/ASIN/073820241X/icongroupinterna

· Clinical Neuroanatomy Made Ridiculously Simple (MedMaster Series, 2000 Edition) by Stephen Goldberg; Paperback: 97 pages; 2nd edition (February 15, 2000), Medmaster; ISBN: 0940780461; http://www.amazon.com/exec/obidos/ASIN/0940780461/icongroupinterna · Helping Your Child in the Hospital: A Practical Guide for Parents by Nancy Keene, Rachel Prentice; Paperback - 176 pages, 3rd edition (April 15, 2002), O’Reilly & Associates; ISBN: 0596500114; http://www.amazon.com/exec/obidos/ASIN/0596500114/icongroupinterna · It’s Not a Tumor!: The Patient’s Guide to Common Neurological Problems by Robert Wiedemeyer; Paperback: (January 1996), Boxweed Pub; ISBN: 0964740796; http://www.amazon.com/exec/obidos/ASIN/0964740796/icongroupinterna · Medical Emergencies & Childhood Illnesses: Includes Your Child’s Personal Health Journal (Parent Smart) by Penny A. Shore, William Sears (Contributor); Paperback - 115 pages (February 2002), Parent Kit Corporation; ISBN: 1896833187; http://www.amazon.com/exec/obidos/ASIN/1896833187/icongroupinterna · Neurology for the Non-Neurologist by William J. Weiner (Editor), Christopher G. Goetz (Editor); Paperback (May 1999), Lippincott, Williams & Wilkins Publishers; ISBN: 0781717078; http://www.amazon.com/exec/obidos/ASIN/0781717078/icongroupinterna · Taking Care of Your Child: A Parent’s Guide to Complete Medical Care by Robert H. Pantell, M.D., et al; Paperback - 524 pages, 6th edition (March 5, 2002), Perseus Press; ISBN: 0738206016; http://www.amazon.com/exec/obidos/ASIN/0738206016/icongroupinterna

Books 115

Vocabulary Builder Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Aphasia: Defect or loss of the power of expression by speech, writing, or signs, or of comprehending spoken or written language, due to injury or disease of the brain centres. [EU] Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]

Aura: A subjective sensation or motor phenomenon that precedes and marks the of a paroxysmal attack, such as an epileptic attack on set. [EU] Autonomic: Self-controlling; functionally independent. [EU] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Cardiogenic: Originating in the heart; caused by abnormal function of the heart. [EU] Cerebellar: Pertaining to the cerebellum. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chorea: The ceaseless occurrence of a wide variety of rapid, highly complex, jerky movements that appear to be well coordinated but are performed involuntarily. [EU] Cochlear: Of or pertaining to the cochlea. [EU] Contraceptive: conception. [EU]

An agent that diminishes the likelihood of or prevents

Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Encephalopathy: Any degenerative disease of the brain. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Evacuation: An emptying, as of the bowels. [EU] Exocrine: 1. secreting outwardly, via a duct;. [EU] Hoarseness: An unnaturally deep or rough quality of voice. [NIH]


Intoxication: Poisoning, the state of being poisoned. [EU] Laryngectomy: Total or partial excision of the larynx. [NIH] Laryngoscopy: Examination, therapy or surgery of the interior of the larynx performed with a specially designed endoscope. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Midwifery: The practice of assisting women in childbirth. [NIH] Mutism: Inability or refusal to speak. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Obsession: A recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions involve thoughts of violence, contamination, and self-doubt. [EU] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis

Books 117

is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Polyneuritis: Inflammation of many nerves at once; multiple or disseminated, neuritis. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Teratogens: An agent that causes the production of physical defects in the developing embryo. [NIH]


Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Vagal: Pertaining to the vagus nerve. [EU] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU]

Multimedia 119

CHAPTER 7. MULTIMEDIA ON TOURETTE SYNDROME Overview Information on Tourette syndrome can come in a variety of formats. Among multimedia sources, video productions, slides, audiotapes, and computer databases are often available. In this chapter, we show you how to keep current on multimedia sources of information on Tourette syndrome. We start with sources that have been summarized by federal agencies, and then show you how to find bibliographic information catalogued by the National Library of Medicine. If you see an interesting item, visit your local medical library to check on the availability of the title.

Bibliography: Multimedia on Tourette Syndrome The National Library of Medicine is a rich source of information on healthcare-related multimedia productions including slides, computer software, and databases. To access the multimedia database, go to the following Web site: http://locatorplus.gov/. Select “Search LOCATORplus.” Once in the search area, simply type in Tourette syndrome (or synonyms). Then, in the option box provided below the search box, select “Audiovisuals and Computer Files.” From there, you can choose to sort results by publication date, author, or relevance. The following multimedia has been indexed on Tourette syndrome. For more information, follow the hyperlink indicated: ·

Pitfalls and misunderstandings in diagnosing Tourette syndrome. Source: Marshfield Clinic, Saint Joseph's Hospital; a presentation of the Marshfield Video Network; Year: 1994; Format: Videorecording; Marshfield, WI: The Network, [1994]


·

·

·

·

·

·

Tics and related disorders (Tourette syndrome). Source: presented by the Department of Pediatrics, Emory University, School of Medicine; Year: 1983; Format: Videorecording; Atlanta, Ga.: Emory Medical Television Network, 1983 Tics and Tourette's syndrome. Source: presented by the Department of Pediatrics, Emory University, School of Medicine; Year: 1987; Format: Videorecording; Atlanta, Ga.: The University, c1987 Tourette syndrome : the sudden intruder. Source: Behavioral Sciences Media Laboratory, the Neuropsychiatric Institute, Center for the Health Sciences, University of California, Los Angeles; Year: 1978; Format: Motion picture; [Berkeley, Calif]: Regents of the University of California; [Los Angeles: for loan and sale by University of California, Los Angeles, Behavioral Sciences Media Laboratory], c1978 Treating Tourette's and other mental illnesses. Source: a presentation of Films for the Humanities & Sciences, a presentation of KSDK and Medstar Communications, Inc; Year: 1995; Format: Videorecording; Princeton, N.J.: Films for the Humanities ; Sciences, c1995 Twitch and shout. Source: New Day Films; produced in association with Newton Television Foundation; Year: 1994; Format: Videorecording; [New York?]: Twitch ; Shout Productions, c1994 What is Tourette syndrome? Source: [presented by] Marshfield Clinic, Saint Joseph's Hospital, Marshfield Medical Research Foundation; a presentation of the Marshfield Video Network; Year: 1992; Format: Videorecording; Marshfield, WI: Marshfield Video Network, [1992]

Vocabulary Builder Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH]

Periodicals and News 121

CHAPTER 8. PERIODICALS AND NEWS ON TOURETTE SYNDROME Overview Keeping up on the news relating to Tourette syndrome can be challenging. Subscribing to targeted periodicals can be an effective way to stay abreast of recent developments on Tourette syndrome. Periodicals include newsletters, magazines, and academic journals. In this chapter, we suggest a number of news sources and present various periodicals that cover Tourette syndrome beyond and including those which are published by parent associations mentioned earlier. We will first focus on news services, and then on periodicals. News services, press releases, and newsletters generally use more accessible language, so if you do chose to subscribe to one of the more technical periodicals, make sure that it uses language you can easily follow.

News Services & Press Releases Well before articles show up in newsletters or the popular press, they may appear in the form of a press release or a public relations announcement. One of the simplest ways of tracking press releases on Tourette syndrome is to search the news wires. News wires are used by professional journalists, and have existed since the invention of the telegraph. Today, there are several major “wires” that are used by companies, universities, and other organizations to announce new medical breakthroughs. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing.


PR Newswire Perhaps the broadest of the wires is PR Newswire Association, Inc. To access this archive, simply go to http://www.prnewswire.com. Below the search box, select the option “The last 30 days.” In the search box, type “Tourette syndrome” or synonyms. The search results are shown by order of relevance. When reading these press releases, do not forget that the sponsor of the release may be a company or organization that is trying to sell a particular product or therapy. Their views, therefore, may be biased.

Reuters The Reuters’ Medical News database can be very useful in exploring news archives relating to Tourette syndrome. While some of the listed articles are free to view, others can be purchased for a nominal fee. To access this archive, go to http://www.reutershealth.com/frame2/arch.html and search by “Tourette syndrome” (or synonyms). The following was recently listed in this archive for Tourette syndrome: ·

Pimozide Superior To Haloperidol For Children With Tourette's Disorder Source: Reuters Medical News Date: August 08, 1997 http://www.reuters.gov/archive/1997/08/08/professional/links/19970 808clin003.html

·

Caudate Nucleus Linked To Tourette Syndrome Severity Source: Reuters Medical News Date: August 30, 1996 http://www.reuters.gov/archive/1996/08/30/professional/links/19960 830clin002.html

·

Three Different Genes Linked To Tourette Syndrome Source: Reuters Medical News Date: June 05, 1996 http://www.reuters.gov/archive/1996/06/05/professional/links/19960 605scie001.html

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at


http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within their search engine.

Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com. You can scan the news by industry category or company name.

Internet Wire Internet Wire is more focused on technology than the other wires. To access this site, go to http://www.internetwire.com and use the “Search Archive” option. Type in “Tourette syndrome” (or synonyms). As this service is oriented to technology, you may wish to search for press releases covering diagnostic procedures or tests that you may have read about.

Search Engines Free-to-view news can also be found in the news section of your favorite search engines (see the health news page at Yahoo: http://dir.yahoo.com/Health/News_and_Media/, or use this Web site’s general news search page http://news.yahoo.com/. Type in “Tourette syndrome” (or synonyms). If you know the name of a company that is relevant to Tourette syndrome, you can go to any stock trading Web site (such as www.etrade.com) and search for the company name there. News items across various news sources are reported on indicated hyperlinks.

BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “Tourette syndrome” (or synonyms).


Newsletters on Tourette Syndrome Given their focus on current and relevant developments, newsletters are often more useful to parents than academic articles. You can find newsletters using the Combined Health Information Database (CHID). You will need to use the “Detailed Search” option. To access CHID, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. Your investigation must limit the search to “Newsletter” and “Tourette syndrome.” Go to the bottom of the search page where “You may refine your search by.” Select the dates and language that you prefer. For the format option, select “Newsletter.” By making these selections and typing in “Tourette syndrome” or synonyms into the “For these words:” box, you will only receive results on newsletters. The following list was generated using the options described above: ·

Tourette Syndrome Association, Inc. Newsletter Source: Bayside, NY: Tourette Syndrome Association, Inc. (TSA). 1995. 16 p. (average). Contact: Available from Tourette Syndrome Association, Inc. (TSA). 42-40 Bell Boulevard, Bayside, NY 11361. (800) 237-0717 or (718) 224-2999; FAX (718) 279-9596. Price: Free with membership. Summary: This newsletter offers information about the activities of the Tourette Syndrome Association (TSA) and about persons with Tourette Syndrome. A typical issue includes news about medical conferences, letters to the editor, a column written by the president, fundraising updates, chapter news, notes about persons with Tourette Syndrome, medical articles, information about obtaining Social Security benefits, a list of scientific articles, questions for the medical advisory board, and numbers to contact local chapters.

Newsletter Articles If you choose not to subscribe to a newsletter, you can nevertheless find references to newsletter articles. We recommend that you use the Combined Health Information Database, while limiting your search criteria to “newsletter articles.” Again, you will need to use the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. Go to the bottom of the search page where “You may refine your search by.”


Select the dates and language that you prefer. For the format option, select “Newsletter Article.” By making these selections, and typing in “Tourette syndrome” (or synonyms) into the “For these words:” box, you will only receive results on newsletter articles. You should check back periodically with this database as it is updated every 3 months. The following is a typical result when searching for newsletter articles on Tourette syndrome: ·

Botulinum Toxin: Can A Poison Help? Source: Mayo Clinic Health Letter. 18(6): 6. June 2000. Contact: Available from Mayo Clinic Health Letter. 200 First Street SW, Rochester, MN 55905. (800) 333-9037 or (303) 604-1465. Email: [email protected]. Summary: This newsletter article provides people who have muscular problems with information on the medicinal uses of botulinum toxin. Although botulinum toxin causes muscle paralysis throughout the body when it is ingested, it can halt unwanted movements when injected into specific muscles. Botulinum toxin is currently used to treat spasmodic torticollis; facial tics; eyelid twitching; crossed eyes; muscle spasms associated with cerebral palsy, multiple sclerosis, stroke, and Parkinson's disease; swallowing and speech difficulties; migraines; chronic anal fissures; and vaginal spasms. Injections are usually done in a doctor's office. Several injections are typical, and a few days or weeks may be needed before the toxin becomes fully effective. Treatment usually lasts 3 months or longer before it must be repeated.

Academic Periodicals covering Tourette Syndrome Academic periodicals can be a highly technical yet valuable source of information on Tourette syndrome. We have compiled the following list of periodicals known to publish articles relating to Tourette syndrome and which are currently indexed within the National Library of Medicine’s PubMed database (follow hyperlinks to view more information, summaries, etc., for each). In addition to these sources, to keep current on articles written on Tourette syndrome published by any of the periodicals listed below, you can simply follow the hyperlink indicated or go to the following Web site: www.ncbi.nlm.nih.gov/pubmed. Type the periodical’s name into the search box to find the latest studies published.


If you want complete details about the historical contents of a periodical, you can also visit http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/ you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.” The following is a sample of periodicals which publish articles on Tourette syndrome: ·

Acta Psychiatrica Scandinavica. (Acta Psychiatr Scand) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ac ta+Psychiatrica+Scandinavica&dispmax=20&dispstart=0

·

Behaviour Research and Therapy. (Behav Res Ther) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Be haviour+Research+and+Therapy&dispmax=20&dispstart=0

·

International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology. (Int J Psychophysiol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Int ernational+Journal+of+Psychophysiology+:+Official+Journal+of+the+Int ernational+Organization+of+Psychophysiology&dispmax=20&dispstart= 0

·

Journal of Behavior Therapy and Experimental Psychiatry. (J Behav Ther Exp Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Behavior+Therapy+and+Experimental+Psychiatry&dispmax=2 0&dispstart=0

·

Journal of Child Neurology. (J Child Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Child+Neurology&dispmax=20&dispstart=0

·

Journal of Neurology, Neurosurgery, and Psychiatry. (J Neurol Neurosurg Psychiatry) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Jo urnal+of+Neurology,+Neurosurgery,+and+Psychiatry&dispmax=20&dis pstart=0


·

Pediatric Neurology. (Pediatr Neurol) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Pe diatric+Neurology&dispmax=20&dispstart=0

·

Pediatric Nursing. (Pediatr Nurs) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Pe diatric+Nursing&dispmax=20&dispstart=0

·

Psychiatry Research. (Psychiatry Res) http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi?field=0®exp=Ps ychiatry+Research&dispmax=20&dispstart=0

Vocabulary Builder Dysphagia: Difficulty in swallowing. [EU] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Neuromuscular: Pertaining to muscles and nerves. [EU] Strabismus: Deviation of the eye which the patient cannot overcome. The visual axes assume a position relative to each other different from that required by the physiological conditions. The various forms of strabismus are spoken of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia. Called also cast, heterotropia, manifest deviation, and squint. [EU] Torticollis: Wryneck; a contracted state of the cervical muscles, producing twisting of the neck and an unnatural position of the head. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU]

Physician Guidelines and Databases 129

CHAPTER 9. PHYSICIAN GUIDELINES AND DATABASES Overview Doctors and medical researchers rely on a number of information sources to help children with Tourette syndrome. Many will subscribe to journals or newsletters published by their professional associations or refer to specialized textbooks or clinical guides published for the medical profession. In this chapter, we focus on databases and Internet-based guidelines created or written for this professional audience.

NIH Guidelines For the more common medical conditions, the National Institutes of Health publish guidelines that are frequently consulted by physicians. Publications are typically written by one or more of the various NIH Institutes. For physician guidelines, commonly referred to as “clinical” or “professional” guidelines, you can visit the following Institutes: ·

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

·

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

·

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

·

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm


NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.26 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:27 ·

Bioethics: Access to published literature on the ethical, legal and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

·

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

·

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

·

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

·

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

·

Cancer Information: Access to caner-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 27 See http://www.nlm.nih.gov/databases/databases.html. 26


·

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

·

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

·

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

·

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

·

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

·

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

·

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

While all of the above references may be of interest to physicians who study and treat Tourette syndrome, the following are particularly noteworthy.


The Combined Health Information Database A comprehensive source of information on clinical guidelines written for professionals is the Combined Health Information Database. You will need to limit your search to “Brochure/Pamphlet,” “Fact Sheet,” or “Information Package” and Tourette syndrome using the “Detailed Search” option. Go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For the publication date, select “All Years,” select your preferred language, and the format option “Fact Sheet.” By making these selections and typing “Tourette syndrome” (or synonyms) into the “For these words:” box above, you will only receive results on fact sheets dealing with Tourette syndrome. The following is a sample result: ·

Catalog of Publications and Films Source: Bayside, NY: Tourette Syndrome Association, Inc. 1995. 4 p. Contact: Available from Tourette Syndrome Association, Inc. 42-40 Bell Boulevard, Bayside, NY 11361. (718) 224-2999; Fax (718) 279-9596. Price: Single copy free. Summary: This publication lists materials available through the Tourette Syndrome Association, Inc. (TSA). After a listing of brochures and flyers, videos and films, the brochure lists books in four categories: for families and professionals, education, legal, and medical and research audiences. Items related to the communication aspects of Tourette cover activities of everyday life with Tourette syndrome (TS); children with TS; school advocacy; parenting a TS child; talking about TS as a mode of coping; historical biography; understanding coprolalia; classroom considerations; learning disabilities and TS; attention deficit disorders; and behavior therapy. Each item is described; pricing information is included.

·

[Brain Bank] Source: Bayside, NY: Tourette Syndrome Association, Inc. (TSA). Contact: Available from Tourette Syndrome Association, Inc. (TSA). 42-40 Bell Boulevard, Bayside, NY 11361. (800) 237-0717 or (718) 224-2999; FAX (718) 279-9596. Price: Free. Summary: This brochure asks the general public and persons with Tourette Syndrome to donate their brains for medical research upon their deaths. Included is a wallet card and a card for the donor's next-of-kin.


The NLM Gateway28 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing “one-stop searching” for many of NLM’s information resources or databases.29 One target audience for the Gateway is the Internet user who is new to NLM’s online resources and does not know what information is available or how best to search for it. This audience may include physicians and other healthcare providers, researchers, librarians, students, and, increasingly, parents and the public.30 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “Tourette syndrome” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Items Found Journal Articles 349060 Books / Periodicals / Audio Visual 2577 Consumer Health 294 Meeting Abstracts 2575 Other Collections 100 Total 354606

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x. The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 30 Other users may find the Gateway useful for an overall search of NLM’s information resources. Some searchers may locate what they need immediately, while others will utilize the Gateway as an adjunct tool to other NLM search services such as PubMed® and MEDLINEplus®. The Gateway connects users with multiple NLM retrieval systems while also providing a search interface for its own collections. These collections include various types of information that do not logically belong in PubMed, LOCATORplus, or other established NLM retrieval systems (e.g., meeting announcements and pre-1966 journal citations). The Gateway will provide access to the information found in an increasing number of NLM retrieval systems in several phases. 28 29


HSTAT31 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.32 HSTAT’s audience includes healthcare providers, health service researchers, policy makers, insurance companies, consumers, and the information professionals who serve these groups. HSTAT provides access to a wide variety of publications, including clinical practice guidelines, quick-reference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.33 Simply search by “Tourette syndrome” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

Coffee Break: Tutorials for Biologists34 Some parents may wish to have access to a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. To this end, we recommend “Coffee Break,” a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.35 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.36 This site has new Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. The HSTAT URL is http://hstat.nlm.nih.gov/. 33 Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force’s Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations. 34 Adapted from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html. 35 The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 36 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process. 31 32


articles every few weeks, so it can be considered an online magazine of sorts, and intended for general background information. Access the Coffee Break Web site at http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are a few examples that may interest you: ·

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

·

Image Engine: Multimedia electronic medical record system that integrates a wide range of digitized clinical images with textual data stored in the University of Pittsburgh Medical Center’s MARS electronic medical record system; see the following Web site: http://www.cml.upmc.edu/cml/imageengine/imageEngine.html.

·

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

·

MedWeaver: Prototype system that allows users to search differential diagnoses for any list of signs and symptoms, to search medical literature, and to explore relevant Web sites; see http://www.med.virginia.edu/~wmd4n/medweaver.html.

·

Metaphrase: Middleware component intended for use by both caregivers and medical records personnel. It converts the informal language generally used by caregivers into terms from formal, controlled vocabularies; see the following Web site: http://www.lexical.com/Metaphrase.html.

The Genome Project and Tourette Syndrome With all the discussion in the press about the Human Genome Project, it is only natural that physicians, researchers, and parents want to know about how human genes relate to Tourette syndrome. In the following section, we will discuss databases and references used by physicians and scientists who work in this area.


Online Mendelian Inheritance in Man (OMIM) The Online Mendelian Inheritance in Man (OMIM) database is a catalog of human genes and genetic disorders authored and edited by Dr. Victor A. McKusick and his colleagues at Johns Hopkins and elsewhere. OMIM was developed for the World Wide Web by the National Center for Biotechnology Information (NCBI).37 The database contains textual information, pictures, and reference information. It also contains copious links to NCBI’s Entrez database of MEDLINE articles and sequence information. Go to http://www.ncbi.nlm.nih.gov/Omim/searchomim.html to search the database. Type “Tourette syndrome” (or synonyms) in the search box, and click “Submit Search.” If too many results appear, you can narrow the search by adding the word “clinical.” Each report will have additional links to related research and databases. By following these links, especially the link titled “Database Links,” you will be exposed to numerous specialized databases that are largely used by the scientific community. These databases are overly technical and seldom used by the general public, but offer an abundance of information. The following is an example of the results you can obtain from the OMIM for Tourette syndrome: ·

Gilles De La Tourette Syndrome Web site: http://www.ncbi.nlm.nih.gov/htbinpost/Omim/dispmim?137580

Adapted from http://www.ncbi.nlm.nih.gov/. Established in 1988 as a national resource for molecular biology information, NCBI creates public databases, conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information--all for the better understanding of molecular processes affecting human health and disease.

37


Genes and Disease (NCBI - Map) The Genes and Disease database is produced by the National Center for Biotechnology Information of the National Library of Medicine at the National Institutes of Health. This Web site categorizes each disorder by the system of the body associated with it. Go to http://www.ncbi.nlm.nih.gov/disease/, and browse the system pages to have a full view of important conditions linked to human genes. Since this site is regularly updated, you may wish to re-visit it from time to time. The following systems and associated disorders are addressed: ·

Muscle and Bone: Movement and growth. Examples: Duchenne muscular dystrophy, Ellis-van Creveld syndrome, Marfan syndrome, myotonic dystrophy, spinal muscular atrophy. Web site: http://www.ncbi.nlm.nih.gov/disease/Muscle.html

·

Nervous System: Mind and body. Examples: Alzheimer disease, Amyotrophic lateral sclerosis, Angelman syndrome, Charcot-Marie-Tooth disease, epilepsy, essential tremor, Fragile X syndrome, Friedreich’s ataxia, Huntington disease, NiemannPick disease, Parkinson disease, Prader-Willi syndrome, Rett syndrome, Spinocerebellar atrophy, Williams syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Brain.html

·

Signals: Cellular messages. Examples: Ataxia telangiectasia, Baldness, Cockayne syndrome, Glaucoma, SRY: sex determination, Tuberous sclerosis, Waardenburg syndrome, Werner syndrome. Web site: http://www.ncbi.nlm.nih.gov/disease/Signals.html

Entrez Entrez is a search and retrieval system that integrates several linked databases at the National Center for Biotechnology Information (NCBI). These databases include nucleotide sequences, protein sequences, macromolecular structures, whole genomes, and MEDLINE through PubMed. Entrez provides access to the following databases: ·

PubMed: Biomedical literature (PubMed), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed

·

Nucleotide Sequence Database (Genbank): Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Nucleotide


·

Protein Sequence Database: Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Protein

·

Structure: Three-dimensional macromolecular structures, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Structure

·

Genome: Complete genome assemblies, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Genome

·

PopSet: Population study data sets, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Popset

·

OMIM: Online Mendelian Inheritance in Man, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=OMIM

·

Taxonomy: Organisms in GenBank, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Taxonomy

·

Books: Online books, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=books

·

ProbeSet: Gene Expression Omnibus (GEO), Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

3D Domains: Domains from Entrez Structure, Web site: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=geo

·

NCBI’s Protein Sequence Information Survey Results: Web site: http://www.ncbi.nlm.nih.gov/About/proteinsurvey/

To access the Entrez system at the National Center for Biotechnology Information, go to http://www.ncbi.nlm.nih.gov/entrez/, and then select the database that you would like to search. The databases available are listed in the drop box next to “Search.” In the box next to “for,” enter “Tourette syndrome” (or synonyms) and click “Go.”


Jablonski’s Multiple Congenital Anomaly/Mental Retardation (MCA/MR) Syndromes Database38 This online resource can be quite useful. It has been developed to facilitate the identification and differentiation of syndromic entities. Special attention is given to the type of information that is usually limited or completely omitted in existing reference sources due to space limitations of the printed form. At the following Web site you can also search across syndromes using an index: http://www.nlm.nih.gov/mesh/jablonski/syndrome_toc/toc_a.html. You can search by keywords at this Web site: http://www.nlm.nih.gov/mesh/jablonski/syndrome_db.html. The Genome Database39 Established at Johns Hopkins University in Baltimore, Maryland in 1990, the Genome Database (GDB) is the official central repository for genomic mapping data resulting from the Human Genome Initiative. In the spring of 1999, the Bioinformatics Supercomputing Centre (BiSC) at the Hospital for Sick Children in Toronto, Ontario assumed the management of GDB. The Human Genome Initiative is a worldwide research effort focusing on structural analysis of human DNA to determine the location and sequence of the estimated 100,000 human genes. In support of this project, GDB stores and curates data generated by researchers worldwide who are engaged in the mapping effort of the Human Genome Project (HGP). GDB’s mission is to provide scientists with an encyclopedia of the human genome which is continually revised and updated to reflect the current state of scientific knowledge. Although GDB has historically focused on gene mapping, its focus will broaden as the Genome Project moves from mapping to sequence, and finally, to functional analysis. To access the GDB, simply go to the following hyperlink: http://www.gdb.org/. Search “All Biological Data” by “Keyword.” Type “Tourette syndrome” (or synonyms) into the search box, and review the results. If more than one word is used in the search box, then separate each one with the word “and” or “or” (using “or” might be useful when using synonyms). This database is extremely technical as it was created for Adapted from the National Library of Medicine: http://www.nlm.nih.gov/mesh/jablonski/about_syndrome.html. 39 Adapted from the Genome Database: http://gdbwww.gdb.org/gdb/aboutGDB.html#mission. 38


specialists. The articles are the results which are the most accessible to nonprofessionals and often listed under the heading “Citations.” The contact names are also accessible to non-professionals.

Specialized References The following books are specialized references written for professionals interested in Tourette syndrome (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Atlas of Pediatric Physical Diagnosis by Basil J. Zitelli, Holly W. Davis (Editor); Hardcover, 3rd edition (March 1997), Mosby-Year Book; ISBN: 0815199309; http://www.amazon.com/exec/obidos/ASIN/0815199309/icongroupinterna · The 5-Minute Pediatric Consult by M. William Schwartz (Editor); Hardcover - 1050 pages, 2nd edition (January 15, 2000), Lippincott, Williams & Wilkins; ISBN: 0683307444; http://www.amazon.com/exec/obidos/ASIN/0683307444/icongroupinterna · The Behavioral Neurology of White Matter by Christopher M. Filley; Paperback - 279 pages; 1st edition (September 15, 2001), Oxford University Press; ISBN: 019513561X; http://www.amazon.com/exec/obidos/ASIN/019513561X/icongroupinterna

· The Cerebellum and Its Disorders by Mario-Ubaldo Manto, Massimo Pandolfo; Hardcover - 1st edition (January 2002), Cambridge University Press; ISBN: 0521771560; http://www.amazon.com/exec/obidos/ASIN/0521771560/icongroupinterna · Clinical Neurology by David A. Greenberg, et al; Paperback - 390 pages; 5th edition (February 9, 2002), Appleton & Lange; ISBN: 0071375430; http://www.amazon.com/exec/obidos/ASIN/0071375430/icongroupinterna · Clinical Neurology for Psychiatrists by David M. Kaufman; Hardcover 670 pages, 5th edition (January 15, 2001), W. B. Saunders Co.; ISBN: 0721689957; http://www.amazon.com/exec/obidos/ASIN/0721689957/icongroupinterna · Comprehensive Neurology by Roger N. Rosenberg (Editor), David E. Pleasure (Editor); 1280 pages, 2nd edition (April 1998), Wiley-Liss; ISBN: 0471169587; http://www.amazon.com/exec/obidos/ASIN/0471169587/icongroupinterna · Emergent and Urgent Neurology by William J. Weiner (Editor), Lisa M. Shulman (Editor); Hardcover - 571 pages; 2nd edition (January 15, 1999),


Lippincott, Williams & Wilkins Publishers; ISBN: 0397518579; http://www.amazon.com/exec/obidos/ASIN/0397518579/icongroupinterna · Nelson Textbook of Pediatrics by Richard E. Behrman (Editor), et al; Hardcover - 2414 pages, 16th edition (January 15, 2000), W B Saunders Co; ISBN: 0721677673; http://www.amazon.com/exec/obidos/ASIN/0721677673/icongroupinterna · Neurology in Clinical Practice: Volume I: Principles of Diagnosis and Management, Volume II: The Neurological Disorders (2-Volume Set, Includes a 12-Month Subscription to the Online Edition) by W. G. Bradley, et al; Hardcover - 2413 pages, 3rd edition, Vol 1-2 (January 15, 2000), Butterworth-Heinemann; ISBN: 0750699736; http://www.amazon.com/exec/obidos/ASIN/0750699736/icongroupinterna · Neuroscience: Exploring the Brain by Mark F. Bear, et al; Hardcover - 855 pages, 2nd edition (January 15, 2001), Lippincott, Williams & Wilkins Publishers; ISBN: 0683305964; http://www.amazon.com/exec/obidos/ASIN/0683305964/icongroupinterna · Office Practice of Neurology by Martain A. Samuels, Steven F. Feske; Hardcover, Churchill Livingstone; ISBN: 0443065578; http://www.amazon.com/exec/obidos/ASIN/0443065578/icongroupinterna · Patient-Based Approaches to Cognitive Neuroscience by Martha J. Farah (Editor), Todd E. Feinberg (Editor); Paperback - 425 pages (April 3, 2000), MIT Press; ISBN: 0262561239; http://www.amazon.com/exec/obidos/ASIN/0262561239/icongroupinterna · Principles of Neural Science by Eric R. Kandel (Editor), et al; Hardcover 1414 pages, 4th edition (January 5, 2000), McGraw-Hill Professional Publishing; ISBN: 0838577016; http://www.amazon.com/exec/obidos/ASIN/0838577016/icongroupinterna · Review Manual for Neurology in Clinical Practice by Karl E. Misulis, et al; Paperback, Butterworth-Heinemann Medical; ISBN: 0750671920; http://www.amazon.com/exec/obidos/ASIN/0750671920/icongroupinterna

Vocabulary Builder Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH]

Dissertations 143

CHAPTER 10. DISSERTATIONS ON TOURETTE SYNDROME Overview University researchers are active in studying almost all known medical conditions. The result of research is often published in the form of Doctoral or Master’s dissertations. You should understand, therefore, that applied diagnostic procedures and/or therapies can take many years to develop after the thesis that proposed the new technique or approach was written. In this chapter, we will give you a bibliography on recent dissertations relating to Tourette syndrome. You can read about these in more detail using the Internet or your local medical library. We will also provide you with information on how to use the Internet to stay current on dissertations.

Dissertations on Tourette Syndrome ProQuest Digital Dissertations is the largest archive of academic dissertations available. From this archive, we have compiled the following list covering dissertations devoted to Tourette syndrome. You will see that the information provided includes the dissertation’s title, its author, and the author’s institution. To read more about the following, simply use the Internet address indicated. The following covers recent dissertations dealing with Tourette syndrome: ·

Adlerian Personality Priorities of Siblings of Individuals with Tourette Syndrome by Sims, Deanna, Phd from University of North Texas, 1998, 78 pages http://wwwlib.umi.com/dissertations/fullcit/9841451


·

An Exploratory Study of the Educational Services Provided for Students with Tourette Syndrome (behaviors, Perceptions, Parents, Naturalistic Design; Florida) by Anderson, Donna, Phd from University of South Florida, 1984, 304 pages http://wwwlib.umi.com/dissertations/fullcit/8508829

·

Characterlogical Anger and Aggression in Tourette Syndrome: a Review and Psychoanalytic Investigation by Smith, Neil Robert; Psyd from University of Hartford, 2001, 188 pages http://wwwlib.umi.com/dissertations/fullcit/3043199

·

Children and Adolescents with Tourette Syndrome: towards a Better Understanding of Rage Reactions by Rockmore, Lori Michelle; Psyd from Pace University, 2001, 67 pages http://wwwlib.umi.com/dissertations/fullcit/3016205

·

Clinical and Attentional Effects of Acute Nicotine Treatment in Tourette Syndrome by Howson, Anne L.; Phd from University of Ottawa (canada), 2001, 246 pages http://wwwlib.umi.com/dissertations/fullcit/NQ66157

·

Counseling Families with Children Affected by Attentiondeficit/hyperactivity Disorder, Obsessive-compulsive Disorder, And/or Tourette Syndrome: a Training Manual for Mental Health Professionals by Andrade, Miriam M.; Psyd from California School of Professional Psychology - Berkeley/alameda, 2001, 128 pages http://wwwlib.umi.com/dissertations/fullcit/3026978

·

Evaluation of a Chromosome 18 Locus Associated with Tourette Syndrome Phenotypes: Breakpoint Characterization, Transcript Assessment, and Candidate Gene Analysis by State, Matthew William; Phd from Yale University, 2001, 155 pages http://wwwlib.umi.com/dissertations/fullcit/3030834

·

Neuropsychological Functioning of School-age Children with Tourette Syndrome by Dornbush, Marilyn Pierce, Phd from Georgia State University, 1984, 260 pages http://wwwlib.umi.com/dissertations/fullcit/8425845

·

The Actualization of the Psychic Life of the Child with Tourette Syndrome (afrikaans Text) by Pelser, Izelda, Phd from University of Pretoria (south Africa), 1995 http://wwwlib.umi.com/dissertations/fullcit/f651459

·

The Organic Characteristics of Children with Tourette Syndrome: Counseling Implications by Swallow, Ward Kent, Phd from The University of Akron, 1986, 139 pages http://wwwlib.umi.com/dissertations/fullcit/8616445

Dissertations 145

Keeping Current As previously mentioned, an effective way to stay current on dissertations dedicated to Tourette syndrome is to use the database called ProQuest Digital Dissertations via the Internet, located at the following Web address: http://wwwlib.umi.com/dissertations. The site allows you to freely access the last two years of citations and abstracts. Ask your medical librarian if the library has full and unlimited access to this database. From the library, you should be able to do more complete searches than with the limited 2-year access available to the general public.

Vocabulary Builder Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU]

147

PART III. APPENDICES

ABOUT PART III Part III is a collection of appendices on general medical topics relating to Tourette syndrome and related conditions.

Researching Your Child’s Medications 149

APPENDIX A. RESEARCHING YOUR CHILD’S MEDICATIONS Overview There are a number of sources available on new or existing medications which could be prescribed to treat Tourette syndrome. While a number of hard copy or CD-Rom resources are available to parents and physicians for research purposes, a more flexible method is to use Internet-based databases. In this chapter, we will begin with a general overview of medications. We will then proceed to outline official recommendations on how you should view your child’s medications. You may also want to research medications that your child is currently taking for other conditions as they may interact with medications for Tourette syndrome. Research can give you information on the side effects, interactions, and limitations of prescription drugs used in the treatment of Tourette syndrome. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.


Your Child’s Medications: The Basics40 The Agency for Health Care Research and Quality has published extremely useful guidelines on the medication aspects of Tourette syndrome. Giving your child medication can involve many steps and decisions each day. The AHCRQ recommends that parents take part in treatment decisions. Do not be afraid to ask questions and talk about your concerns. By taking a moment to ask questions, your child may be spared from possible problems. Here are some points to cover each time a new medicine is prescribed: ·

Ask about all parts of your child’s treatment, including diet changes, exercise, and medicines.

·

Ask about the risks and benefits of each medicine or other treatment your child might receive.

·

Ask how often you or your child’s doctor will check for side effects from a given medication.

Do not hesitate to tell the doctor about preferences you have for your child’s medicines. You may want your child to have a medicine with the fewest side effects, or the fewest doses to take each day. You may care most about cost. Or, you may want the medicine the doctor believes will work the best. Sharing your concerns will help the doctor select the best treatment for your child. Do not be afraid to “bother” the doctor with your questions about medications for Tourette syndrome. You can also talk to a nurse or a pharmacist. They can help you better understand your child’s treatment plan. Talking over your child’s options with someone you trust can help you make better choices. Specifically, ask the doctor the following: ·

The name of the medicine and what it is supposed to do.

·

How and when to give your child the medicine, how much, and for how long.

·

What food, drinks, other medicines, or activities your child should avoid while taking the medicine.

·

What side effects your child may experience, and what to do if they occur.

·

If there are any refills, and how often.

·

About any terms or directions you do not understand.

·

What to do if your child misses a dose.

40

This section is adapted from AHCRQ: http://www.ahcpr.gov/consumer/ncpiebro.htm.


·

If there is written information you can take home (most pharmacies have information sheets on prescription medicines; some even offer large-print or Spanish versions).

Do not forget to tell the doctor about all the medicines your child is currently taking (not just those for Tourette syndrome). This includes prescription medicines and the medicines that you buy over the counter. When talking to the doctor, you may wish to prepare a list of medicines your child is currently taking including why and in what forms. Be sure to include the following information for each: ·

Name of medicine

·

Reason taken

·

Dosage

·

Time(s) of day

Also include any over-the-counter medicines, such as: ·

Laxatives

·

Diet pills

·

Vitamins

·

Cold medicine

·

Aspirin or other pain, headache, or fever medicine

·

Cough medicine

·

Allergy relief medicine

·

Antacids

·

Sleeping pills

·

Others (include names)

Learning More about Your Child’s Medications Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications the doctor has recommended for Tourette syndrome. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the “U.S. Pharmacopeia (USP).” Today, the USP is a non-profit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state


associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at www.usp.org. The USP currently provides standards for over 3,700 medications. The resulting USP DIÒ Advice for the PatientÒ can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database.41 While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopoeia (USP). It is important to read the disclaimer by the USP (http://www.nlm.nih.gov/medlineplus/drugdisclaimer.html) before using the information provided. Of course, we as editors cannot be certain as to what medications your child is taking. Therefore, we have compiled a list of medications associated with the treatment of Tourette syndrome. Once again, due to space limitations, we only list a sample of medications and provide hyperlinks to ample documentation (e.g. typical dosage, side effects, drug-interaction risks, etc.). The following drugs have been mentioned in the Pharmacopeia and other sources as being potentially applicable to Tourette syndrome: Altretamine ·

Systemic - U.S. Brands: Hexalen http://www.nlm.nih.gov/medlineplus/druginfo/altretaminesyste mic202634.html

Though cumbersome, the FDA database can be freely browsed at the following site: www.fda.gov/cder/da/da.htm.

41


Anesthetics ·

Dental - U.S. Brands: Anbesol Maximum Strength Gel; Anbesol Maximum Strength Liquid; Anbesol Regular Strength Gel; Anbesol Regular Strength Liquid; Anbesol, Baby; Benzodent; Chloraseptic Lozenges; Chloraseptic Lozenges, Children's; Dentapaine; DentZel-Ite; Hurricaine; Numzi http://www.nlm.nih.gov/medlineplus/druginfo/anestheticsdent al202038.html

·

Ophthalmic - U.S. Brands: Ak-Taine; Ak-T-Caine; Alcaine; OcuCaine; Ophthaine; Ophthetic; Opticaine; Pontocaine; Spectro-Caine http://www.nlm.nih.gov/medlineplus/druginfo/anestheticsopht halmic202039.html

·

Ophthalmic - U.S. Brands: Ak-Taine; Ak-T-Caine; Alcaine; OcuCaine; Ophthaine; Ophthetic; Opticaine; Pontocaine; Spectro-Caine http://www.nlm.nih.gov/medlineplus/druginfo/antidyskineticss ystemic202057.html

·

Ophthalmic - U.S. Brands: Ak-Taine; Ak-T-Caine; Alcaine; OcuCaine; Ophthaine; Ophthetic; Opticaine; Pontocaine; Spectro-Caine http://www.nlm.nih.gov/medlineplus/druginfo/betaadrenergicb lockingagentsop202654.html

·

Ophthalmic - U.S. Brands: Ak-Taine; Ak-T-Caine; Alcaine; OcuCaine; Ophthaine; Ophthetic; Opticaine; Pontocaine; Spectro-Caine http://www.nlm.nih.gov/medlineplus/druginfo/erythromycinto pical202221.html

·

Parenteral-Local - U.S. Brands: Carbocaine; Carbocaine with NeoCobefrin; Chirocaine; Citanest Forte; Citanest Plain; Dalcaine; Dilocaine; Duranest; Duranest-MPF; Isocaine; L-Caine; Lidoject-1; Lidoject-2; Marcaine; Marcaine Spinal; Nesacaine; Nesacaine-MPF; Novocain; Octocaine; Poloc http://www.nlm.nih.gov/medlineplus/druginfo/anestheticspare nterallocal202040.html

·

Rectal - U.S. Brands: Americaine Hemorrhoidal; Fleet Relief; Nupercainal; Pontocaine Cream+; Pontocaine Ointment; ProctoFoam/non-steroid; Tronolane; Tronothane http://www.nlm.nih.gov/medlineplus/druginfo/anestheticsrectal 202041.html


·

Topical - U.S. Brands: Almay Anti-itch Lotion; Americaine Topical Anesthetic First Aid Ointment; Americaine Topical Anesthetic Spray; Butesin Picrate; DermaFlex; Dermoplast; Lagol; Nupercainal Cream; Nupercainal Ointment; Pontocaine Cream; Pontocaine Ointment; Pramegel; Prax; http://www.nlm.nih.gov/medlineplus/druginfo/anestheticstopic al202042.html

Anesthetics, General ·

Systemic - U.S. Brands: Amidate; Brevital; Diprivan; Ethrane; Fluothane; Forane; Ketalar; Penthrane; Pentothal http://www.nlm.nih.gov/medlineplus/druginfo/anestheticsgene ralsystemic203043.html

Arsenic Trioxide ·

Systemic - U.S. Brands: Trisenox http://www.nlm.nih.gov/medlineplus/druginfo/arsenictrioxides ystemic500241.html

Aztreonam ·

Systemic - U.S. Brands: Azactam http://www.nlm.nih.gov/medlineplus/druginfo/aztreonamsyste mic202078.html

Beta-Adrenergic Blocking Agents and Thiazide Diuretics ·

Systemic - U.S. Brands: Corzide 40/5; Corzide 80/5; Inderide; Inderide LA; Lopressor HCT; Tenoretic 100; Tenoretic 50; Timolide 10-25; Ziac http://www.nlm.nih.gov/medlineplus/druginfo/betaadrenergicb lockingagentsan202088.html Bleomycin ·

Systemic - U.S. Brands: Blenoxane http://www.nlm.nih.gov/medlineplus/druginfo/bleomycinsyste mic202093.html


Cephalosporins ·

Systemic - U.S. Brands: Ancef; Ceclor; Ceclor CD; Cedax; Cefadyl; Cefizox; Cefobid; Cefotan; Ceftin; Cefzil; Ceptaz; Claforan; Duricef; Fortaz; Keflex 20; Keftab 20; Kefurox; Kefzol; Mandol; Maxipime; Mefoxin; Monocid; Omnicef; Rocephin; Suprax; Tazicef; Tazidime; Vantin; Velo http://www.nlm.nih.gov/medlineplus/druginfo/cephalosporinss ystemic202119.html

Chloramphenicol ·

Systemic - U.S. Brands: Chloromycetin http://www.nlm.nih.gov/medlineplus/druginfo/chloramphenico lsystemic202127.html

Clindamycin ·

Topical - U.S. Brands: Clinda-Derm http://www.nlm.nih.gov/medlineplus/druginfo/clindamycintopi cal202146.html

Clonidine ·

Systemic - U.S. Brands: Catapres; Catapres-TTS http://www.nlm.nih.gov/medlineplus/druginfo/clonidinesystem ic202152.html

Cycloserine ·

Systemic - U.S. Brands: Seromycin http://www.nlm.nih.gov/medlineplus/druginfo/cycloserinesyste mic202175.html

Cytarabine, Liposomal ·

Intrathecal - U.S. Brands: DepoCyt http://www.nlm.nih.gov/medlineplus/druginfo/cytarabinelipos omalintrathecal500008.html

Dactinomycin ·

Systemic - U.S. Brands: Cosmegen http://www.nlm.nih.gov/medlineplus/druginfo/dactinomycinsy stemic202179.html


Daunorubicin ·

Systemic - U.S. Brands: Cerubidine http://www.nlm.nih.gov/medlineplus/druginfo/daunorubicinsy stemic202183.html

Daunorubicin, Liposomal ·

Systemic - U.S. Brands: DaunoXome http://www.nlm.nih.gov/medlineplus/druginfo/daunorubicinlip osomalsystemic203539.html

Desflurane ·

Inhalation-Systemic - U.S. Brands: Suprane http://www.nlm.nih.gov/medlineplus/druginfo/desfluraneinhal ationsystemic202685.html

Diclofenac ·

Topical - U.S. Brands: Solaraze http://www.nlm.nih.gov/medlineplus/druginfo/diclofenactopica l500247.html

Difenoxin and Atropine ·

Systemic - U.S. Brands: Motofen http://www.nlm.nih.gov/medlineplus/druginfo/difenoxinandatr opinesystemic202193.html

Diphenoxylate and Atropine ·

Systemic - U.S. Brands: Lofene; Logen; Lomocot; Lomotil; Lonox; Vi-Atro http://www.nlm.nih.gov/medlineplus/druginfo/diphenoxylatea ndatropinesystem202200.html

Diuretics, Loop ·

Systemic - U.S. Brands: Bumex; Edecrin; Lasix; Myrosemide http://www.nlm.nih.gov/medlineplus/druginfo/diureticsloopsys temic202205.html

Diuretics, Potassium-Sparing ·

Systemic - U.S. Brands: Aldactone; Dyrenium; Midamor http://www.nlm.nih.gov/medlineplus/druginfo/diureticspotassi umsparingsyste202206.html


Diuretics, Potassium-Sparing, and Hydrochlorothiazide ·

Systemic - U.S. Brands: Aldactazide; Dyazide; Maxzide; Moduretic; Spirozide http://www.nlm.nih.gov/medlineplus/druginfo/diureticspotassi umsparingandhy202207.html

Diuretics, Thiazide ·

Systemic - U.S. Brands: Aquatensen; Diucardin; Diulo; Diuril; Enduron; Esidrix; Hydro-chlor; Hydro-D; HydroDIURIL; Hydromox; Hygroton; Metahydrin; Microzide; Mykrox; Naqua; Naturetin; Oretic; Renese; Saluron; Thalitone; Trichlorex 10; Zaroxolyn http://www.nlm.nih.gov/medlineplus/druginfo/diureticsthiazid esystemic202208.html

Docetaxel ·

Systemic - U.S. Brands: Taxotere http://www.nlm.nih.gov/medlineplus/druginfo/docetaxelsystem ic202920.html

Dornase Alfa ·

Inhalation - U.S. Brands: Pulmozyme http://www.nlm.nih.gov/medlineplus/druginfo/dornasealfainha lation202710.html

Doxorubicin ·

Systemic - U.S. Brands: Rubex http://www.nlm.nih.gov/medlineplus/druginfo/doxorubicinsyst emic202209.html

Doxorubicin, Liposomal ·

Systemic - U.S. Brands: Doxil http://www.nlm.nih.gov/medlineplus/druginfo/doxorubicinlipo somalsystemic203540.html

Doxycycline for Dental Use ·

Systemic - U.S. Brands: Periostat http://www.nlm.nih.gov/medlineplus/druginfo/doxycyclineford entalusesystemi203724.html


Eflornithine ·

Topical - U.S. Brands: Vaniqa http://www.nlm.nih.gov/medlineplus/druginfo/eflornithinetopi cal500227.html

Epirubicin ·

Systemic - U.S. Brands: Ellence http://www.nlm.nih.gov/medlineplus/druginfo/epirubicinsyste mic500038.html

Erythromycin ·

Ophthalmic - U.S. Brands: Ilotycin http://www.nlm.nih.gov/medlineplus/druginfo/erythromycinop hthalmic202220.html

Fentanyl ·

Systemic - U.S. Brands: Actiq http://www.nlm.nih.gov/medlineplus/druginfo/fentanylsystemi c203780.html

·

Transdermal-Systemic - U.S. Brands: Duragesic http://www.nlm.nih.gov/medlineplus/druginfo/fentanyltransde rmalsystemic202702.html

Gentamicin ·

Ophthalmic - U.S. Brands: Garamycin; Gentacidin; Gentafair; Gentak; Ocu-Mycin; Spectro-Genta http://www.nlm.nih.gov/medlineplus/druginfo/gentamicinopht halmic202604.html

·

Topical - U.S. Brands: Garamycin; Gentamar; G-Myticin http://www.nlm.nih.gov/medlineplus/druginfo/gentamicintopic al202258.html

Haloperidol ·

Systemic - U.S. Brands: Haldol http://www.nlm.nih.gov/medlineplus/druginfo/haloperidolsyst emic202278.html

Idarubicin ·

Systemic - U.S. Brands: Idamycin http://www.nlm.nih.gov/medlineplus/druginfo/idarubicinsyste mic202611.html


Indapamide ·

Systemic - U.S. Brands: Lozol http://www.nlm.nih.gov/medlineplus/druginfo/indapamidesyst emic202296.html

Irinotecan ·

Systemic - U.S. Brands: Camptosar http://www.nlm.nih.gov/medlineplus/druginfo/irinotecansyste mic203051.html

Kanamycin ·

Oral - U.S. Brands: Kantrex http://www.nlm.nih.gov/medlineplus/druginfo/kanamycinoral2 02312.html

Ketorolac ·

Systemic - U.S. Brands: Toradol http://www.nlm.nih.gov/medlineplus/druginfo/ketorolacsystem ic202318.html

Lansoprazole ·

Systemic - U.S. Brands: Prevacid http://www.nlm.nih.gov/medlineplus/druginfo/lansoprazolesys temic202787.html

Laxatives ·

Oral - U.S. Brands: Afko-Lube; Afko-Lube Lax 40; Agoral Marshmallow; Agoral Raspberry; Alaxin; Alophen; Alphamul; Alramucil Orange; Alramucil Regular; Bilagog; Bilax; Bisac-Evac; Black-Draught; Black-Draught Lax-Senna; Carter's Little Pills; Cholac; Chronulac; Cillium; Cit http://www.nlm.nih.gov/medlineplus/druginfo/laxativesoral202 319.html

Levomethadyl ·

Systemic - U.S. Brands: Orlaam http://www.nlm.nih.gov/medlineplus/druginfo/levomethadylsy stemic202766.html


Lidocaine ·

Topical - U.S. Brands: Lidoderm http://www.nlm.nih.gov/medlineplus/druginfo/lidocainetopical 500058.html

Lidocaine and Prilocaine ·

Topical - U.S. Brands: EMLA http://www.nlm.nih.gov/medlineplus/druginfo/lidocaineandpril ocainetopical203679.html

Lincomycin ·

Systemic - U.S. Brands: Lincocin; Lincorex http://www.nlm.nih.gov/medlineplus/druginfo/lincomycinsyste mic202328.html

Linezolid ·

Systemic - U.S. Brands: Zyvox http://www.nlm.nih.gov/medlineplus/druginfo/linezolidsystemi c500165.html

Mebendazole ·

Systemic - U.S. Brands: Vermox http://www.nlm.nih.gov/medlineplus/druginfo/mebendazolesys temic202339.html

Mequinol and Tretinoin ·

Topical - U.S. Brands: Solagй http://www.nlm.nih.gov/medlineplus/druginfo/mequinolandtre tinointopical500074.html

Methyldopa and Thiazide Diuretics ·

Systemic - U.S. Brands: Aldoclor; Aldoril http://www.nlm.nih.gov/medlineplus/druginfo/methyldopaand thiazidediuretics202360.html

Mitomycin ·

Systemic - U.S. Brands: Mutamycin http://www.nlm.nih.gov/medlineplus/druginfo/mitomycinsyste mic202376.html


Mitoxantrone ·

Systemic - U.S. Brands: Novantrone http://www.nlm.nih.gov/medlineplus/druginfo/mitoxantronesy stemic202378.html

Mometasone ·

Nasal - U.S. Brands: Nasonex http://www.nlm.nih.gov/medlineplus/druginfo/mometasonenas al203589.html

Naltrexone ·

Systemic - U.S. Brands: ReVia http://www.nlm.nih.gov/medlineplus/druginfo/naltrexonesyste mic202388.html

Narcotic Analgesics and Acetaminophen ·

Systemic - U.S. Brands: Allay; Anexsia 5/500; Anexsia 7.5/650; Anolor DH 5; Bancap-HC; Capital with Codeine; Co-Gesic; Darvocet-N 100; Darvocet-N 50; DHCplus; Dolacet; Dolagesic; Duocet; E-Lor; Endocet; EZ III; Hycomed; Hyco-Pap; Hydrocet; Hydrogesic; HY-PHEN; Lorcet 10/650; L http://www.nlm.nih.gov/medlineplus/druginfo/narcoticanalgesi csandacetamino202392.html

Narcotic Analgesics and Aspirin ·

Systemic - U.S. Brands: Damason-P; Darvon Compound-65; Empirin with Codeine No.3; Empirin with Codeine No.4; Endodan; Lortab ASA; Panasal 5/500; PC-Cap; Percodan; Percodan-Demi; Propoxyphene Compound-65; Roxiprin; Synalgos-DC; Talwin Compound http://www.nlm.nih.gov/medlineplus/druginfo/narcoticanalgesi csandaspirinsy202393.html

Narcotic Analgesics for Pain Relief ·

Systemic - U.S. Brands: Astramorph PF; Buprenex; Cotanal-65; Darvon; Darvon-N; Demerol; Dilaudid; Dilaudid-5; Dilaudid-HP; Dolophine; Duramorph; Hydrostat IR; Kadian; Levo-Dromoran; M S Contin; Methadose; MS/L; MS/L Concentrate; MS/S; MSIR; Nubain; Numorphan; OMS Concentrate; http://www.nlm.nih.gov/medlineplus/druginfo/narcoticanalgesi csforpainrelie202390.html


Neomycin ·

Topical - U.S. Brands: Myciguent http://www.nlm.nih.gov/medlineplus/druginfo/neomycintopica l202397.html

Niclosamide ·

Oral - U.S. Brands: Niclocide http://www.nlm.nih.gov/medlineplus/druginfo/niclosamideoral 202406.html

Omeprazole ·

Systemic - U.S. Brands: Prilosec http://www.nlm.nih.gov/medlineplus/druginfo/omeprazolesyst emic202423.html

Paclitaxel ·

Systemic - U.S. Brands: Taxol http://www.nlm.nih.gov/medlineplus/druginfo/paclitaxelsyste mic202682.html

Pegaspargase ·

Systemic - U.S. Brands: Oncaspar http://www.nlm.nih.gov/medlineplus/druginfo/pegaspargasesy stemic203543.html

Penicillins ·

Systemic - U.S. Brands: Amoxil; Bactocill; Beepen-VK; BetapenVK; Bicillin L-A; Cloxapen; Crysticillin 300 A.S.; Dycill; Dynapen; Geocillin; Geopen; Ledercillin VK; Mezlin; Nafcil; Nallpen; Omnipen; Omnipen-N; Pathocil; Pen Vee K; Pentids; Permapen; Pfizerpen; Pfizerpen-AS; Pi http://www.nlm.nih.gov/medlineplus/druginfo/penicillinssyste mic202446.html

Pimozide ·

Systemic - U.S. Brands: Orap http://www.nlm.nih.gov/medlineplus/druginfo/pimozidesystem ic202466.html


Plicamycin ·

Systemic - U.S. Brands: Mithracin http://www.nlm.nih.gov/medlineplus/druginfo/plicamycinsyste mic202467.html

Porfimer ·

Systemic - U.S. Brands: Photofrin http://www.nlm.nih.gov/medlineplus/druginfo/porfimersystemi c203593.html

Potassium Supplements ·

Systemic - U.S. Brands: Cena-K; Effer-K; Gen-K; Glu-K; K+ 10; K+ Care; K+ Care ET; K-8; Kaochlor 10%; Kaochlor S-F 10%; Kaon; Kaon-Cl; Kaon-Cl 20% Liquid; Kaon-Cl-10; Kato; Kay Ciel; Kaylixir; K-Dur; K-Electrolyte; K-G Elixir; K-Ide; K-Lease; K-Lor; Klor-Con 10; Klor-Con 8; Kl http://www.nlm.nih.gov/medlineplus/druginfo/potassiumsuppl ementssystemic202473.html

Praziquantel ·

Systemic - U.S. Brands: Biltricide http://www.nlm.nih.gov/medlineplus/druginfo/praziquantelsys temic202474.html

Probenecid ·

Systemic - U.S. Brands: Benemid; Probalan http://www.nlm.nih.gov/medlineplus/druginfo/probenecidsyste mic202480.html Pyrantel ·

Oral - U.S. Brands: Pin-X http://www.nlm.nih.gov/medlineplus/druginfo/pyranteloral202 490.html

Quinupristin and Dalfopristin ·

Systemic - U.S. Brands: Synercid http://www.nlm.nih.gov/medlineplus/druginfo/quinupristinand dalfopristinsys500048.html


Rauwolfia Alkaloids and Thiazide Diuretics ·

Systemic - U.S. Brands: Demi-Regroton; Diupres; Diurigen with Reserpine; Diutensen-R; Enduronyl; Enduronyl Forte; Oreticyl; Oreticyl Forte; Rauzide; Regroton http://www.nlm.nih.gov/medlineplus/druginfo/rauwolfiaalkaloi dsandthiazided202504.html

Sevoflurane ·

Inhalation-Systemic - U.S. Brands: Ultane http://www.nlm.nih.gov/medlineplus/druginfo/sevofluraneinha lationsystemic202793.html

Sparfloxacin ·

Systemic - U.S. Brands: Zagam http://www.nlm.nih.gov/medlineplus/druginfo/sparfloxacinsyst emic203530.html

Temozolomide ·

Systemic - U.S. Brands: Temodar http://www.nlm.nih.gov/medlineplus/druginfo/temozolomides ystemic500076.html

Teniposide ·

Systemic - U.S. Brands: Vumon http://www.nlm.nih.gov/medlineplus/druginfo/teniposidesyste mic203661.html

Testolactone ·

Systemic - U.S. Brands: Teslac http://www.nlm.nih.gov/medlineplus/druginfo/testolactonesyst emic202549.html

Tetracyclines ·

Topical - U.S. Brands: Achromycin; Aureomycin; Meclan; Topicycline http://www.nlm.nih.gov/medlineplus/druginfo/tetracyclinestopi cal202553.html


Thiabendazole ·

Systemic - U.S. Brands: Mintezol http://www.nlm.nih.gov/medlineplus/druginfo/thiabendazolesy stemic202558.html

Topotecan ·

Systemic - U.S. Brands: Hycamtin http://www.nlm.nih.gov/medlineplus/druginfo/topotecansyste mic203049.html

Torsemide ·

Systemic - U.S. Brands: Demadex http://www.nlm.nih.gov/medlineplus/druginfo/torsemidesyste mic202740.html

Vancomycin ·

Oral - U.S. Brands: Vancocin http://www.nlm.nih.gov/medlineplus/druginfo/vancomycinoral 202589.html

·

Systemic - U.S. Brands: Vancocin http://www.nlm.nih.gov/medlineplus/druginfo/vancomycinsyst emic202590.html

Vinorelbine ·

Systemic - U.S. Brands: Navelbine http://www.nlm.nih.gov/medlineplus/druginfo/vinorelbinesyste mic203542.html

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. You may be able to access these sources from your local medical library or your child’s doctor’s office.


Reuters Health Drug Database The Reuters Health Drug Database can be searched by keyword at the hyperlink: http://www.reutershealth.com/frame2/drug.html.42

Mosby’s GenRx Mosby’s GenRx database (also available on CD-Rom and book format) covers 45,000 drug products including generics and international brands. It provides information on prescribing and drug interactions. Information can be obtained at the following hyperlink: http://www.genrx.com/Mosby/PhyGenRx/group.html.

Physicians Desk Reference The Physicians Desk Reference database (also available in CD-Rom and book format) is a full-text drug database. The database is searchable by brand name, generic name or by indication. It features multiple drug interactions reports. Information can be obtained at the following hyperlink: http://physician.pdr.net/physician/templates/en/acl/psuser_t.htm.

Other Web Sites A number of additional Web sites discuss drug information. As an example, you may like to look at www.drugs.com which reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. which allows users to download articles on various drugs and therapeutics for a nominal fee: http://www.medletter.com/.

Contraindications and Interactions (Hidden Dangers) Some of the medications mentioned in the previous discussions can be problematic for children with Tourette syndrome--not because they are used in the treatment process, but because of contraindications, or side effects. Medications with contraindications are those that could react with drugs used to treat Tourette syndrome or potentially create deleterious side effects 42

Adapted from A to Z Drug Facts by Facts and Comparisons.


in patients with Tourette syndrome. You should ask the physician about any contraindications, especially as these might apply to other medications that your child may be taking for common ailments. Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause your child to experience an unexpected side effect. Drug interactions may make medications less effective, cause unexpected side effects, or increase the action of a particular drug. Some drug interactions can even be harmful to your child. Be sure to read the label every time you give your child a nonprescription or prescription drug, and take the time to learn about drug interactions. These precautions may be critical to your child’s health. You can reduce the risk of potentially harmful drug interactions and side effects with a little bit of knowledge and common sense. Drug labels contain important information about ingredients, uses, warnings, and directions which you should take the time to read and understand. Labels also include warnings about possible drug interactions. Further, drug labels may change as new information becomes avaiable. This is why it’s especially important to read the label every time you give your child a medication. When the doctor prescribes a new drug, discuss all overthe-counter and prescription medications, dietary supplements, vitamins, botanicals, minerals and herbals your child takes. Ask your pharmacist for the package insert for each drug prescribed. The package insert provides more information about potential drug interactions.

A Final Warning At some point, you may hear of alternative medications from friends, relatives, or in the news media. Advertisements may suggest that certain alternative drugs can produce positive results for Tourette syndrome. Exercise caution--some of these drugs may have fraudulent claims, and others may actually hurt your child. The Food and Drug Administration (FDA) is the official U.S. agency charged with discovering which medications are likely to improve the health of patients with Tourette syndrome. The FDA warns to watch out for43: ·

Secret formulas (real scientists share what they know)

This section has been adapted from http://www.fda.gov/opacom/lowlit/medfraud.html.

43


·

Amazing breakthroughs or miracle cures (real breakthroughs don’t happen very often; when they do, real scientists do not call them amazing or miracles)

·

Quick, painless, or guaranteed cures

·

If it sounds too good to be true, it probably isn’t true.

If you have any questions about any kind of medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

General References In addition to the resources provided earlier in this chapter, the following general references describe medications (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): · Current Therapy in Neurologic Disease by Richard T. Johnson, et al; Hardcover - 457 pages, 6th edition (January 15, 2002), Mosby-Year Book; ISBN: 0323014720; http://www.amazon.com/exec/obidos/ASIN/0323014720/icongroupinterna · Emerging Pharmacological Tools in Clinical Neurology by MedPanel Inc. (Author); Digital - 66 pages, MarketResearch.com; ISBN: B00005RBN8; http://www.amazon.com/exec/obidos/ASIN/B00005RBN8/icongroupinter na · Goodman & Gilman’s The Pharmacological Basis of Therapeutics by Joel G. Hardman (Editor), Lee E. Limbird; Hardcover - 1825 pages, 10th edition (August 13, 2001), McGraw-Hill Professional Publishing; ISBN: 0071354697; http://www.amazon.com/exec/obidos/ASIN/0071354697/icongroupinterna · Neurology and General Medicine by Michael J. Aminoff (Editor), Hardcover - 992 pages, 3rd edition (March 15, 2001), Churchill Livingstone; ISBN: 0443065713; http://www.amazon.com/exec/obidos/ASIN/0443065713/icongroupinterna · Neurology and Medicine by Hughes Perkins; Hardcover - 415 pages, 1st edition (December 15, 1999), B. M. J. Books; ISBN: 0727912240; http://www.amazon.com/exec/obidos/ASIN/0727912240/icongroupinterna · Pharmacological Management of Neurological and Psychiatric Disorders by S. J. Enna (Editor), et al; Hardcover - 736 pages, 1st edition, McGraw-


Hill Professional Publishing; ISBN: 0070217645; http://www.amazon.com/exec/obidos/ASIN/0070217645/icongroupinterna

Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Altretamine: An alkylating agent proposed as an antineoplastic. It also acts as a chemosterilant for male houseflies and other insects. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Aztreonam: A monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum. It is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. It may cause a superinfection with gram-positive organisms. [NIH] Bleomycin: A complex of related glycopeptide antibiotics from Streptomyces verticillus consisting of bleomycin A2 and B2. It inhibits DNA metabolism and is used as an antineoplastic, especially for solid tumors. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Cycloserine: Antibiotic substance produced by Streptomyces garyphalus. It may be used in the treatment of resistant tuberculosis as part of a multi-drug regimen. It has also been used in urinary tract infections. [NIH] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH]


Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water and also increase excretion of potassium ions. [NIH] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Epirubicin: An anthracycline antibiotic which is the 4'-epi-isomer of doxorubicin. The compound exerts its antitumor effects by interference with the synthesis and function of DNA. Clinical studies indicate activity in breast cancer, non-Hodgkin's lymphomas, ovarian cancer, soft-tissue sarcomas, pancreatic cancer, gastric cancer, small-cell lung cancer and acute leukemia. It is equal in activity to doxorubicin but exhibits less acute toxicities and less cardiotoxicity. [NIH] Idarubicin: An orally administered anthracycline antibiotic. The compound has shown activity against breast cancer, lymphomas and leukemias, together with potential for reduced cardiac toxicity. [NIH] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]

Inhalation: The drawing of air or other substances into the lungs. [EU] Intrathecal: Within a sheath. [EU] Kanamycin: Antibiotic complex produced by Streptomyces kanamyceticus from Japanese soil. Comprises 3 components: kanamycin A, the major component, and kanamycins B and C, the minor components. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Mebendazole: A nematocide in humans and animals. It acts by interfering with the carbohydrate metabolism and associated energy production of the parasite. [NIH] Mitomycin: An antineoplastic antibiotic produced by Streptomyces caespitosus. It acts as a bi- or trifunctional alkylating agent causing crosslinking of DNA and inhibition of DNA synthesis. [NIH] Mitoxantrone: An anthracenedione-derived antineoplastic agent. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl


congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Ophthalmic: Pertaining to the eye. [EU] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins C-mos. [NIH] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Plicamycin: A tricyclic pentaglycosidic antibiotic from Streptomyces strains that inhibits RNA and protein synthesis by adhering to DNA. It is used as a fluorescent dye and as an antineoplastic agent, especially in bone and testicular tumors. Plicamycin is also used to reduce hypercalcemia, especially that due to malignancies. [NIH] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Praziquantel: An anthelmintic used in most schistosome and many cestode infestations. [NIH] Probenecid: The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. [NIH] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its


clinical use. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Teniposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Teniposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent cells from entering into the mitotic phase of the cell cycle, and lead to cell death. Teniposide acts primarily in the G2 and S phases of the cycle. [NIH] Testolactone: An antineoplastic agent that is a derivative of progesterone and used to treat advanced breast cancer. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Topotecan: An antineoplastic agent used to treat ovarian cancer. It works by inhibiting DNA topoisomerase. [NIH] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH]

Researching Alternative Medicine 173

APPENDIX B. RESEARCHING ALTERNATIVE MEDICINE Overview Complementary and alternative medicine (CAM) is one of the most contentious aspects of modern medical practice. You may have heard of these treatments on the radio or on television. Maybe you have seen articles written about these treatments in magazines, newspapers, or books. Perhaps your child’s doctor or your friends have mentioned alternatives. In this chapter, we will begin by giving you a broad perspective on complementary and alternative therapies. Next, we will introduce you to official information sources on CAM relating to Tourette syndrome. Finally, at the conclusion of this chapter, we will provide a list of readings on Tourette syndrome from various authors. We will begin, however, with the National Center for Complementary and Alternative Medicine’s (NCCAM) overview of complementary and alternative medicine.


What Is CAM?44 Complementary and alternative medicine (CAM) covers a broad range of healing philosophies, approaches, and therapies. Generally, it is defined as those treatments and healthcare practices which are not taught in medical schools, used in hospitals, or reimbursed by medical insurance companies. Many CAM therapies are termed “holistic,” which generally means that the healthcare practitioner considers the whole person, including physical, mental, emotional, and spiritual health. Some of these therapies are also known as “preventive,” which means that the practitioner educates and treats the person to prevent health problems from arising, rather than treating symptoms after problems have occurred. People use CAM treatments and therapies in a variety of ways. Therapies are used alone (often referred to as alternative), in combination with other alternative therapies, or in addition to conventional treatment (sometimes referred to as complementary). Complementary and alternative medicine, or “integrative medicine,” includes a broad range of healing philosophies, approaches, and therapies. Some approaches are consistent with physiological principles of Western medicine, while others constitute healing systems with non-Western origins. While some therapies are far outside the realm of accepted Western medical theory and practice, others are becoming established in mainstream medicine. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. Some commonly used methods of complementary or alternative therapy include mind/body control interventions such as visualization and relaxation, manual healing including acupressure and massage, homeopathy, vitamins or herbal products, and acupuncture.

What Are the Domains of Alternative Medicine?45 The list of CAM practices changes continually. The reason being is that these new practices and therapies are often proved to be safe and effective, and therefore become generally accepted as “mainstream” healthcare practices. Today, CAM practices may be grouped within five major domains: (1) alternative medical systems, (2) mind-body interventions, (3) biologicallybased treatments, (4) manipulative and body-based methods, and (5) energy 44 45

Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/faq/index.html#what-is. Adapted from the NCCAM: http://nccam.nih.gov/nccam/fcp/classify/index.html.


therapies. The individual systems and treatments comprising these categories are too numerous to list in this sourcebook. Thus, only limited examples are provided within each. Alternative Medical Systems Alternative medical systems involve complete systems of theory and practice that have evolved independent of, and often prior to, conventional biomedical approaches. Many are traditional systems of medicine that are practiced by individual cultures throughout the world, including a number of venerable Asian approaches. Traditional oriental medicine emphasizes the balance or disturbances of qi (pronounced chi) or vital energy in health and illness, respectively. Traditional oriental medicine consists of a group of techniques and methods including acupuncture, herbal medicine, oriental massage, and qi gong (a form of energy therapy). Acupuncture involves stimulating specific anatomic points in the body for therapeutic purposes, usually by puncturing the skin with a thin needle. Ayurveda is India’s traditional system of medicine. Ayurvedic medicine (meaning “science of life”) is a comprehensive system of medicine that places equal emphasis on body, mind, and spirit. Ayurveda strives to restore the innate harmony of the individual. Some of the primary Ayurvedic treatments include diet, exercise, meditation, herbs, massage, exposure to sunlight, and controlled breathing. Other traditional healing systems have been developed by the world’s indigenous populations. These populations include Native American, Aboriginal, African, Middle Eastern, Tibetan, and Central and South American cultures. Homeopathy and naturopathy are also examples of complete alternative medicine systems. Homeopathic medicine is an unconventional Western system that is based on the principle that “like cures like,” i.e., that the same substance that in large doses produces the symptoms of an illness, in very minute doses cures it. Homeopathic health practitioners believe that the more dilute the remedy, the greater its potency. Therefore, they use small doses of specially prepared plant extracts and minerals to stimulate the body’s defense mechanisms and healing processes in order to treat illness.


Naturopathic medicine is based on the theory that a medical condition is the manifestation of alterations in the processes by which the body naturally heals itself and emphasizes health restoration rather than treatment for the condition itself. Naturopathic physicians employ an array of healing practices, including the following: diet and clinical nutrition, homeopathy, acupuncture, herbal medicine, hydrotherapy (the use of water in a range of temperatures and methods of applications), spinal and soft-tissue manipulation, physical therapies (such as those involving electrical currents, ultrasound, and light), therapeutic counseling, and pharmacology.

Mind-Body Interventions Mind-body interventions employ a variety of techniques designed to facilitate the mind’s capacity to affect bodily function and symptoms. Only a select group of mind-body interventions having well-documented theoretical foundations are considered CAM. For example, patient education and cognitive-behavioral approaches are now considered “mainstream.” On the other hand, complementary and alternative medicine includes meditation, certain uses of hypnosis, dance, music, and art therapy, as well as prayer and mental healing. Biological-Based Therapies This category of CAM includes natural and biological-based practices, interventions, and products, many of which overlap with conventional medicine’s use of dietary supplements. This category includes herbal, special dietary, orthomolecular, and individual biological therapies. Herbal therapy employs an individual herb or a mixture of herbs for healing purposes. An herb is a plant or plant part that produces and contains chemical substances that act upon the body. Special diet therapies, such as those proposed by Drs. Atkins, Ornish, Pritikin, and Weil, are believed to prevent and/or control illness as well as promote health. Orthomolecular therapies aim to treat medical conditions with varying concentrations of chemicals such as magnesium, melatonin, and mega-doses of vitamins. Biological therapies include, for example, the use of laetrile and shark cartilage to treat cancer and the use of bee pollen to treat autoimmune and inflammatory conditions.


Manipulative and Body-Based Methods This category includes methods that are based on manipulation and/or movement of the body. For example, chiropractors focus on the relationship between structure and function, primarily pertaining to the spine, and how that relationship affects the preservation and restoration of health. Chiropractors use manipulative therapy as an integral treatment tool. In contrast, osteopaths place particular emphasis on the musculoskeletal system and practice osteopathic manipulation. Osteopaths believe that all of the body’s systems work together and that disturbances in one system may have an impact upon function elsewhere in the body. Massage therapists manipulate the soft tissues of the body to normalize those tissues. Energy Therapies Energy therapies focus on energy fields originating within the body (biofields) or those from other sources (electromagnetic fields). Biofield therapies are intended to affect energy fields (the existence of which is not yet experimentally proven) that surround and penetrate the human body. Some forms of energy therapy manipulate biofields by applying pressure and/or manipulating the body by placing the hands in or through these fields. Examples include Qi gong, Reiki and Therapeutic Touch. Qi gong is a component of traditional oriental medicine that combines movement, meditation, and regulation of breathing to enhance the flow of vital energy (qi) in the body, improve blood circulation, and enhance immune function. Reiki, the Japanese word representing Universal Life Energy, is based on the belief that, by channeling spiritual energy through the practitioner, the spirit is healed and, in turn, heals the physical body. Therapeutic Touch is derived from the ancient technique of “laying-on of hands.” It is based on the premises that the therapist’s healing force affects recovery and that healing is promoted when the body’s energies are in balance. By passing their hands over the patient, these healers identify energy imbalances. Bioelectromagnetic-based therapies involve the unconventional use of electromagnetic fields to treat illnesses or manage pain. These therapies are often used to treat asthma, cancer, and migraine headaches. Types of electromagnetic fields which are manipulated in these therapies include pulsed fields, magnetic fields, and alternating current or direct current fields.


Can Alternatives Affect My Child’s Treatment? A critical issue in pursuing complementary alternatives mentioned thus far is the risk that these might have undesirable interactions with your child’s medical treatment. It becomes all the more important to speak with the doctor who can offer advice on the use of alternatives. Official sources confirm this view. Though written for women, we find that the National Women’s Health Information Center’s advice on pursuing alternative medicine is appropriate for everyone.46 Is It Okay to Want Both Traditional and Alternative or Complementary Medicine? Should you wish to explore non-traditional types of treatment, be sure to discuss all issues concerning treatments and therapies with your child’s healthcare provider, whether a physician or practitioner of complementary and alternative medicine. Competent healthcare management requires that the practitioner know of all conventional and alternative therapies that your child is taking. The decision to use complementary and alternative treatments is an important one. Consider before selecting an alternative therapy, the safety and effectiveness of the therapy or treatment, the expertise and qualifications of the healthcare practitioner, and the quality of delivery. These topics should be considered when selecting any practitioner or therapy.

Finding CAM References on Tourette Syndrome Having read the previous discussion, you may be wondering which complementary or alternative treatments might be appropriate for Tourette syndrome. For the remainder of this chapter, we will direct you to a number of official sources which can assist you in researching studies and publications. Some of these articles are rather technical, so some patience may be required.

46

Adapted from http://www.4woman.gov/faq/alternative.htm.


National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov) has created a link to the National Library of Medicine’s databases to allow parents to search for articles that specifically relate to Tourette syndrome and complementary medicine. To search the database, go to the following Web site: www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “Tourette syndrome” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine (CAM) that are related to Tourette syndrome: ·

"Dude, you don't have Tourette's:" Tourette's syndrome, beyond the tics. Author(s): Schapiro NA. Source: Pediatric Nursing. 2002 May-June; 28(3): 243-6, 249-53. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=12087644&dopt=Abstract

·

156 cases of Gilles de la Tourette's syndrome treated by acupuncture. Author(s): Wu L, Li H, Kang L. Source: J Tradit Chin Med. 1996 September; 16(3): 211-3. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9389122&dopt=Abstract

·

A behavioural intervention for Gilles de la Tourette syndrome in a severely mentally handicapped girl. Author(s): Zarkowska E, Crawley B, Locke J. Source: J Ment Defic Res. 1989 June; 33 ( Pt 3): 245-53. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2666670&dopt=Abstract

·

A brief behavior therapy protocol for Tourette syndrome. Author(s): Carr JE, Bailey JS. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1996 March; 27(1): 33-40. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8814519&dopt=Abstract

·

A four-step hypnotherapy model for Gilles de la Tourette's syndrome. Author(s): Culbertson FM.


Source: Am J Clin Hypn. 1989 April; 31(4): 252-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2653022&dopt=Abstract ·

A new hypnobehavioral method for the treatment of children with Tourette's disorder. Author(s): Young MH, Montano RJ. Source: Am J Clin Hypn. 1988 October; 31(2): 97-106. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3228065&dopt=Abstract

·

A simple and a complex tic (Gilles de la Tourette's syndrome): their response to EEG sensorimotor rhythm biofeedback training. Author(s): Tansey MA. Source: International Journal of Psychophysiology : Official Journal of the International Organization of Psychophysiology. 1986 July; 4(2): 91-7. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3460976&dopt=Abstract

·

A treatment model for motor tics based on a specific tension-reduction technique. Author(s): Evers RA, van de Wetering BJ. Source: Journal of Behavior Therapy and Experimental Psychiatry. 1994 September; 25(3): 255-60. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=7852608&dopt=Abstract

·

An evaluation of behavioral treatments for Tourette syndrome. Author(s): Peterson AL, Azrin NH. Source: Behaviour Research and Therapy. 1992 March; 30(2): 167-74. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1567346&dopt=Abstract

·

Cannabinoids: possible role in patho-physiology and therapy of Gilles de la Tourette syndrome. Author(s): Muller-Vahl KR, Kolbe H, Schneider U, Emrich HM. Source: Acta Psychiatrica Scandinavica. 1998 December; 98(6): 502-6. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9879795&dopt=Abstract


·

Cannabis in movement disorders. Author(s): Muller-Vahl KR, Kolbe H, Schneider U, Emrich HM. Source: Forschende Komplementarmedizin. 1999 October; 6 Suppl 3: 237. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10627163&dopt=Abstract

·

Cortical evoked potentials in Gilles de la Tourette's syndrome--a single case study. Author(s): Surwillo WW. Source: Psychiatry Research. 1981 February; 4(1): 31-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6938999&dopt=Abstract

·

Dopamine autoreceptor stimulation: clinical significance. Author(s): Meltzer HY. Source: Pharmacology, Biochemistry, and Behavior. 1982; 17 Suppl 1: 110. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6223322&dopt=Abstract

·

Effects of massed practice and cue-controlled relaxation on tic frequency in Gilles de la Tourette's syndrome. Author(s): Turpin G, Powell GE. Source: Behaviour Research and Therapy. 1984; 22(2): 165-78. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6370223&dopt=Abstract

·

Gilles de la Tourette's syndrome--an overview of development and treatment of a case, using hypnotherapy, haloperidol, and psychotherapy. Author(s): Clements RO. Source: Am J Clin Hypn. 1972 January; 14(3): 167-72. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=4526606&dopt=Abstract

·

Hypnosis as an "entree" for consultation-liaison psychiatry. Author(s): Sandor RS.


Source: General Hospital Psychiatry. 1980 March; 2(1): 65-8. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6929771&dopt=Abstract ·

Influence of treatment of Tourette syndrome with delta9tetrahydrocannabinol (delta9-THC) on neuropsychological performance. Author(s): Muller-Vahl KR, Koblenz A, Jobges M, Kolbe H, Emrich HM, Schneider U. Source: Pharmacopsychiatry. 2001 January; 34(1): 19-24. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11229617&dopt=Abstract

·

Inherited diseases in North American Mennonites: focus on Old Colony (Chortitza) Mennonites. Author(s): Jaworski MA, Severini A, Mansour G, Hennig K, Slater JD, Jeske R, Schlaut J, Yoon JW, Maclaren NK, Nepom GT. Source: American Journal of Medical Genetics. 1989 February; 32(2): 15868. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2784628&dopt=Abstract

·

Man's tripartite brain and psychosomatic medicine. Author(s): Knopp W. Source: Psychotherapy and Psychosomatics. 1970; 18(1): 130-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=5286242&dopt=Abstract

·

Nicotine for the treatment of Tourette's syndrome. Author(s): Sanberg PR, Silver AA, Shytle RD, Philipp MK, Cahill DW, Fogelson HM, McConville BJ. Source: Pharmacology & Therapeutics. 1997; 74(1): 21-5. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9336013&dopt=Abstract

·

'Obsessions' in children with autism or Asperger syndrome. Content analysis in terms of core domains of cognition. Author(s): Baron-Cohen S, Wheelwright S.


Source: The British Journal of Psychiatry; the Journal of Mental Science. 1999 November; 175: 484-90. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10789283&dopt=Abstract ·

Obsessive compulsive disorder: is there an association with childhood streptococcal infections and altered immune function? Author(s): Murphy TK, Petitto JM, Voeller KK, Goodman WK. Source: Semin Clin Neuropsychiatry. 2001 October; 6(4): 266-76. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11607922&dopt=Abstract

·

Occurrence of tics in Asperger's syndrome and autistic disorder. Author(s): Ringman JM, Jankovic J. Source: Journal of Child Neurology. 2000 June; 15(6): 394-400. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=10868783&dopt=Abstract

·

Opiatergic and dopaminergic function and Lesch-Nyhan syndrome. Author(s): Gillman MA, Sandyk R. Source: The American Journal of Psychiatry. 1985 October; 142(10): 1226. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2994499&dopt=Abstract

·

Pharmacological options for the treatment of Tourette's disorder. Author(s): Jimenez-Jimenez FJ, Garcia-Ruiz PJ. Source: Drugs. 2001; 61(15): 2207-20. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11772131&dopt=Abstract

·

Psychiatric aspects of abnormal movement disorders. Author(s): Flinn D, Bazzell W. Source: Brain Research Bulletin. 1983 August; 11(2): 153-61. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6138131&dopt=Abstract

·

Relaxation therapy in Tourette syndrome: a pilot study. Author(s): Bergin A, Waranch HR, Brown J, Carson K, Singer HS.


Source: Pediatric Neurology. 1998 February; 18(2): 136-42. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9535299&dopt=Abstract ·

Relaxation-imagery (self-hypnosis) in Tourette syndrome: experience with four children. Author(s): Kohen DP, Botts P. Source: Am J Clin Hypn. 1987 April; 29(4): 227-37. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3296729&dopt=Abstract

·

Reward deficiency syndrome: genetic aspects of behavioral disorders. Author(s): Comings DE, Blum K. Source: Prog Brain Res. 2000; 126: 325-41. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11105655&dopt=Abstract

·

Startle in Tourette's syndrome. Author(s): Swerdlow NR. Source: Biological Psychiatry. 1998 November 1; 44(9): 935-6. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9807655&dopt=Abstract

·

Stimulus induced behaviours in Tourette's syndrome. Author(s): Eapen V, Moriarty J, Robertson MM. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1994 July; 57(7): 853-5. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8021678&dopt=Abstract

·

Stress management and Gilles de la Tourette's syndrome. Author(s): Michultka DM, Blanchard EB, Rosenblum EL. Source: Biofeedback Self Regul. 1989 June; 14(2): 115-23. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=2571359&dopt=Abstract

·

Tactile prepuff inhibition of startle in children with Tourette's syndrome: in search of an "fMRI-friendly" startle paradigm. Author(s): Swerdlow NR, Karban B, Ploum Y, Sharp R, Geyer MA, Eastvold A.


Source: Biological Psychiatry. 2001 October 15; 50(8): 578-85. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11690592&dopt=Abstract ·

The audiogenic startle reflex in Tourette's syndrome. Author(s): Sachdev PS, Chee KY, Aniss AM. Source: Biological Psychiatry. 1997 April 1; 41(7): 796-803. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=9084898&dopt=Abstract

·

The audiogenic startle response in Tourette's syndrome. Author(s): Stell R, Thickbroom GW, Mastaglia FL. Source: Movement Disorders : Official Journal of the Movement Disorder Society. 1995 November; 10(6): 723-30. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=8749991&dopt=Abstract

·

The treatment of tics. Author(s): Singer HS. Source: Curr Neurol Neurosci Rep. 2001 March; 1(2): 195-202. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11898516&dopt=Abstract

·

Tics through Tourette's syndrome. Author(s): Carter JH. Source: J Neurosci Nurs. 1991 June; 23(3): 145-7. Review. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=1678768&dopt=Abstract

·

Tonic, phasic and cortical arousal in Gilles de la Tourette's syndrome. Author(s): Bock RD, Goldberger L. Source: Journal of Neurology, Neurosurgery, and Psychiatry. 1985 June; 48(6): 535-44. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=3859582&dopt=Abstract

·

Tourette syndrome. Author(s): Carey M, Carbonari C. Source: Nurs News (Meriden). 1979 May; 52(9): 2. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=286980&dopt=Abstract


·

Tourette syndrome: pieces of the puzzle. Author(s): Leckman JF, Cohen DJ, Goetz CG, Jankovic J. Source: Adv Neurol. 2001; 85: 369-90. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11530445&dopt=Abstract

·

Tourette's syndrome: an expanded view. Author(s): O'Quinn AN, Thompson RJ Jr. Source: Pediatrics. 1980 September; 66(3): 420-4. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=6932642&dopt=Abstract

·

Treatment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Author(s): Muller-Vahl KR, Schneider U, Koblenz A, Jobges M, Kolbe H, Daldrup T, Emrich HM. Source: Pharmacopsychiatry. 2002 March; 35(2): 57-61. http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db= PubMed&list_uids=11951146&dopt=Abstract

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: ·

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

·


·

Chinese Medicine: http://www.newcenturynutrition.com/

·

drkoop.comÒ: http://www.drkoop.com/InteractiveMedicine/IndexC.html

·

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

·

Google: http://directory.google.com/Top/Health/Alternative/

·

Healthnotes: http://www.thedacare.org/healthnotes/

·

Open Directory Project: http://dmoz.org/Health/Alternative/

·

TPN.com: http://www.tnp.com/

·

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

·

WebMDÒHealth: http://my.webmd.com/drugs_and_herbs


·

WellNet: http://www.wellnet.ca/herbsa-c.htm

·

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to Tourette Syndrome; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

Alternative Therapy 30-Day Body Purification Program Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/t.html Absent healing Alternative names: absentee healing distance healing distant healing remote healing teleotherapeutics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Acro-sage Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Acupuncture Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Acu puncturecm.html Acupuncture anesthesia Alternative names: acupuncture analgesia acupuncture assisted anesthesia anesthetic acupuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html


Acupuncture energetics Alternative names: core acupuncture energetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Acupuncture imaging Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html African holistic health Alternative names: African holistics African holistic science African medicine Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Alphabiotic Alignment/Unification Process Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Alphabiotics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html American macrobiotics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Anthroposophical medicine Alternative names: anthroposophically-extended medicine anthroposophical therapeutics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html


Apitherapy Alternative names: bee sting therapy bee venom therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Apitherapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 669,00.html Aroma-Genera Alternative names: Aroma-Genera system Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Aromatherapy Alternative names: aromatic medicine conventional aromatherapy holistic aromatherapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Auditing Alternative names: pastoral counseling processing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/a.html Ayurveda Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ayu rvedacm.html


B.E.S.T. Alternative names: Morter Bio Energetic Synchronization Technique Morter B.E.S.T. Morter B.E.S.T. Technique; originally called "bio energetics" Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Bach flower remedies Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 673,00.html Basic Polarity counseling Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Biodynamic psychology Alternative names: Biodynamic therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Bioenergetic therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Bioenergetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Biogenic Support Alternative names: homeovitic support Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html


Biomagnetics Alternative names: biomagnetic medicine Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html BioSonic Repatterning Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html BodyMind Dynamics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/b.html Chelation therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 679,00.html Chi-Therapy Alternative names: Gestalt energy work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Clear Certainty Rundown Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Clearing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Colon Therapy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Colon_Therapy.ht m


Colorpuncture Alternative names: Colorpuncture system Osho Esogetic Colorpuncture system Lightpuncture Osho Lightpuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Core energetics Alternative names: Core Energetic Therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Craniosacral therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 685,00.html Crystal healing Alternative names: crystal therapeutics crystal therapy crystal work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Crystal Therapeutics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Cymatic therapy Alternative names: cymatic medicine Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html Cymatics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/c.html


Detoxification Therapy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Therapy/Detoxification_Th erapy.htm Dianetics Alternative names: dianetic therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/d.html Diet #7 Alternative names: Diet No. 7 Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/d.html Do-In Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/d.html Dr. Lynch's Holistic Self-Health Program Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/d.html Energy Body Work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/e.html Esogetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/e.html Fasting Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 694,00.html


French acupuncture Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/f.html Gentle Bioenergetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/g.html Gestalt Somatic method Alternative names: Gestalt Somatics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/g.html Hakomi Alternative names: Hakomi body-centered psychotherapy Hakomi Body-Mind Process Hakomi Body-Oriented Psychotherapy Hakomi Method Hakomi Method of Body/Mind Therapy Hakomi Therapy Hakomi work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Hakomi Integrative Somatics Alternative names: formerly Hakomi Bodywork Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Holoenergetic healing Alternative names: Holoenergetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html


Homeopathy Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ho meopathycm.html Homeopathy Alternative names: homeopathic medicine homeotherapeutics homoeopathy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Homeopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 703,00.html Homeovitic cellular detoxification Alternative names: homeovitic detoxification Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Homeovitics Alternative names: homoeovitics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Hypnoaesthetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html Integral counseling psychology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/i.html


Intuitive diagnosis Alternative names: intuitive diagnostics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/i.html Iridology Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 709,00.html Ki Energetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/k.html Kripalu DansKinetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/k.html Macrobiotic counseling Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Macrobiotic diagnosis Alternative names: macrobiotic Oriental diagnosis Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Macrobiotic palm healing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html


Macrobiotics Alternative names: the macrobiotic way; formerly called "Zen Macrobiotics" Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Macrobiotics Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 714,00.html Magnet therapy Alternative names: biomagnetics biomagnetic therapeutics biomagnetic therapy biomagnetism Electro-Biomagnetics electrobiomagnetics therapy magnetic energy therapy magnetic field therapy magnetic healing magnetics magnetic therapies Magnetic Therapy magnetotherapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Massage therapy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 716,00.html Medical Dianetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html Medical graphology Alternative names: grapho-diagnostics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/m.html


Native American medicine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 721,00.html Naturopathy Alternative names: natural healing natural health natural medicine natural therapies nature cure naturology naturopathic healing naturopathic health care naturopathic medicine Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/n.html Naturopathy Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 722,00.html Neural therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/n.html New Era Dianetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/n.html Oki-Do Alternative names: Master Oki's way Okido Okido way of living Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/o.html Orthopractic Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/o.html


Osteokinetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/o.html Pathwork Alternative names: The Pathwork Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Planetary Herbology Alternative names: Planetary Herbalism Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Polarity testing Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Preventive Dianetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Psychoenergetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Psychofeedback Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Psychogenetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html


Psychometry Alternative names: object reading psychoscopy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/p.html Qigong therapy Alternative names: buqi buqi therapy external qigong external Qigong healing External Qi Healing medical Qigong Qi An Mo Qigong healing Qi healing Qi Massage wai Qi liao fa Wai Qi Zhi Liao Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/q.html Reichian Therapies Alternative names: Reichian-based therapies Reichian-oriented therapies Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html RL-test Alternative names: electropuncture RL-test Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/r.html Scientology Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Shiatsu Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 733,00.html SkyDancing Tantra Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html


Somatic emotional therapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Somatic therapy Alternative names: somatic disciplines somatic methods somatics somatic techniques somatic therapies Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Sound Energetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Spirituality Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Spiri tualitycm.html Standard Macrobiotic Diet Alternative names: Standard Macrobiotic Dietary Practice Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Suggestive Therapy Alternative names: suggestive therapeutics Suggestive Therapy work Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html The Human Ecology Program Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/h.html


The Sunshine Rundown Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/s.html Theotherapy Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/t.html Therapeutic Touch Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsModalities/Ther apeuticTouchcm.html Therapeutic touch Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 739,00.html Trager Alternative names: psychophysical integration Trager approach Trager bodywork Tragering Trager method Trager Psychophysical Integration Tragerwork Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/t.html Trager approach Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 741,00.html Trager Mentastics Alternative names: Mentastics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/t.html


Transformation-oriented bodywork Alternative names: transformational bodywork Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/t.html TranZenDans Kinetics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/t.html Vibrational medicine Alternative names: energetic medicine energetics medicine energy medicine subtle-energy medicine vibrational healing vibrational therapies Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/v.html Zen Macrobiotics Source: The Canoe version of A Dictionary of Alternative-Medicine Methods, by Priorities for Health editor Jack Raso, M.S., R.D. Hyperlink: http://www.canoe.ca/AltmedDictionary/z.html ·

Chinese Medicine Shexiang Baoxin Wan Alternative names: Shexiang Baoxin Pills; Shexiang Baoxin Wan
(She Xiang Bao Xin Wan) Source: Pharmacopoeia Commission of the Ministry of Health, People's Republic of China Hyperlink: http://www.newcenturynutrition.com/cgilocal/patent_herbs_db/db.cgi?db=default&Chinese=Shexiang%20Ba oxin%20Wan&mh=10&sb=---&view_records=View+Records Weilingxian Alternative names: Chinese Clematis Root; Radix Clematidis Source: Chinese Materia Medica Hyperlink: http://www.newcenturynutrition.com/


·

Herbs and Supplements 5-HTP Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/5 Hydroxytryptophan5HTPcs.html 5-Hydroxytryptophan (5-HTP) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/5 Hydroxytryptophan5HTPcs.html Acanthopanax senticosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengS iberianch.html Acebutolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Acebutolol.htm Achillea Alternative names: Yarrow; Achillea millefolium L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Acidophilus Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 748,00.html Acidophilus and Other Probiotics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000089.html


Aesculus Alternative names: Horse Chestnut; Aesculus hippocastanum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Albuterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Albuterol.htm Aldactazide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Aldactazide. htm Aldoclor Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Aldoclor.htm Aldoril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Aldoril.htm Alfalfa Alternative names: Medicago sativa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Alfalfa.htm Allopurinol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Allopurinol.htm Aloe Alternative names: Aloe vera L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Aloe Alternative names: Aloe vera, Aloe barbadensis, Aloe ferox , Aloe Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Aloech.h tml Aloe Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000091.html Aloe Vera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Aloech.h tml Alpha2-Adrenergic Agonists Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Car diovascularMedicationsAlpha2AdrenergicAgonistscl.html Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/AlphaLipoicAcidcs.html Alpha-Lipoic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Al phaLipoicAcidcs.html


Althaea officinalis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Marshm allowch.html Amiloride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Amiloride.htm Amiloride/Hydrochlorothiazide Alternative names: Moduretic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000325.html Aminoglycoside Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Aminoglycosides.htm Aminoglycosides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsAminoglycosidescl.html Amlodipine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Amlodipine.htm Amoxicillin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Amoxicillin.htm Amoxicillin Alternative names: Amoxil, Trimox, Wymox Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000329.html


Ampicillin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ampicillin.htm Ananas comosus Alternative names: Bromelain Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Bromelaincs.html Ananas comosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br omelaincs.html Andrographis Alternative names: Andrographis paniculata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Andrographis.htm Androstenedione Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Androstenedione.htm Androstenedione Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000095.html Anthelmintics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Anthelmintics.htm


Antibiotic Combination: Sulfa Drugs Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsSulfaDrugscl.html Antibiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Antibiotics.htm Antibiotics (General) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000315.html Anticonvulsants Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Anticonvulsants.htm Anti-Infective Agents Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Anti_Infectives.htm Antitubercular Agents Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Antituberculars.htm Apium graveolens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/CelerySe edch.html Apresazide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Apresazide.h tm


Aralia Alternative names: Spikenard; Aralia sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Arctostaphylos Alternative names: Bearberry; Arctostaphylos uva-ursi (L.) Spreng. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Arctostaphylos uva ursi Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursic h.html Arnica Alternative names: Arnica montana L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Asian Ginseng Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ginseng Asianch.html Astragalus Alternative names: Astragalus membranaceus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Astragalus.htm Atenolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Atenolol.htm


Australian Fevertree Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Eucalypt usch.html Azithromycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Azithromycin.htm Barberry Alternative names: Berberis vulgaris, Berberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Barberry ch.html Barbiturates Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Barbiturates.htm Barbiturates Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti convulsantMedicationsBarbituratescl.html Bearberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursic h.html


Beargrape Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursic h.html Bee products Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 756,00.html Benazepril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Benazepril.htm Bendroflumethiazide/Nadolol Alternative names: Corzide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000344.html Benzamycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Benzamycin.htm Berberis Alternative names: Barberry; Berberis sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Berberis vulgaris Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Barberry ch.html


Berberry Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Barberry ch.html Beta-Blockers Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Car diovascularMedicationsBetaBlockerscl.html Beta-Blockers Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000308.html Beta-Carotene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Beta_Carotene.htm Beta-Carotene Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000104.html Betaine Alternative names: Trimethylglycine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Be tainecs.html Beta-Sitosterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Beta_Sitosterol.htm


Betula Alternative names: Birch; Betula sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Biguanides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti diabeticMedicationsBiguanidescl.html Bilberry Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000107.html Bile Acid Sequestrants Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Bile_Acid_Sequestran ts.htm Bile Acid Sequestrants Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Cho lesterolLoweringMedicationsBileAcidSequestrantscl.html Bismuth Subsalicylate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Bismuth_Subsalicylat e.htm Bisoprolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Bisoprolol.htm


Black Cohosh Alternative names: Cimicifuga racemosa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Black_Cohosh.htm Blood Pressure Drugs Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000347.html Blue Flag Alternative names: Iris versicolor Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Blue_Flag.htm Boldo Alternative names: Peumus boldus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Boldo.htm Boswellia Alternative names: Frankincense; Boswellia serrata Roxb. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Branched-Chain Amino Acids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Branched_Chain_Am inos.htm Brewer's Yeast Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Brewers_Yea st.htm Bromelain Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Bromelain.htm


Bromelain Alternative names: Ananas comosus, Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br omelaincs.html Bromelain Alternative names: Ananas comosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Bromelaincs.html Bromelainum Alternative names: Bromelain Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Bromelaincs.html Bromelainum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Br omelaincs.html Buchu Alternative names: Barosma betulina, Agathosma betulina, Agathosma crenultata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Buchu.htm Bupropion Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Bupropion.htm


Butalbital Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Butalbital.htm Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Calciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminDcs.html Calcitrol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Calcitrol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminDcs.html Calendula Alternative names: Calendula officinalis L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Calendula Alternative names: Calendula officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Calendula.htm Calophyllum Alternative names: Punna, Kamani; Calophyllum sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Camellia sinensis Alternative names: Green Tea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/GreenTeach.html Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTe ach.html Caprylic acid Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10111,00.html Captozide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Captozide.ht m Carnosine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Carnosine.htm


Carotenoids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Carotenes.htm Cascara Alternative names: Cascara sagrada, Rhamnus purshiani cortex Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cascara.htm Cascara sagrada Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10013,00.html Celery Seed Alternative names: Apium graveolens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/CelerySe edch.html Centella Alternative names: Gotu Kola; Centella asiatica (Linn.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Cephalosporins Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cephalosporins.htm Cephalosporins Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsCephalosporinscl.html


Cephalosporins Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000346.html Chamaemelum nobile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileRomanch.html Chamomile, Roman Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileRomanch.html Chemotherapy Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Chemotherapy.htm Chlorhexidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Chlorhexidine.htm Chlorothiazide/Methyldopa Alternative names: Aldoclor Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000318.html Chlorthalidone/Atenolol Alternative names: Tenoretic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000354.html Chlorthalidone/Clonidine Alternative names: Combipres Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000355.html


Chlorzoxazone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Chlorzoxazone.htm Cholecalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html Cholecalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminDcs.html Cimetidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cimetidine.htm Cinnamomum Alternative names: Cinnamon; Cinnamomum zeylanicum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Ciprofloxacin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ciprofloxacin.htm Clarithromycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clarithromycin.htm


Clindamycin Oral Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clindamycin_Oral.ht m Clindamycin Topical Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clindamycin_Topical .htm Clonidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clonidine.htm Clonidine Alternative names: Catapres Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000352.html Cobalamin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB12Cobalamincs.html Coenzyme Q Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 768,00.html Coenzyme Q10 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Coenzyme_Q10.htm


Coenzyme Q10 Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C oenzymeQ10cs.html Coenzyme Q10 (CoQ10) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000135.html Colestipol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Colestipol.htm Coleus Alternative names: Coleus forskohlii Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Coleus.htm Colloidal Silver Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Colloidal_Silver.htm Combipres Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Combipres.h tm CoQ10 Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C oenzymeQ10cs.html


Cornus Alternative names: Dogwood; Cornus florida & officinalis Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids.htm Corticosteroids Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000336.html Cranberry Alternative names: Vaccinium macrocarpon Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cranberry.htm Cranberry Alternative names: Vaccinium macrocarpon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cranberr ych.html Cranberry Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10019,00.html Crataegus Alternative names: Hawthorn; Crataegus oxyacantha L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Crataegus laevigata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Hawthor nch.html Crataegus monogyna Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Hawthor nch.html Cyclophosphamide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cyclophosphamide.h tm Cycloserine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cycloserine.htm Dandelion Alternative names: Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/Dandelionch.html Dandelion Alternative names: Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Dandelio nch.html


Dandelion Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000143.html Dandelion Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10021,00.html Dapsone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Dapsone.htm Dehydroepiandrosterone (DHEA) Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/DHEA.htm DHA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/D ocosahexaenoicAcidDHAcs.html Diclofenac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diclofenac.htm Dicloxacillin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Dicloxacillin.htm Digoxin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Digoxin.htm


Diltiazem Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diltiazem.htm Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Diuretics.htm Diuretics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000366.html Docosahexaenoic Acid (DHA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/D ocosahexaenoicAcidDHAcs.html Doxycycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Doxycycline.htm Dryopteris Alternative names: Male Fern; Dryopteris sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Dyazide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Dyazide.htm


Echinacea Alternative names: Echinacea angustifolia, Echinacea pallida, Echinacea purpurea, Purple Coneflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Echinacea Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000149.html Echinacea Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 775,00.html Echinacea angustifolia Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Echinacea pallida Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Echinacea purpurea Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html


EDTA Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Et hylenediaminetetraaceticAcidEDTAcs.html Elecampane Alternative names: Inula helenium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Elecampane.htm Electrolytes Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Car diovascularMedicationsElectrolytescl.html Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengS iberianch.html Eleutherococcus senticosus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengS iberianch.html Enalapril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Enalapril.htm


Ephedra Alternative names: Ephedra sinica, Ephedra intermedia, Ephedra equisetina Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ephedra.htm Ephedra Alternative names: Ephedra sinensis, Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedra ch.html Ephedra (Ma huang) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 777,00.html Ephedra sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedra ch.html Epinephrine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Epinephrine.htm Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html


Erocalciferol Alternative names: Vitamin D Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminDcs.html Erythromycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Erythromycin.htm Ethylenediaminetetraacetic Acid (EDTA) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Et hylenediaminetetraaceticAcidEDTAcs.html Etodolac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Etodolac.htm Eucalyptus Alternative names: Eucalyptus globulus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Eucalyptus.htm Eucalyptus Alternative names: Eucalyptus globulus, Eucalyptus fructicetorum, polybractea, smithii, Australian Fevertree Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Eucalypt usch.html


Eucalyptus globulus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Eucalypt usch.html Eugenia Clove Alternative names: Cloves; Eugenia sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Evening Primrose Alternative names: Oenothera biennis, Sun Drop Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Evening Primrosech.html Fenugreek Alternative names: Trigonella foenum-graecum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Fenugreek.htm Fenugreek Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000156.html Fiber Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Fiber.htm Fluvoxamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Fluvoxamine.htm


FOS Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10026,00.html Garcinia cambogia Alternative names: Citrin, Gambooge Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Gemfibrozil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Gemfibrozil.htm General Anesthetics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Anesthetic_Major.ht m Gentamicin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Gentamicin.htm Ginkgo Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000167.html Ginkgo biloba Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb_Drugix/Ginkgo_Bilob a.htm


Ginkgo Biloba Alternative names: Maidenhair Tree Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/GinkgoBilobach.html Ginkgo Biloba Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinkgoBi lobach.html Ginseng (Panax) Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10029,00.html Ginseng, Asian Alternative names: Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ginseng Asianch.html Ginseng, Siberian Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus, Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengS iberianch.html Glandular Extracts Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glandular_Extracts.ht m


Glipizide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Glipizide.htm Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Glucosamine.htm Glucosamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Gl ucosaminecs.html Glucosamine Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000168.html Glucosamine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 790,00.html Glyburide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Glyburide.htm Glycyrrhiza glabra Alternative names: Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/Licoricech.html


Glycyrrhiza glabra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricec h.html Glycyrrhiza1 Alternative names: Licorice; Glycyrrhiza glabra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Golden Seal Source: The Canadian Internet Directory for Holistic Help, WellNet, Health and Wellness Network; www.wellnet.ca Hyperlink: http://www.wellnet.ca/herbsg-i.htm Goldenrod Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000170.html Goldenseal Alternative names: Hydrastis canadensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Goldenseal.htm Goldenseal Alternative names: Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldense alch.html Goldenseal Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000171.html


Grape Seed Alternative names: Vitis vinifera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GrapeSe edExtractch.html Grapefruit Seed Extract Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Grapefruit_Seed_Extr act.htm Green Tea Alternative names: Camellia sinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Green_Tea.htm Green Tea Alternative names: Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/GreenTeach.html Green Tea Alternative names: Camellia sinensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GreenTe ach.html Gymnema Alternative names: Gurmar; Gymnema sylvestre Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Gymnema Alternative names: Gymnema sylvestre Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Gymnema.htm Haloperidol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Haloperidol.htm Hawthorn Alternative names: Crataegus monogyna, Crataegus laevigata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Hawthor nch.html Heparin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Heparin.htm Heparin Alternative names: Hep-Lock Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000373.html Histamine H2 Antagonists Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Ulce rMedicationsHistamineH2Antagonistscl.html Horehound Alternative names: Marrubium vulgare Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horehound.htm


Horseradish Alternative names: Cochlearia armoracia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horseradish.htm Horsetail Alternative names: Equisetum arvense Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Horsetail.htm Horsetail Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000183.html Huperzia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Huperzia.htm Huperzine A Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000184.html Hydantoin Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti convulsantMedicationsHydantoinDerivativescl.html Hydralazine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Hydralazine.htm Hydralazine Alternative names: Apresoline Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000334.html


Hydrastis canadensis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Goldense alch.html Hydrochlorothiazide/Benazepril Alternative names: Lotensin HCT Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000375.html Hydrochlorothiazide/Bisoprolol Alternative names: Ziac Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000376.html Hydrochlorothiazide/Captopril Alternative names: Capozide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000350.html Hydrochlorothiazide/Enalapril Alternative names: Vaseretic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000377.html Hydrochlorothiazide/Hydralazine Alternative names: Apresazide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000333.html Hydrochlorothiazide/Lisinopril Alternative names: Prinzide, Zestoretic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000378.html Hydrochlorothiazide/Methyldopa Alternative names: Aldoril Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000320.html


Hydrochlorothiazide/Metoprolol Alternative names: Lopressor HCT Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000379.html Hydrochlorothiazide/Moexipril Alternative names: Uniretic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000380.html Hydrochlorothiazide/Propranolol Alternative names: Inderide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000381.html Hydrochlorothiazide/Timolol Alternative names: Timolide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000382.html Hypericum perforatum Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohns Wortch.html Hyzaar Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Hyzaar.htm Ibuprofen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ibuprofen.htm Illicium Alternative names: Star Anise; Illicium verum (Hook, F.) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Indapamide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Indapamide.htm Inderide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Inderide.htm Indinavir Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Indinavir.htm Inhalant, Systemic, and Topical Corticosteroids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti inflammatoryMedicationsInhalantSystemicandTopicalCorticosteroids cl.html Inositol Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000187.html Insulin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Insulin.htm Ipecac Alternative names: Cephaelis ipecacuanha Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ipecac.htm Ipriflavone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Ipriflavone.htm


Isoniazid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Isoniazid.htm Isoniazid Alternative names: Laniazid, Nydrazid Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000383.html Isosorbide Dinitrate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Isosorbide_Dinitrate. htm Isosorbide Mononitrate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Isosorbide_Mononitr ate.htm Ispaghula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps ylliumcs.html Juniper Berry Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000191.html Juniperus Alternative names: Juniper; Juniperus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Kava Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 798,00.html Ketoprofen Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ketoprofen.htm Ketorolac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ketorolac.htm Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohns Wortch.html Kochia Alternative names: Summer Cypress, Fireweed; Kochia scoparia (L.) Schrad Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Kudzu Alternative names: Pueraria lobata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Kudzu.htm L. Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/L actobacillusacidophiluscs.html


Labetalol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Labetalol.htm Lactobacillus Acidophilus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/L actobacillusacidophiluscs.html Lavandula Alternative names: Lavender; Lavandula sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Lavender Alternative names: Lavandula officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Lavender.htm Lecithin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000150.html Lemon Balm Alternative names: Melissa officinalis, Melissa Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/LemonBa lmch.html Lepidium sp Alternative names: Cress; Lepidium sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Levodopa/Carbidopa Alternative names: Sinemet Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000351.html Levofloxacin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Levofloxacin.htm Licorice Alternative names: Glycyrrhiza glabra, Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricec h.html Licorice Alternative names: Glycyrrhiza glabra Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/Licoricech.html Licorice Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 801,00.html Ligustrum Alternative names: Ligustrum lucidum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Ligustrum.htm Linden Alternative names: Tilia spp. Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Linden.htm


Lipotropic combination Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 861,00.html Lobelia Alternative names: Lobelia inflata L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Lobelia Alternative names: Lobelia inflata Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Lobelia.htm Loop Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Loop_Diuretics.htm Loop Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diur eticsLoopDiureticscl.html Loop Diuretics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000349.html Lopressor HCT Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Lopressor_H CT.htm


Loracarbef Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Loracarbef.htm Losartan Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Losartan.htm Lotrel Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Lotrel.htm Lysine Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 862,00.html Ma huang Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ephedra ch.html Macrolides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Macrolides.htm Macrolides Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsMacrolidescl.html


Maidenhair Tree Alternative names: Ginkgo Biloba Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/GinkgoBilobach.html Maidenhair Tree Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinkgoBi lobach.html Marshmallow Alternative names: Althaea officinalis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Marshm allowch.html Maxzide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Maxzide.htm Medium Chain Triglycerides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Medium_Chain_Trigl ycerides.htm Melatonin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/M elatonincs.html


Menadione Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminKcs.html Menadione Alternative names: Vitamin K Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminKcs.html Menaphthone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminKcs.html Menaphthone Alternative names: Vitamin K Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminKcs.html Menaquinone Alternative names: Vitamin K Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminKcs.html


Menaquinone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminKcs.html Metformin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Metformin.htm Methotrexate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Methotrexate.htm Methyldopa Alternative names: Aldomet Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000319.html Metoprolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Metoprolol.htm Metronidazole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Metronidazole.htm Milk Thistle Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000209.html Milk thistle Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10044,00.html


Minocycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Minocycline.htm Mistletoe Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10109,00.html Mixed Amphetamines Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Mixed_Amphetamine s.htm Moduretic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Moduretic.ht m Monophasic, Biphasic, and Triphasic Preparations Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Birt hControlMedicationscl.html Mupirocin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Mupirocin.htm Musa Banana Alternative names: Plantain, Banana; Musa sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Myrrh Alternative names: Commiphora molmol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Myrrh.htm Nabumetone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nabumetone.htm N-Acetyl-Glucosamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/N_Acetyl_Glucosami ne.htm Nadolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nadolol.htm Neomycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Neomycin.htm Nettle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Stinging Nettlech.html Nifedipine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nifedipine.htm Nitrofurantoin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nitrofurantoin.htm


Nitroglycerin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nitroglycerin.htm Nitrous Oxide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Nitrous_Oxide.htm Oak Alternative names: Quercus spp. Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Oak.htm Ocimum Alternative names: Basil, Albahaca; Ocimum basilicum Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Oenothera biennis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Evening Primrosech.html Ofloxacin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ofloxacin.htm Oral Contraceptives Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000321.html Oral Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids_Oral. htm


Oral Hypoglycemics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000304.html Orlistat Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Orlistat.htm Oxaprozin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Oxaprozin.htm PABA Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/PABA.htm PABA Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10049,00.html PABA (Para-Aminobenzoic Acid) Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000217.html Panax Alternative names: Ginseng; Panax ginseng Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Panax ginseng Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Ginseng Asianch.html


Passiflora Alternative names: Passion Flower; Passiflora alata L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Penicillamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Penicillamine.htm Penicillin Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsPenicillinDerivativescl.html Penicillin V Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Penicillin_V.htm Penicillins Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Penicillins.htm Perphenazine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Perphenazine.htm Phenobarbital Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Phenobarbital.htm Phenobarbital Alternative names: Bellatal, Solfoton Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000343.html


Phenothiazines Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000330.html Phenylalanine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P henylalaninecs.html Phenylpropanolamine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Phenylpropanolamin e.htm Phenytoin Alternative names: Dilantin Infatab, Dilantin-125 Oral Suspension Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000364.html Phosphorus Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P hosphoruscs.html Phylloquinone Alternative names: Vitamin K Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminKcs.html Phylloquinone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminKcs.html


Piper nigrum Alternative names: Black Pepper Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps ylliumcs.html Plantago major Alternative names: Plantain; Plantago major/lanceolata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Plantago psyllium Alternative names: Psyllium, Ispaghula; Plantago psyllium/ovata Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Potentilla Alternative names: Cinquefoil, Silverweed; Potentilla sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Prazosin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Prazosin.htm Prickly Ash Alternative names: Zanthoxylum clava-herculis, Zanthoxylum americanum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Prickly_Ash.htm


Primidone Alternative names: Mysoline Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000387.html Prinizide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Prinizide.ht m Probiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Probiotics.htm Probiotics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Probiotics.ht m Propranolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Propranolol.htm Proton Pump Inhibitors (Gastric Acid Secretion Inhibitors) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Ulce rMedicationsProtonPumpInhibitorscl.html Prunella Alternative names: Self Heal; Prunella vulgaris L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Psyllium Alternative names: Plantago ovata, Plantago ispaghula Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Psyllium.htm Psyllium Alternative names: Ispaghula,Plantago isphagula Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ps ylliumcs.html Psyllium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 814,00.html Purple Coneflower Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Echinace ach.html Quinapril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Quinapril.htm Quinidine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Quinidine.htm Quinolones Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Quinolones.htm


Quinolones Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsQuinolonescl.html Ramipril Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Ramipril.htm Red Clover Alternative names: Trifolium pratense Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Red_Clover.htm Red Clover Alternative names: Trifolium pratense , beebread, cow clover, cow grass, meadow clover, purple clover Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/RedClov erch.html Reishi Alternative names: Ganoderma lucidum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Reishi.htm Repaglinide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Repaglinide.htm Ribes Alternative names: Black Currant; Ribes nigrum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Risedronate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Risedronate.htm Roman Chamomile Alternative names: Chamaemelum nobile Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Chamom ileRomanch.html Rosemary Alternative names: Rosmarinus officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Rosemary.htm Sabal serrulata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/SawPalm ettoch.html Sambucus Alternative names: Black Elderberry; Sambucus nigra L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Saw Palmetto Alternative names: Serenoa repens, Sabal serrulata Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/SawPalm ettoch.html


Schisandra Alternative names: Schisandra chinensis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Schisandra.htm Serenoa repens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/SawPalm ettoch.html Sertraline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sertraline.htm Siberian Ginseng Alternative names: Eleutherococcus senticosus, Acanthopanax senticosus, Eleuthero Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GinsengS iberianch.html Silybum Alternative names: Milk Thistle; Silybum marianum (L.) Gaertn. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Sotalol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sotalol.htm


Spanish Licorice Alternative names: Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/Licoricech.html Spanish Licorice Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Licoricec h.html St. John's Wort Alternative names: Hypericum perforatum, Klamathweed Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/StJohns Wortch.html St. John's Wort Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000237.html St. John's wort Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 824,00.html Stevia Alternative names: Sweetleaf; Stevia rebaudiana Bertoni Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Stevia Alternative names: Stevia rebaudiana Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Stevia.htm


Stevia Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000238.html Sulfamethoxazole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sulfamethoxazole.ht m Sulfasalazine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sulfasalazine.htm Sulfonamides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sulfonamides.htm Sulfonylureas Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti diabeticMedicationsSulfonylureascl.html Sun Drop Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Evening Primrosech.html Syzygium Clove Alternative names: Clove, Jamun; Syzygium sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Tanacetum Alternative names: Feverfew; Tanacetum parthenium (L.) Schultz-Bip. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Taraxacum Alternative names: Dandelion; Taraxacum officinale (Dhudhal) Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Taraxacum officinale Alternative names: Dandelion Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsHerbs/Interacti ons/Dandelionch.html Taraxacum officinale Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Dandelio nch.html Taurine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Taurine.htm Tea Tree Alternative names: Melaleuca alternifolia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Tea_Tree.htm Tea Tree Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000240.html


Tenoretic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Tenoretic.ht m Terbinafine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Terbinafine.htm Tetracycline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tetracycline.htm Tetracycline Derivatives Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Anti bioticMedicationsTetracyclineDerivativescl.html Tetracyclines Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tetracyclines.htm Theophylline/Aminophylline Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Theophylline.htm Thiazide Diuretics Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Thiazide_Diuretics.ht m


Thiazide Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diur eticsThiazideDiureticscl.html Thiazide Diuretics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000335.html Thuja occid Alternative names: Arbor Vitae; Thuja occidentalis Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thuja plicata Alternative names: Western Red Cedar Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Thyme Alternative names: Thymus vulgaris Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Thyme.htm Timolide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Timolide.ht m Timolol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Timolol.htm


Tobramycin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tobramycin.htm Topical Corticosteroids Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Corticosteroids_Topic al.htm Trazodone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Trazodone.htm Triamterene Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Triamterene.htm Triamterene/Hydrochlorothiazide Alternative names: Dyazide, Maxzide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000367.html Tribulus Puncture Alternative names: Puncture Vine, Goathead; Tribulus terrestris L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Tricyclic Antidepressants Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tricyclic_Antidepress ants.htm Trigonella Alternative names: Fenugreek; Trigonella foenum graecum L. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/


Trimethoprim Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Trimethoprim.htm Trimethoprim/Sulfamethoxazole Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Trimethoprim_Sulfa methoxazole.htm Trimethoprim/Sulfamethoxazole Alternative names: Bactrim, Cotrim, Septra, Sulfatrim Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000342.html Trimethylglycine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Be tainecs.html Uricosuric Agents Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: Uricosuric Agents Urtica dioica Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Stinging Nettlech.html Urtica urens Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Stinging Nettlech.html


Uva Ursi Alternative names: Arctostaphylos uva ursi, Bearberry, Beargrape Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Uvaursic h.html Uva Ursi Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000103.html Vaccinium macrocarpon Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Cranberr ych.html Valerian Alternative names: Valeriana officinalis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Valerianc h.html Valeriana officinalis Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Valerianc h.html Valproic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Valproic_Acid.htm


Vaseretic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Vaseretic.ht m Verapamil Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Verapamil.htm Vervain Alternative names: Verbena officinalis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Vervain.htm Viburnum Alternative names: Cramp Bark, Highbush Cranberry; Viburnum sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Vitex Alternative names: Chaste; Vitex agnus-castus Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Vitis vinifera Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/GrapeSe edExtractch.html Warfarin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Warfarin.htm


Wild Cherry Alternative names: Prunus serotina Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Wild_Cherry.htm Wormwood Alternative names: Artemisia absinthium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Wormwood.htm Zestoretic Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Zestoretic.ht m Ziac Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug_Combo/Ziac.htm Zingiber Alternative names: Ginger; Zingiber officinale Roscoe Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Zizyphus Alternative names: Jujube; Ziziphus sp. Source: Alternative Medicine Foundation, Inc.; www.amfoundation.org Hyperlink: http://www.herbmed.org/ Zolpidem Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Zolpidem.htm


General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at: www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources. The following additional references describe, in broad terms, alternative and complementary medicine (sorted alphabetically by title; hyperlinks provide rankings, information, and reviews at Amazon.com): · Alternative and Complementary Treatment in Neurologic Illness by Michael I. Weintraub (Editor); Paperback - 288 pages (March 23, 2001), Churchill Livingstone; ISBN: 0443065586; http://www.amazon.com/exec/obidos/ASIN/0443065586/icongroupinterna · Healthy Child, Whole Child: Integrating the Best of Conventional and Alternative Medicine to Keep Your Kids Healthy by Stuart H. Ditchek, M.D. and Russell H. Greenfield; Paperback - 464 pages (June 2002), Harper Resource; ISBN: 0062737465; http://www.amazon.com/exec/obidos/ASIN/0062737465/icongroupinterna · Radical Healing: Integrating the World’s Great Therapeutic Traditions to Create a New Transformative Medicine by Rudolph Ballentine, M.D., Linda Funk (Illustrator); Paperback - 612 pages; Reprint edition (March 14, 2000), Three Rivers Press; ISBN: 0609804847; http://www.amazon.com/exec/obidos/ASIN/0609804847/icongroupinterna ·

The Review of Natural Products by Facts and Comparisons (Editor); CdRom edition (January 2002), Facts & Comparisons; ISBN: 1574391453; http://www.amazon.com/exec/obidos/ASIN/1574391453/icongroupinterna

For additional information on complementary and alternative medicine, ask your child’s doctor or write to: National Institutes of Health National Center for Complementary and Alternative Medicine Clearinghouse P. O. Box 8218 Silver Spring, MD 20907-8218


Vocabulary Builder The following vocabulary builder gives definitions of words used in this chapter that have not been defined in previous chapters: Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Acebutolol: A cardioselective beta-adrenergic antagonist with little effect on the bronchial receptors. The drug has stabilizing and quinidine-like effects on cardiac rhythm as well as weak inherent sympathomimetic action. [NIH] Acidity: L. aciditas) the quality of being acid or sour; containing acid (hydrogen ions). [EU] Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock,


and death. [NIH] Androstenedione: A steroid with androgenic properties that is produced in the testis, ovary, and adrenal cortex. It is a precursor to testosterone and other androgenic hormones. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

Anthelmintic: An agent that is destructive to worms. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aromatic: Having a spicy odour. [EU] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU] Ascariasis: Infection by nematodes of the genus ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]

Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH]


Bisoprolol: A cardioselective beta-1-adrenergic blocker. It is effective in the management of hypertension and angina pectoris. [NIH] Blepharitis: Inflammation of the eyelids. [EU] Bronchitis: Inflammation of one or more bronchi. [EU] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU]

Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbidopa: A peripheral inhibitor of dopa decarboxylase. It is given in parkinsonism along with levodopa to inhibit the conversion of levodopa to dopamine in the periphery, thereby reducing the peripheral adverse effects, increasing the amount of levodopa that reaches the central nervous system, and reducing the dose needed. It has no antiparkinson actions when given alone. [NIH] Cardiac: Pertaining to the heart. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble,


unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]

Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU] Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Colestipol: Highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic. It may also may reduce triglyceride levels. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal


region but may occur in other body regions as well. [NIH] Colloidal: Of the nature of a colloid. [EU] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects, mutations, and cancer. [NIH] Dermatitis: Inflammation of the skin. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU]

Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Dysmenorrhea: Painful menstruation. [NIH] Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of


the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity; called also adenomyosis externa and endometriosis externa. [EU] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Equisetum: A genus of plants closely related to ferns. Some species have medicinal use and some are poisonous. [NIH] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Filariasis: Infections with nematodes of the superfamily filarioidea. The presence of living worms in the body is mainly asymptomatic but the death of adult worms leads to granulomatous inflammation and permanent fibrosis. Organisms of the genus Elaeophora infect wild elk and domestic sheep causing ischaemic necrosis of the brain, blindness, and dermatosis of the face. [NIH] Frostbite: Damage to tissues as the result of low environmental temperatures. [NIH] Gastritis: Inflammation of the stomach. [EU] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glipizide: An oral hypoglycemic agent which is rapidly absorbed and completely metabolized. [NIH]


Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Glycyrrhiza: A genus of leguminous herbs or shrubs whose roots yield glycyrrhetinic acid and its derivatives, carbenoxolone for example. Licorice toxicity is manifested as hypokalemia, low blood potassium. Licorice is used as flavoring and aromatic in pharmaceuticals and as candy. [NIH] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatitis: Inflammation of the liver. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate, tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and


only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral bioavailability. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH] Intestinal: Pertaining to the intestine. [EU] Ipecac: A syrup made from the dried rhizomes of two different species, Cephaelis ipecacuanha and C. acuminata, belonging to the rubiaciae family. They contain emetine, cephaeline, psychotrine and other isoquinolines. Ipecac syrup is used widely as an emetic acting both locally on the gastric mucosa and centrally on the chemoreceptor trigger zone. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Isosorbide: 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. [NIH] Juniper:

A slow growing coniferous evergreen tree or shrub, genus


Juniperus. The Juniper is cultivated for its berries, which take up to three years to ripen. The resinous, sweetly flavored berries are borne only by the female juniper, and can be found in various stages of ripeness on the same plant. [NIH] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Labetalol: Blocker of both alpha- and beta-adrenergic receptors that is used as an antihypertensive. [NIH] Larva: Wormlike or grublike stage, following the egg in the life cycle of insects, worms, and other metamorphosing animals. [NIH] Laryngitis: Inflammation of the larynx, a condition attended with dryness and soreness of the throat, hoarseness, cough and dysphagia. [EU] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH]

Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Menorrhagia: Excessive uterine bleeding occurring at the regular intervals of menstruation, the period of flow being of greater than usual duration. [EU] Methotrexate: An antineoplastic antimetabolite with immunosuppressant


properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an essential component of DNA. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [NIH] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]

Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac


regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Pelvic: Pertaining to the pelvis. [EU] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Pharyngitis: Inflammation of the pharynx. [EU] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory gaba subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280-400 mm. There are two main types : photoallergy and photoxicity. [EU] Plantago: Three different species of Plantago or plantain, P. psyllium, P. ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH]


Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Proctitis: Inflammation of the rectum. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Pulmonary: Pertaining to the lungs. [EU] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission. [NIH] Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]

Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any


particular involuntary activity. [EU] Reishi: A mushroom, Ganoderma lucidum, of the aphyllophorales order of basidomycetous fungi. It has long been used in traditional Chinese medicine in various forms. Contains sterols, coumarin, mannitol, polysaccharides, and triterpenoids. [NIH] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Sotalol: An adrenergic beta-antagonist that is used in the treatment of lifethreatening arrhythmias. [NIH] Stenosis: Narrowing or stricture of a duct or canal. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Thrombocytosis: Increased numbers of platelets in the peripheral blood. [EU] Timolol: A beta-adrenergic antagonist similar in action to propranolol. The levo-isomer is the more active. Timolol has been proposed as an antihypertensive, antiarrhythmic, antiangina, and antiglaucoma agent. It is also used in the treatment of migraine and tremor. [NIH] Tobramycin: An aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius. It is effective against gram-negative bacteria, especially the Pseudomonas species. It is a 10% component of the antibiotic


complex, nebramycin, produced by the same species. [NIH] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Trichinosis: A disease due to infection with trichinella spiralis. It is caused by eating undercooked meat, usually pork. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Uricosuric: 1. pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. an agent that promotes uricosuria. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Veins: The vessels carrying blood toward the heart. [NIH] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitex: A genus of trees in the lamiaceae family containing assorted flavonoids with possible analgesic and antineoplastic properties. The fruit of these trees is used in herbal preparations. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]

Researching Nutrition 289

APPENDIX C. RESEARCHING NUTRITION Overview Since the time of Hippocrates, doctors have understood the importance of diet and nutrition to health and well-being. Since then, they have accumulated an impressive archive of studies and knowledge dedicated to this subject. Based on their experience, doctors and healthcare providers may recommend particular dietary supplements for Tourette syndrome. Any dietary recommendation is based on age, body mass, gender, lifestyle, eating habits, food preferences, and health condition. It is therefore likely that different patients with Tourette syndrome may be given different recommendations. Some recommendations may be directly related to Tourette syndrome, while others may be more related to general health. In this chapter we will begin by briefly reviewing the essentials of diet and nutrition that will broadly frame more detailed discussions of Tourette syndrome. We will then show you how to find studies dedicated specifically to nutrition and Tourette syndrome.


Food and Nutrition: General Principles What Are Essential Foods? Food is generally viewed by official sources as consisting of six basic elements: (1) fluids, (2) carbohydrates, (3) protein, (4) fats, (5) vitamins, and (6) minerals. Consuming a combination of these elements is considered to be a healthy diet: ·

Fluids are essential to human life as 80-percent of the body is composed of water. Water is lost via urination, sweating, diarrhea, vomiting, diuretics (drugs that increase urination), caffeine, and physical exertion.

·

Carbohydrates are the main source for human energy (thermoregulation) and the bulk of typical diets. They are mostly classified as being either simple or complex. Simple carbohydrates include sugars which are often consumed in the form of cookies, candies, or cakes. Complex carbohydrates consist of starches and dietary fibers. Starches are consumed in the form of pastas, breads, potatoes, rice, and other foods. Soluble fibers can be eaten in the form of certain vegetables, fruits, oats, and legumes. Insoluble fibers include brown rice, whole grains, certain fruits, wheat bran and legumes.

·

Proteins are eaten to build and repair human tissues. Some foods that are high in protein are also high in fat and calories. Food sources for protein include nuts, meat, fish, cheese, and other dairy products.

·

Fats are consumed for both energy and the absorption of certain vitamins. There are many types of fats, with many general publications recommending the intake of unsaturated fats or those low in cholesterol.

Vitamins and minerals are fundamental to human health, growth, and, in some cases, disease prevention. Most are consumed in your child’s diet (exceptions being vitamins K and D which are produced by intestinal bacteria and sunlight on the skin, respectively). Each vitamin and mineral plays a different role in health. The following outlines essential vitamins: ·

Vitamin A is important to the health of eyes, hair, bones, and skin; sources of vitamin A include foods such as eggs, carrots, and cantaloupe.

·

Vitamin B1, also known as thiamine, is important for the nervous system and energy production; food sources for thiamine include meat, peas, fortified cereals, bread, and whole grains.

·

Vitamin B2, also known as riboflavin, is important for the nervous system and muscles, but is also involved in the release of proteins from


nutrients; food sources for riboflavin include dairy products, leafy vegetables, meat, and eggs. ·

Vitamin B3, also known as niacin, is important for healthy skin and helps the body use energy; food sources for niacin include peas, peanuts, fish, and whole grains

·

Vitamin B6, also known as pyridoxine, is important for the regulation of cells in the nervous system and is vital for blood formation; food sources for pyridoxine include bananas, whole grains, meat, and fish.

·

Vitamin B12 is vital for a healthy nervous system and for the growth of red blood cells in bone marrow; food sources for vitamin B12 include yeast, milk, fish, eggs, and meat.

·

Vitamin C allows the body’s immune system to fight various medical conditions, strengthens body tissue, and improves the body’s use of iron; food sources for vitamin C include a wide variety of fruits and vegetables.

·

Vitamin D helps the body absorb calcium which strengthens bones and teeth; food sources for vitamin D include oily fish and dairy products.

·

Vitamin E can help protect certain organs and tissues from various degenerative diseases; food sources for vitamin E include margarine, vegetables, eggs, and fish.

·

Vitamin K is essential for bone formation and blood clotting; common food sources for vitamin K include leafy green vegetables.

·

Folic Acid maintains healthy cells and blood; food sources for folic acid include nuts, fortified breads, leafy green vegetables, and whole grains.

It should be noted that one can overdose on certain vitamins which become toxic if consumed in excess (e.g. vitamin A, D, E and K). Like vitamins, minerals are chemicals that are required by the body to remain in good health. Because the human body does not manufacture these chemicals internally, we obtain them from food and other dietary sources. The more important minerals include: ·

Calcium is needed for healthy bones, teeth, and muscles, but also helps the nervous system function; food sources for calcium include dry beans, peas, eggs, and dairy products.

·

Chromium is helpful in regulating sugar levels in blood; food sources for chromium include egg yolks, raw sugar, cheese, nuts, beets, whole grains, and meat.


·

Fluoride is used by the body to help prevent tooth decay and to reinforce bone strength; sources of fluoride include drinking water and certain brands of toothpaste.

·

Iodine helps regulate the body’s use of energy by synthesizing into the hormone thyroxine; food sources include leafy green vegetables, nuts, egg yolks, and red meat.

·

Iron helps maintain muscles and the formation of red blood cells and certain proteins; food sources for iron include meat, dairy products, eggs, and leafy green vegetables.

·

Magnesium is important for the production of DNA, as well as for healthy teeth, bones, muscles, and nerves; food sources for magnesium include dried fruit, dark green vegetables, nuts, and seafood.

·

Phosphorous is used by the body to work with calcium to form bones and teeth; food sources for phosphorous include eggs, meat, cereals, and dairy products.

·

Selenium primarily helps maintain normal heart and liver functions; food sources for selenium include wholegrain cereals, fish, meat, and dairy products.

·

Zinc helps wounds heal, the formation of sperm, and encourage rapid growth and energy; food sources include dried beans, shellfish, eggs, and nuts.

The United States government periodically publishes recommended diets and consumption levels of the various elements of food. Again, the doctor may encourage deviations from the average official recommendation based on your child’s specific condition. To learn more about basic dietary guidelines, visit the Web site: http://www.health.gov/dietaryguidelines/. Based on these guidelines, many foods are required to list the nutrition levels on the food’s packaging. Labeling Requirements are listed at the following site maintained by the Food and Drug Administration: http://www.cfsan.fda.gov/~dms/lab-cons.html. When interpreting these requirements, the government recommends that consumers become familiar with the following abbreviations before reading FDA literature:47 ·

DVs (Daily Values): A new dietary reference term that will appear on the food label. It is made up of two sets of references, DRVs and RDIs.

·

DRVs (Daily Reference Values): A set of dietary references that applies to fat, saturated fat, cholesterol, carbohydrate, protein, fiber, sodium, and potassium.

47

Adapted from the FDA: http://www.fda.gov/fdac/special/foodlabel/dvs.html.


·

RDIs (Reference Daily Intakes): A set of dietary references based on the Recommended Dietary Allowances for essential vitamins and minerals and, in selected groups, protein. The name “RDI” replaces the term “U.S. RDA.”

·

RDAs (Recommended Dietary Allowances): A set of estimated nutrient allowances established by the National Academy of Sciences. It is updated periodically to reflect current scientific knowledge.

What Are Dietary Supplements?48 Dietary supplements are widely available through many commercial sources, including health food stores, grocery stores, pharmacies, and by mail. Dietary supplements are provided in many forms including tablets, capsules, powders, gel-tabs, extracts, and liquids. Historically in the United States, the most prevalent type of dietary supplement was a multivitamin/mineral tablet or capsule that was available in pharmacies, either by prescription or “over the counter.” Supplements containing strictly herbal preparations were less widely available. Currently in the United States, a wide array of supplement products are available, including vitamin, mineral, other nutrients, and botanical supplements as well as ingredients and extracts of animal and plant origin. The Office of Dietary Supplements (ODS) of the National Institutes of Health is the official agency of the United States which has the expressed goal of acquiring “new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.”49 According to the ODS, dietary supplements can have an important impact on the prevention and management of medical conditions and on the maintenance of health.50 The ODS notes that considerable research on the effects of dietary supplements has been conducted in Asia and Europe where This discussion has been adapted from the NIH: http://ods.od.nih.gov/whatare/whatare.html. 49 Contact: The Office of Dietary Supplements, National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: (301) 435-2920, Fax: (301) 480-1845, E-mail: [email protected]. 50 Adapted from http://ods.od.nih.gov/about/about.html. The Dietary Supplement Health and Education Act defines dietary supplements as “a product (other than tobacco) intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, mineral, amino acid, herb or other botanical; or a dietary substance for use to supplement the diet by increasing the total dietary intake; or a concentrate, metabolite, constituent, extract, or combination of any ingredient described above; and intended for ingestion in the form of a capsule, powder, softgel, or gelcap, and not represented as a conventional food or as a sole item of a meal or the diet.” 48


the use of plant products, in particular, has a long tradition. However, the overwhelming majority of supplements have not been studied scientifically. To explore the role of dietary supplements in the improvement of health care, the ODS plans, organizes, and supports conferences, workshops, and symposia on scientific topics related to dietary supplements. The ODS often works in conjunction with other NIH Institutes and Centers, other government agencies, professional organizations, and public advocacy groups. To learn more about official information on dietary supplements, visit the ODS site at http://ods.od.nih.gov/whatare/whatare.html. Or contact: The Office of Dietary Supplements National Institutes of Health Building 31, Room 1B29 31 Center Drive, MSC 2086 Bethesda, Maryland 20892-2086 Tel: (301) 435-2920 Fax: (301) 480-1845 E-mail: [email protected]

Finding Studies on Tourette Syndrome The NIH maintains an office dedicated to nutrition and diet. The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.51 IBIDS is available to the public free of charge through the ODS Internet page: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. We recommend that you start with the Consumer Database. While you may not find references for the topics that are of most interest to you, check back Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

51


periodically as this database is frequently updated. More studies can be found by searching the Full IBIDS Database. Healthcare professionals and researchers generally use the third option, which lists peer-reviewed citations. In all cases, we suggest that you take advantage of the “Advanced Search” option that allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “Tourette syndrome” (or synonyms) into the search box. To narrow the search, you can also select the “Title” field. The following information is typical of that found when using the “Full IBIDS Database” when searching using “Tourette syndrome” (or a synonym): ·

156 cases of Gilles de la Tourette's syndrome treated by acupuncture. Author(s): First Affiliated Hospital, Tianjin College of Traditional Chinese Medicine. Source: Wu, L Li, H Kang, L J-Tradit-Chin-Med. 1996 September; 16(3): 211-3 0254-6272

·

Biochemical pharmacology of Gilles de la Tourette's syndrome. Author(s): Department of Pharmacology, School of Medicine, University of North Dakota, Grand Forks 58202. Source: Messiha, F S Neurosci-Biobehav-Revolume 1988 Fall-Winter; 12(3-4): 295-305 0149-7634

·

Catechol-O-methyltransferase and Gilles de la Tourette syndrome. Author(s): The Department of Psychiatry, Toronto Hospital Western Division, Toronto, Ontario, Canada. [email protected] Source: Barr, C L Wigg, K G Sandor, P Mol-Psychiatry. 1999 September; 4(5): 492-5 1359-4184

·

Differential effects of transdermal nicotine on microstructured analyses of tics in Tourette's syndrome: an open study. Author(s): Department of Psychiatry, Faculty of Medicine, University of Leicester. Source: Dursun, S M Reveley, M A Psychol-Med. 1997 March; 27(2): 483-7 0033-2917

·

Effects of foods on the brain. Possible implications for understanding and treating Tourette syndrome. Author(s): Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge 02139. Source: Wurtman, R J Adv-Neurol. 1992; 58293-301 0091-3952


·

Gilles de la Tourette's syndrome associated with chronic schizophrenia. Author(s): Department of Neurology, University of Arizona, Tucson 85724. Source: Sandyk, R Bamford, C R Int-J-Neurosci. 1988 July; 41(1-2): 83-6 0020-7454

·

Increased expression of aphidicolin-induced common fragile sites in Tourette syndrome: the key to understand the genetics of comorbid phenotypes? Author(s): Department of Human Genetics, University of Pretoria, South Africa. Source: Gericke, G S Simonic, I Cloete, E Becker, P J Am-J-Med-Genet. 1996 February 16; 67(1): 25-30 0148-7299

·

Mercury intoxication presenting with tics. Author(s): Department of Paediatrics, The Chinese University of Hong Kong, 6th Floor, Clinical Sciences Building, Prince of Wales Hospital, Shatin, Hong Kong SAR, China. [email protected] Source: Li, A M Chan, M H Leung, T F Cheung, R C Lam, C W Fok, T F Arch-Dis-Child. 2000 August; 83(2): 174-5 0003-9888

·

Multicenter, double-blind, placebo-controlled study of mecamylamine monotherapy for Tourette's disorder. Author(s): University of South Florida College of Medicine, Tampa 33613, USA. Source: Silver, A A Shytle, R D Sheehan, K H Sheehan, D V Ramos, A Sanberg, P R J-Am-Acad-Child-Adolesc-Psychiatry. 2001 September; 40(9): 1103-10 0890-8567

·

Neuroendocrine and behavioral effects of naloxone in Tourette syndrome. Author(s): Child Study Center, Yale University School of Medicine, New Haven, Connecticut 06515. Source: Chappell, P B Leckman, J F Riddle, M A Anderson, G M Listwack, S J Ort, S I Hardin, M T Scahill, L D Cohen, D J Adv-Neurol. 1992; 58253-62 0091-3952

·

Nicotine and cannabinoids as adjuncts to neuroleptics in the treatment of Tourette syndrome and other motor disorders. Author(s): Laboratory of Psychobiochemistry, University of Texas El Paso 79968. Source: Moss, D E Manderscheid, P Z Montgomery, S P Norman, A B Sanberg, P R Life-Sci. 1989; 44(21): 1521-5 0024-3205


·

Nicotine attenuates DOI-induced head-twitch response in mice: implications for Tourette syndrome. Author(s): Department of Pharmacology, College of Medicine, Howard University, Washington, DC 20059, USA. [email protected] Source: Tizabi, Y Russell, L T Johnson, M Darmani, N A ProgNeuropsychopharmacol-Biol-Psychiatry. 2001 October; 25(7): 1445-57 0278-5846

·

Nicotine potentiates the effects of haloperidol in animals and in patients with Tourette syndrome. Author(s): Department of Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559. Source: Sanberg, P R McConville, B J Fogelson, H M Manderscheid, P Z Parker, K W Blythe, M M Klykylo, W M Norman, A B BiomedPharmacother. 1989; 43(1): 19-23 0753-3322

·

Nicotine potentiation of haloperidol in reducing tic frequency in Tourette's disorder. Author(s): Division of Child and Adolescent Psychiatry, University of Cincinnati College of Medicine, OH 45267-0559. Source: McConville, B J Fogelson, M H Norman, A B Klykylo, W M Manderscheid, P Z Parker, K W Sanberg, P R Am-J-Psychiatry. 1991 June; 148(6): 793-4 0002-953X

·

Pergolide in the management of Tourette syndrome. Author(s): Department of Neurology, Medical University of South Carolina, Charleston, USA. Source: Griesemer, D A J-Child-Neurol. 1997 September; 12(6): 402-3 0883-0738

·

Recurrence of complex motor and vocal tics in an elderly woman responsive to opiates. Author(s): Department of Neurology University of Arizona, Tucson 85724. Source: Sandyk, R Awerbuch, G Int-J-Neurosci. 1989 February; 44(3-4): 317-20 0020-7454

·

Response to levodopa challenge in Tourette syndrome. Author(s): Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA. Source: Black, K J Mink, J W Mov-Disord. 2000 November; 15(6): 1194-8 0885-3185


·

The effects of nicotine plus haloperidol compared to nicotine only and placebo nicotine only in reducing tic severity and frequency in Tourette's disorder. Author(s): Department of Psychiatry, University of Cincinnati College of Medicine, Ohio 45267-0559. Source: McConville, B J Sanberg, P R Fogelson, M H King, J Cirino, P Parker, K W Norman, A B Biol-Psychiatry. 1992 April 15; 31(8): 832-40 0006-3223

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: ·

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

·

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

·

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

·

The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

·

The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

·

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

·

Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

·

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/


Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: ·


·

Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

·

Google: http://directory.google.com/Top/Health/Nutrition/

·

Healthnotes: http://www.thedacare.org/healthnotes/

·

Open Directory Project: http://dmoz.org/Health/Nutrition/

·

Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

·

WebMDÒHealth: http://my.webmd.com/nutrition

·

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,,00.html

The following is a specific Web list relating to Tourette Syndrome; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: ·

Vitamins Ascorbic Acid Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminCAscorbicAcidcs.html Folic Acid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Folic_Acid.ht m


Niacin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB3Niacincs.html Pyridoxine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB6Pyridoxinecs.html Riboflavin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB2Riboflavincs.html Riboflavin Alternative names: Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminB2Riboflavincs.html Riboflavin (vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 895,00.html Thiamin (vitamin B Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10060,00.html


Thiamine Alternative names: Vitamin B1 (Thiamine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminB1Thiaminecs.html Thiamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB1Thiaminecs.html Vitamin A Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000230.html Vitamin B1 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Vitamin_B1.h tm Vitamin B1 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000241.html Vitamin B1 (Thiamine) Alternative names: Thiamine Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminB1Thiaminecs.html Vitamin B1 (Thiamine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB1Thiaminecs.html


Vitamin B12 (Cobalamin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB12Cobalamincs.html Vitamin B2 (Riboflavin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB2Riboflavincs.html Vitamin B2 (Riboflavin) Alternative names: Riboflavin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminB2Riboflavincs.html Vitamin B3 (Niacin) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB3Niacincs.html Vitamin B6 Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_B6.htm Vitamin B6 Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000225.html


Vitamin B6 (Pyridoxine) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminB6Pyridoxinecs.html Vitamin C Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_C.htm Vitamin C Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000098.html Vitamin C (Ascorbic Acid) Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminCAscorbicAcidcs.html Vitamin D Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Vitamin_D.ht m Vitamin D Alternative names: Calciferol, Calcitrol, Cholecalciferol, Erocalciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminDcs.html


Vitamin D Alternative names: Calciferol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminDcs.html Vitamin D Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 905,00.html Vitamin E Alternative names: Alpha-Tocopherol, Beta-Tocopherol, D-AlphaTocopherol, Delta-Tocopherol, Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Vitamin K Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Vitamin_K.ht m Vitamin K Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Vitamin_K.htm Vitamin K Alternative names: Menadione, Menaphthone, Menaquinone, Phylloquinone Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminKcs.html


Vitamin K Alternative names: Menadione Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/VitaminKcs.html Vitamin K Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000246.html ·

Minerals Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Atorvastatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Atorvastatin.htm Beta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Biotin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Biotin.htm Biotin Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000108.html


Biotin Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10008,00.html Calcium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Calcium.htm Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Calciumcs.html Calcium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C alciumcs.html Calcium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000113.html Calcium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 884,00.html Chondroitin Alternative names: chondroitin sulfate, sodium chondroitin sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C hondroitincs.html


Chromium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C hromiumcs.html Cisplatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Cisplatin.htm Clorazepate Dipotassium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Clorazepate_Dipotass ium.htm Copper Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/C oppercs.html D-Alpha-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Delta-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Folate Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000161.html


Gabapentin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Gabapentin.htm Gamma-Tocopherol Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Vi taminEcs.html Iron Alternative names: Ferrous Sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ir oncs.html Iron Alternative names: Ferrous Sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Ironcs.html Lovastatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Lovastatin.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Magnesium.htm Magnesium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Magnesium.h tm


Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Magnesiumcs.html Magnesium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/M agnesiumcs.html Magnesium Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000202.html Magnesium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 890,00.html Magnesium Hydroxide Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Magnesium_Hydroxi de.htm Naproxen/Naproxen Sodium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Naproxen.htm Paroxetine Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Paroxetine.htm


Potassium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Potassium.ht m Potassium Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Potassium.htm Potassium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/P otassiumcs.html Potassium Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Potassiumcs.html Potassium Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10086,00.html Potassium Chloride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Potassium_Chloride. htm Potassium-Sparing Diuretics Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsDepletions/Diur eticsPotassiumSparingDiureticscl.html


Potassium-Sparing Diuretics Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000317.html Pravastatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Pravastatin.htm Quercetin Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Q uercetincs.html Simvastatin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Simvastatin.htm Sodium Fluoride Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Sodium_Fluoride.ht m Spironolactone Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Spironolactone.htm Spironolactone/Hydrochlorothiazide Alternative names: Aldactazide Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000316.html


Stinging Nettle Alternative names: Urtica dioica, Urtica urens, Nettle Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsHerbs/Stinging Nettlech.html Tretinoin Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Drug/Tretinoin.htm Zinc Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp_Drugix/Zinc.htm Zinc Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Zi nccs.html Zinc Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Zinccs.html Zinc Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000128.html Zinc Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/substances_view/0,1525, 10071,00.html


·

Food and Diet Artichoke Alternative names: Cynara scolymus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Artichoke.htm Atkins Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Atkins_Diet.htm Berries Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Berries.htm Blood Type Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Blood_Type_Diet.htm Burdock Alternative names: Arctium lappa Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Burdock.htm Cantaloupe Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,125,0 0.html Carbo-Loading Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Carbohydrate_Loadin g_Diet.htm


Cheese Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Cheese.htm Chondroitin Sulfate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/Chondroitin_Sulfate. htm Cinnamon Alternative names: Cinnamomum zeylanicum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Cinnamon.htm Corn, fresh Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,17,00. html Corn-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Corn_Free_Diet.htm Crème Fraîche Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Creme_Fraich e.htm Eggs Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Eggs.htm Fasting Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Fasting_Diet.htm


Ferrous Sulfate Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/Ir oncs.html Ferrous Sulfate Alternative names: Iron Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/InteractiveMedicine/ConsSupplements/In teractions/Ironcs.html Fructo-oligosaccharides (FOS) and Other Oligosaccharides Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Supp/FOS.htm Garlic Alternative names: Allium sativum Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Herb/Garlic.htm Garlic Source: Prima Communications, Inc. Hyperlink: http://www.personalhealthzone.com/pg000164.html High Cholesterol Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/High_Cholesterol. htm Hypoglycemia Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Hypoglycemia.ht m Juices Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Juices.htm


Kefir Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Kefir.htm Lhassi Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Lhassi.htm Limes Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Limes.htm Low-Oxalate Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Oxalate_Diet.ht m Low-Purine Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Purine_Diet.htm Low-Salt Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Low_Salt_Diet.htm Macrobiotic Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Macrobiotic_Diet.htm Melons Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Melons.htm


Melons Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,57,00. html Milk Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Milk.htm Milk Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,95,00. html Octopus Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Octopus.htm Omega-6 Fatty Acids Source: Integrative Medicine Communications; www.onemedicine.com Hyperlink: http://www.drkoop.com/interactivemedicine/ConsSupplements/O mega6FattyAcidscs.html Peas, fresh Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,30,00. html Pomegranate Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Pomegranate. htm


Prunes Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,66,00. html Squid Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Squid.htm Tendinitis Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Tendinitis.htm The Dean Ornish Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Dean_Ornish_Diet.ht m The Zone Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Zone_Diet.htm Tyramine-Free Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Tyramine_Free_Diet.h tm Variety Meats Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Variety_Meats .htm Vegetarian Diet Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Diet/Vegetarian_Diet.htm


Weight Loss and Obesity Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Weight_Loss.htm Wound Healing Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Concern/Wound_Healing.h tm Yogurt Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Yogurt.htm Yogurt Source: WholeHealthMD.com, LLC.; www.wholehealthmd.com Hyperlink: http://www.wholehealthmd.com/refshelf/foods_view/0,1523,97,00. html Yogurt Cheese Source: Healthnotes, Inc.; www.healthnotes.com Hyperlink: http://www.thedacare.org/healthnotes/Food_Guide/Yogurt_Chees e.htm

Vocabulary Builder The following vocabulary builder defines words used in the references in this chapter that have not been defined in previous chapters: Aphidicolin: An antiviral antibiotic produced by Cephalosporium aphidicola and other fungi. It inhibits the growth of eukaryotic cells and certain animal viruses by selectively inhibiting the cellular replication of DNA polymerase II or the viral-induced DNA polymerases. The drug may be useful for controlling excessive cell proliferation in patients with cancer, psoriasis or other dermatitis with little or no adverse effect upon nonmultiplying cells. [NIH]


Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Monotherapy: A therapy which uses only one drug. [EU] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU]


Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Thermoregulation: Heat regulation. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH]

Finding Medical Libraries 323

APPENDIX D. FINDING MEDICAL LIBRARIES Overview At a medical library you can find medical texts and reference books, consumer health publications, specialty newspapers and magazines, as well as medical journals. In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Before going to the library, highlight the references mentioned in this sourcebook that you find interesting. Focus on those items that are not available via the Internet, and ask the reference librarian for help with your search. He or she may know of additional resources that could be helpful to you. Most importantly, your local public library and medical libraries have Interlibrary Loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. NLM’s interlibrary loan services are only available to libraries. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.52

52

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.


Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries Open to the Public In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries that are generally open to the public and have reference facilities. The following is the NLM’s list plus hyperlinks to each library Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located):53 ·

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

·

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute), http://www.asmi.org/LIBRARY.HTM

·

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

·

California: Kris Kelly Health Information Center (St. Joseph Health System), http://www.humboldt1.com/~kkhic/index.html

·

California: Community Health Library of Los Gatos (Community Health Library of Los Gatos), http://www.healthlib.org/orgresources.html

·

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

·

California: Gateway Health Library (Sutter Gould Medical Foundation)

·

California: Health Library (Stanford University Medical Center), http://www-med.stanford.edu/healthlibrary/

53

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.


·

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

·

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

·

California: San José PlaneTree Health Library, http://planetreesanjose.org/

·

California: Sutter Resource Library (Sutter Hospitals Foundation), http://go.sutterhealth.org/comm/resc-library/sac-resources.html

·

California: University of California, Davis. Health Sciences Libraries

·

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System), http://www.valleycare.com/library.html

·

California: Washington Community Health Resource Library (Washington Community Health Resource Library), http://www.healthlibrary.org/

·

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.exempla.org/conslib.htm

·

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

·

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

·

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital), http://www.waterburyhospital.com/library/consumer.shtml

·

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute), http://www.christianacare.org/health_guide/health_guide_pmri_health _info.cfm

·

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine), http://www.delamed.org/chls.html

·

Georgia: Family Resource Library (Medical College of Georgia), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

·

Georgia: Health Resource Center (Medical Center of Central Georgia), http://www.mccg.org/hrc/hrchome.asp

·

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library), http://hml.org/CHIS/


·

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center), http://www.nicon.org/DeArmond/index.htm

·

Illinois: Health Learning Center of Northwestern Memorial Hospital (Northwestern Memorial Hospital, Health Learning Center), http://www.nmh.org/health_info/hlc.html

·

Illinois: Medical Library (OSF Saint Francis Medical Center), http://www.osfsaintfrancis.org/general/library/

·

Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital), http://www.centralbap.com/education/community/library.htm

·

Kentucky: University of Kentucky - Health Information Library (University of Kentucky, Chandler Medical Center, Health Information Library), http://www.mc.uky.edu/PatientEd/

·

Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation), http://www.ochsner.org/library/

·

Louisiana: Louisiana State University Health Sciences Center Medical Library-Shreveport, http://lib-sh.lsuhsc.edu/

·

Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital), http://www.fchn.org/fmh/lib.htm

·

Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center), http://www.cmmc.org/library/library.html

·

Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare), http://www.emh.org/hll/hpl/guide.htm

·

Maine: Maine Medical Center Library (Maine Medical Center), http://www.mmc.org/library/

·

Maine: Parkview Hospital, http://www.parkviewhospital.org/communit.htm#Library

·

Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center), http://www.smmc.org/services/service.php3?choice=10

·

Maine: Stephens Memorial Hospital Health Information Library (Western Maine Health), http://www.wmhcc.com/hil_frame.html

·

Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

·

Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre), http://www.deerlodge.mb.ca/library/libraryservices.shtml


·

Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Md., Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

·

Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

·

Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://medlibwww.bu.edu/library/lib.html

·

Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

·

Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital), http://www.nebh.org/health_lib.asp

·

Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital), http://www.southcoast.org/library/

·

Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

·

Massachusetts: UMass HealthNet (University of Massachusetts Medical School), http://healthnet.umassmed.edu/

·

Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

·

Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

·

Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

·

Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center), http://www.cancer.med.umich.edu/learn/leares.htm

·

Michigan: Sladen Library & Center for Health Information Resources Consumer Health Information, http://www.sladen.hfhs.org/library/consumer/index.html

·

Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center), http://www.saintpatrick.org/chi/librarydetail.php3?ID=41


·

National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

·

National: National Network of Libraries of Medicine (National Library of Medicine) - provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

·

National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

·

Nevada: Health Science Library, West Charleston Library (Las Vegas Clark County Library District), http://www.lvccld.org/special_collections/medical/index.htm

·

New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

·

New Jersey: Consumer Health Library (Rahway Hospital), http://www.rahwayhospital.com/library.htm

·

New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center), http://www.englewoodhospital.com/links/index.htm

·

New Jersey: Meland Foundation (Englewood Hospital and Medical Center), http://www.geocities.com/ResearchTriangle/9360/

·

New York: Choices in Health Information (New York Public Library) NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

·

New York: Health Information Center (Upstate Medical University, State University of New York), http://www.upstate.edu/library/hic/

·

New York: Health Sciences Library (Long Island Jewish Medical Center), http://www.lij.edu/library/library.html

·

New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

·

Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

·

Oklahoma: Saint Francis Health System Patient/Family Resource Center (Saint Francis Health System), http://www.sfhtulsa.com/patientfamilycenter/default.asp


·

Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center), http://www.mcmc.net/phrc/

·

Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center), http://www.hmc.psu.edu/commhealth/

·

Pennsylvania: Community Health Resource Library (Geisinger Medical Center), http://www.geisinger.edu/education/commlib.shtml

·

Pennsylvania: HealthInfo Library (Moses Taylor Hospital), http://www.mth.org/healthwellness.html

·

Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System), http://www.hsls.pitt.edu/chi/hhrcinfo.html

·

Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

·

Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System), http://www.shscares.org/services/lrc/index.asp

·

Pennsylvania: Medical Library (UPMC Health System), http://www.upmc.edu/passavant/library.htm

·

Quebec, Canada: Medical Library (Montreal General Hospital), http://ww2.mcgill.ca/mghlib/

·

South Dakota: Rapid City Regional Hospital - Health Information Center (Rapid City Regional Hospital, Health Information Center), http://www.rcrh.org/education/LibraryResourcesConsumers.htm

·

Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

·

Texas: Matustik Family Resource Center (Cook Children’s Health Care System), http://www.cookchildrens.com/Matustik_Library.html

·

Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

·

Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center), http://www.swmedctr.com/Home/

Online Glossaries 331

APPENDIX E. YOUR CHILD’S RIGHTS AND INSURANCE Overview Parents face a series of issues related more to the healthcare industry than to their children’s medical conditions. This appendix covers two important topics in this regard: your responsibilities and your child’s rights as a patient, and how to get the most out of your child’s medical insurance plan.

Your Child’s Rights as a Patient The President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has created the following summary of your child’s rights as a patient.54 Information Disclosure Consumers have the right to receive accurate, easily understood information. Some consumers require assistance in making informed decisions about health plans, health professionals, and healthcare facilities. Such information includes: ·

Health plans. Covered benefits, cost-sharing, and procedures for resolving complaints, licensure, certification, and accreditation status, comparable measures of quality and consumer satisfaction, provider network composition, the procedures that govern access to specialists and emergency services, and care management information.

54Adapted

from Consumer Bill of Rights and Responsibilities: http://www.hcqualitycommission.gov/press/cbor.html#head1.


·

Health professionals. Education, board certification, and recertification, years of practice, experience performing certain procedures, and comparable measures of quality and consumer satisfaction.

·

Healthcare facilities. Experience in performing certain procedures and services, accreditation status, comparable measures of quality, worker, and consumer satisfaction, and procedures for resolving complaints.

·

Consumer assistance programs. Programs must be carefully structured to promote consumer confidence and to work cooperatively with health plans, providers, payers, and regulators. Desirable characteristics of such programs are sponsorship that ensures accountability to the interests of consumers and stable, adequate funding.

Choice of Providers and Plans Consumers have the right to a choice of healthcare providers that is sufficient to ensure access to appropriate high-quality healthcare. To ensure such choice, the Commission recommends the following: ·

Provider network adequacy. All health plan networks should provide access to sufficient numbers and types of providers to assure that all covered services will be accessible without unreasonable delay -including access to emergency services 24 hours a day and 7 days a week. If a health plan has an insufficient number or type of providers to provide a covered benefit with the appropriate degree of specialization, the plan should ensure that the consumer obtains the benefit outside the network at no greater cost than if the benefit were obtained from participating providers.

·

Access to specialists. Consumers with complex or serious medical conditions who require frequent specialty care should have direct access to a qualified specialist of their choice within a plan’s network of providers. Authorizations, when required, should be for an adequate number of direct access visits under an approved treatment plan.

·

Transitional care. Consumers who are undergoing a course of treatment for a chronic or disabling condition at the time they involuntarily change health plans or at a time when a provider is terminated by a plan for other than cause should be able to continue seeing their current specialty providers for up to 90 days to allow for transition of care.

·

Choice of health plans. Public and private group purchasers should, wherever feasible, offer consumers a choice of high-quality health insurance plans.


Access to Emergency Services Consumers have the right to access emergency healthcare services when and where the need arises. Health plans should provide payment when a consumer presents to an emergency department with acute symptoms of sufficient severity--including severe pain--such that a “prudent layperson” could reasonably expect the absence of medical attention to result in placing that consumer’s health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

Participation in Treatment Decisions Consumers have the right and responsibility to fully participate in all decisions related to their healthcare. Consumers who are unable to fully participate in treatment decisions have the right to be represented by parents, guardians, family members, or other conservators. Physicians and other health professionals should: ·

Provide parents with sufficient information and opportunity to decide among treatment options consistent with the informed consent process.

·

Discuss all treatment options with a parent in a culturally competent manner, including the option of no treatment at all.

·

Ensure that persons with disabilities have effective communications with members of the health system in making such decisions.

·

Discuss all current treatments a consumer may be undergoing.

·

Discuss all risks, nontreatment.

·

Give parents the opportunity to refuse treatment for their children and to express preferences about future treatment decisions.

·

Discuss the use of advance directives -- both living wills and durable powers of attorney for healthcare -- with parents.

·

Abide by the decisions made by parents consistent with the informed consent process.

benefits,

and

consequences

to

treatment

or


Health plans, health providers, and healthcare facilities should: ·

Disclose to consumers factors -- such as methods of compensation, ownership of or interest in healthcare facilities, or matters of conscience -that could influence advice or treatment decisions.

·

Assure that provider contracts do not contain any so-called “gag clauses” or other contractual mechanisms that restrict healthcare providers’ ability to communicate with and advise parents about medically necessary treatment options for their children.

·

Be prohibited from penalizing or seeking retribution against healthcare professionals or other health workers for advocating on behalf of their patients. Respect and Nondiscrimination

Consumers have the right to considerate, respectful care from all members of the healthcare industry at all times and under all circumstances. An environment of mutual respect is essential to maintain a quality healthcare system. To assure that right, the Commission recommends the following: ·

Consumers must not be discriminated against in the delivery of healthcare services consistent with the benefits covered in their policy, or as required by law, based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

·

Consumers eligible for coverage under the terms and conditions of a health plan or program, or as required by law, must not be discriminated against in marketing and enrollment practices based on race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment.

Confidentiality of Health Information Consumers have the right to communicate with healthcare providers in confidence and to have the confidentiality of their individually identifiable healthcare information protected. Consumers also have the right to review and copy their own medical records and request amendments to their records.


Complaints and Appeals Consumers have the right to a fair and efficient process for resolving differences with their health plans, healthcare providers, and the institutions that serve them, including a rigorous system of internal review and an independent system of external review. A free copy of the Patient’s Bill of Rights is available from the American Hospital Association.55

Parent Responsibilities To underscore the importance of finance in modern healthcare as well as your responsibility for the financial aspects of your child’s care, the President’s Advisory Commission on Consumer Protection and Quality in the Healthcare Industry has proposed that parents understand the following “Consumer Responsibilities.”56 In a healthcare system that protects consumers’ rights, it is reasonable to expect and encourage consumers to assume certain responsibilities. Greater involvement by parents in their children’s care increases the likelihood of achieving the best outcome and helps support a quality-oriented, cost-conscious environment. Such responsibilities include: ·

Take responsibility for maximizing your child’s healthy habits.

·

Work collaboratively with healthcare providers in developing and carrying out your child’s agreed-upon treatment plans.

·

Disclose relevant information and clearly communicate wants and needs.

·

Use the insurance company’s internal complaint and appeal processes to address your concerns.

·

Recognize the reality of risks, the limits of the medical science, and the human fallibility of the healthcare professional.

·

Be aware of a healthcare provider’s obligation to be reasonably efficient and equitable in providing care to the community.

·

Become knowledgeable about health plan coverage and options (when available) including all covered benefits, limitations, and exclusions, rules regarding use of network providers, coverage and referral rules,

To order your free copy of the Patient’s Bill of Rights, telephone 312-422-3000 or visit the American Hospital Association’s Web site: http://www.aha.org. Click on “Resource Center,” go to “Search” at bottom of page, and then type in “Patient’s Bill of Rights.” The Patient’s Bill of Rights is also available from Fax on Demand, at 312-422-2020, document number 471124. 56 Adapted from http://www.hcqualitycommission.gov/press/cbor.html#head1. 55


appropriate processes to secure additional information, and the process to appeal coverage decisions. ·

Make a good-faith effort to meet financial obligations.

·

Abide by administrative and operational procedures of health plans, healthcare providers, and Government health benefit programs.

Choosing an Insurance Plan There are a number of official government agencies that help consumers understand their healthcare insurance choices.57 The U.S. Department of Labor, in particular, recommends ten ways to make your health benefits choices work best for your family.58 1. Your options are important. There are many different types of health benefit plans. Find out which one your employer offers, then check out the plan, or plans, offered. Your employer’s human resource office, the health plan administrator, or your union can provide information to help you match your family’s needs and preferences with the available plans. The more information you have, the better your healthcare decisions will be. 2. Reviewing the benefits available. Do the plans offered cover preventive care, well-baby care, vision or dental care? Are there deductibles? Answers to these questions can help determine the out-of-pocket expenses you may face. Cheapest may not always be best. Your goal is high quality health benefits. 3. Look for quality. The quality of healthcare services varies, but quality can be measured. You should consider the quality of healthcare in deciding among the healthcare plans or options available to your family. Not all health plans, doctors, hospitals and other providers give the highest quality care. Fortunately, there is quality information you can use right now to help you compare your healthcare choices. Find out how you can measure quality. Consult the U.S. Department of Health and Human Services publication “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

More information about quality across programs is provided at the following AHRQ Web site: http://www.ahrq.gov/consumer/qntascii/qnthplan.htm. 58 Adapted from the Department of Labor: http://www.dol.gov/dol/pwba/public/pubs/health/top10-text.html. 57


4. Your plan’s summary plan description (SPD) provides a wealth of information. Your health plan administrator can provide you with a copy of your plan’s SPD. It outlines your family’s benefits and your legal rights under the Employee Retirement Income Security Act (ERISA), the federal law that protects your family’s health benefits. It should contain information about the coverage of dependents, what services will require a co-pay, and the circumstances under which your employer can change or terminate a health benefits plan. Save the SPD and all other health plan brochures and documents, along with memos or correspondence from your employer relating to health benefits. 5. Assess your benefit coverage as your family status changes. Marriage, divorce, childbirth or adoption, and the death of a spouse are all life events that may signal a need to change your health benefits. You, your spouse and dependent children may be eligible for a special enrollment period under provisions of the Health Insurance Portability and Accountability Act (HIPAA). Even without life-changing events, the information provided by your employer should tell you how you can change benefits or switch plans, if more than one plan is offered. If your spouse’s employer also offers a health benefits package, consider coordinating both plans for maximum coverage. 6. Changing jobs and other life events can affect your family’s health benefits. Under the Consolidated Omnibus Budget Reconciliation Act (COBRA), you, your covered spouse, and your dependent children may be eligible to purchase extended health coverage under your employer’s plan if you lose your job, change employers, get divorced, or upon occurrence of certain other events. Coverage can range from 18 to 36 months depending on your situation. COBRA applies to most employers with 20 or more workers and requires your plan to notify you of your rights. Most plans require eligible individuals to make their COBRA election within 60 days of the plan’s notice. Be sure to follow up with your plan sponsor if you don’t receive notice, and make sure you respond within the allotted time. 7. HIPAA can also help if you are changing jobs, particularly if you have a medical condition. HIPAA generally limits pre-existing condition exclusions to a maximum of 12 months (18 months for late enrollees). HIPAA also requires this maximum period to be reduced by the length of time you had prior “creditable coverage.” You should receive a certificate documenting your prior creditable coverage from your old plan when coverage ends. 8. Plan for retirement. Before you retire, find out what health benefits, if any, extend to you and your spouse during your retirement years. Consult with


your employer’s human resources office, your union, the plan administrator, and check your SPD. Make sure there is no conflicting information among these sources about the benefits your family will receive or the circumstances under which they can change or be eliminated. With this information in hand, you can make other important choices, like finding out if you are eligible for Medicare and Medigap insurance coverage. 9. Know how to file an appeal if a health benefits claim is denied. Understand how your plan handles grievances and where to make appeals of the plan’s decisions. Keep records and copies of correspondence. Check your health benefits package and your SPD to determine who is responsible for handling problems with benefit claims. Contact PWBA for customer service assistance if you are unable to obtain a response to your complaint. 10. You can take steps to improve the quality of the healthcare and the health benefits your family receives. Look for and use things like Quality Reports and Accreditation Reports whenever you can. Quality reports may contain consumer ratings -- how satisfied consumers are with the doctors in their plan, for instance-- and clinical performance measures -- how well a healthcare organization prevents and treats illness. Accreditation reports provide information on how accredited organizations meet national standards, and often include clinical performance measures. Look for these quality measures whenever possible. Consult “Your Guide to Choosing Quality Health Care” on the Internet at www.ahcpr.gov/consumer.

Medicaid Illness strikes both rich and poor families. For low-income families, Medicaid is available to defer the costs of treatment. In the following pages, you will learn the basics about Medicaid as well as useful contact information on how to find more in-depth information. Medicaid is a joint federal and state program that helps pay medical costs for some people with low incomes and limited resources. Medicaid programs vary from state to state. You can find more information about Medicaid on the HCFA.gov Web site at http://www.hcfa.gov/medicaid/medicaid.htm.

NORD’s Medication Assistance Programs Finally, the National Organization for Rare Disorders, Inc. (NORD) administers medication programs sponsored by humanitarian-minded


pharmaceutical and biotechnology companies to help uninsured or underinsured individuals secure life-saving or life-sustaining drugs.59 NORD programs ensure that certain vital drugs are available “to those families whose income is too high to qualify for Medicaid but too low to pay for their prescribed medications.” The program has standards for fairness, equity, and unbiased eligibility. It currently covers some 14 programs for nine pharmaceutical companies. NORD also offers early access programs for investigational new drugs (IND) under the approved “Treatment INDs” programs of the Food and Drug Administration (FDA). In these programs, a limited number of individuals can receive investigational drugs that have yet to be approved by the FDA. These programs are generally designed for rare medical conditions. For more information, visit www.rarediseases.org.

Additional Resources In addition to the references already listed in this chapter, you may need more information on health insurance, hospitals, or the healthcare system in general. The NIH has set up an excellent guidance Web site that addresses these and other issues. Topics include:60 ·

Health Insurance: http://www.nlm.nih.gov/medlineplus/healthinsurance.html

·

Health Statistics: http://www.nlm.nih.gov/medlineplus/healthstatistics.html

·

HMO and Managed Care: http://www.nlm.nih.gov/medlineplus/managedcare.html

·

Hospice Care: http://www.nlm.nih.gov/medlineplus/hospicecare.html

·

Medicaid: http://www.nlm.nih.gov/medlineplus/medicaid.html

·

Medicare: http://www.nlm.nih.gov/medlineplus/medicare.html

·

Nursing Homes and Long-term Care: http://www.nlm.nih.gov/medlineplus/nursinghomes.html

·

Patient’s Rights, Confidentiality, Informed Consent, Ombudsman Programs, Privacy and Patient Issues: http://www.nlm.nih.gov/medlineplus/patientissues.html

·

Veteran’s Health, Persian Gulf War, Gulf War Syndrome, Agent Orange: http://www.nlm.nih.gov/medlineplus/veteranshealth.html

Adapted from NORD: http://www.rarediseases.org/cgibin/nord/progserv#patient?id=rPIzL9oD&mv_pc=30. 60 You can access this information at: http://www.nlm.nih.gov/medlineplus/healthsystem.html. 59


ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries and glossaries. The National Library of Medicine has compiled the following list of online dictionaries: ·

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

·

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

·

Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

·

Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

·

On-line Medical Dictionary (CancerWEB): http://www.graylab.ac.uk/omd/

·

Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

·

Terms and Definitions (Office of Rare Diseases): http://rarediseases.info.nih.gov/ord/glossary_a-e.html

Beyond these, MEDLINEplus contains a very user-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia Web site address is http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a). Topics of interest can be researched by using keywords before continuing elsewhere, as these basic definitions and concepts will be useful in more advanced areas of research. You may choose to print various pages specifically relating to Tourette syndrome and keep them on file. The NIH, in particular, suggests that parents of children with Tourette syndrome visit the following Web sites in the ADAM Medical Encyclopedia:


·

Basic Guidelines for Tourette Syndrome Chronic motor tic disorder Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000745.htm Gilles de la Tourette syndrome Web site: http://www.nlm.nih.gov/medlineplus/ency/article/000733.htm

·

Signs & Symptoms for Tourette Syndrome Muscle Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003193.htm Seizure Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003200.htm Stress Web site: http://www.nlm.nih.gov/medlineplus/ency/article/003211.htm

·

Background Topics for Tourette Syndrome Incidence Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002387.htm Physical examination Web site: http://www.nlm.nih.gov/medlineplus/ency/article/002274.htm

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries and glossaries: ·

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical


·

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

·

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

·

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

Glossary 343

TOURETTE SYNDROME GLOSSARY The following is a complete glossary of terms used in this sourcebook. The definitions are derived from official public sources including the National Institutes of Health [NIH] and the European Union [EU]. After this glossary, we list a number of additional hardbound and electronic glossaries and dictionaries that you may wish to consult. Abdominal: Pertaining to the abdomen. [EU] Aberrant: Wandering or deviating from the usual or normal course. [EU] Abortion: 1. the premature expulsion from the uterus of the products of conception - of the embryo, or of a nonviable fetus. The four classic symptoms, usually present in each type of abortion, are uterine contractions, uterine haemorrhage, softening and dilatation of the cervix, and presentation or expulsion of all or part of the products of conception. 2. premature stoppage of a natural or a pathological process. [EU] Abrupt: Sudden and unexpected. [EU] Acebutolol: A cardioselective beta-adrenergic antagonist with little effect on the bronchial receptors. The drug has stabilizing and quinidine-like effects on cardiac rhythm as well as weak inherent sympathomimetic action. [NIH] Acidity: L. aciditas) the quality of being acid or sour; containing acid (hydrogen ions). [EU] Acne: An inflammatory disease of the pilosebaceous unit, the specific type usually being indicated by a modifying term; frequently used alone to designate common acne, or acne vulgaris. [EU] Adolescence: The period of life beginning with the appearance of secondary sex characteristics and terminating with the cessation of somatic growth. The years usually referred to as adolescence lie between 13 and 18 years of age. [NIH]

Adrenergic: Activated by, characteristic of, or secreting epinephrine or substances with similar activity; the term is applied to those nerve fibres that liberate norepinephrine at a synapse when a nerve impulse passes, i.e., the sympathetic fibres. [EU] Agonist: In anatomy, a prime mover. In pharmacology, a drug that has affinity for and stimulates physiologic activity at cell receptors normally stimulated by naturally occurring substances. [EU] Albuterol: A racemic mixture with a 1:1 ratio of the r-isomer, levalbuterol, and s-albuterol. It is a short-acting beta2-adrenergic agonist with its main clinical use in asthma. [NIH]


Alkaloid: One of a large group of nitrogenous basis substances found in plants. They are usually very bitter and many are pharmacologically active. Examples are atropine, caffeine, coniine, morphine, nicotine, quinine, strychnine. The term is also applied to synthetic substances (artificial a's) which have structures similar to plant alkaloids, such as procaine. [EU] Allopurinol: A xanthine oxidase inhibitor that decreases uric acid production. [NIH] Altretamine: An alkylating agent proposed as an antineoplastic. It also acts as a chemosterilant for male houseflies and other insects. [NIH] Aminophylline: A drug combination that contains theophylline and ethylenediamine. It is more soluble in water than theophylline but has similar pharmacologic actions. It's most common use is in bronchial asthma, but it has been investigated for several other applications. [NIH] Amoxicillin: A broad-spectrum semisynthetic antibiotic similar to ampicillin except that its resistance to gastric acid permits higher serum levels with oral administration. [NIH] Amphetamines: Analogs or derivatives of amphetamine. Many are sympathomimetics and central nervous system stimulators causing excitation, vasopression, bronchodilation, and to varying degrees, anorexia, analepsis, nasal decongestion, and some smooth muscle relaxation. [NIH] Ampicillin: Semi-synthetic derivative of penicillin that functions as an orally active broad-spectrum antibiotic. [NIH] Amygdala: Almond-shaped group of basal nuclei anterior to the inferior horn of the lateral ventricle of the brain, within the temporal lobe. The amygdala is part of the limbic system. [NIH] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analogous: Resembling or similar in some respects, as in function or appearance, but not in origin or development;. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH] Androstenedione: A steroid with androgenic properties that is produced in the testis, ovary, and adrenal cortex. It is a precursor to testosterone and other androgenic hormones. [NIH] Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia:

A state characterized by loss of feeling or sensation. This

Glossary 345

depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH]

Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Anorexia: Lack or loss of the appetite for food. [EU] Anthelmintic: An agent that is destructive to worms. [EU] Antibiotic: A chemical substance produced by a microorganism which has the capacity, in dilute solutions, to inhibit the growth of or to kill other microorganisms. Antibiotics that are sufficiently nontoxic to the host are used as chemotherapeutic agents in the treatment of infectious diseases of man, animals and plants. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidepressant: An agent that stimulates the mood of a depressed patient, including tricyclic antidepressants and monoamine oxidase inhibitors. [EU] Antihypertensive: An agent that reduces high blood pressure. [EU] Anxiety: The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognized intrapsychic conflict. Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness, and fatigue; psychological concomitants include feelings of impending danger, powerlessness, apprehension, and tension. [EU] Aphasia: Defect or loss of the power of expression by speech, writing, or signs, or of comprehending spoken or written language, due to injury or disease of the brain centres. [EU] Aphidicolin: An antiviral antibiotic produced by Cephalosporium aphidicola and other fungi. It inhibits the growth of eukaryotic cells and certain animal viruses by selectively inhibiting the cellular replication of DNA polymerase II or the viral-induced DNA polymerases. The drug may be useful for controlling excessive cell proliferation in patients with cancer, psoriasis or other dermatitis with little or no adverse effect upon nonmultiplying cells. [NIH] Apnea: A transient absence of spontaneous respiration. [NIH] Appendicitis: Acute inflammation of the vermiform appendix. [NIH] Aromatic: Having a spicy odour. [EU] Arrhythmia: Any variation from the normal rhythm of the heart beat, including sinus arrhythmia, premature beat, heart block, atrial fibrillation, atrial flutter, pulsus alternans, and paroxysmal tachycardia. [EU]


Ascariasis: Infection by nematodes of the genus ascaris. Ingestion of infective eggs causes diarrhea and pneumonitis. Its distribution is more prevalent in areas of poor sanitation and where human feces are used for fertilizer. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Ataxia: Failure of muscular coordination; irregularity of muscular action. [EU]

Atenolol: A cardioselective beta-adrenergic blocker possessing properties and potency similar to propranolol, but without a negative inotropic effect. [NIH]

Atrophy: A wasting away; a diminution in the size of a cell, tissue, organ, or part. [EU] Atypical: Irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. [EU] Aura: A subjective sensation or motor phenomenon that precedes and marks the of a paroxysmal attack, such as an epileptic attack on set. [EU] Autonomic: Self-controlling; functionally independent. [EU] Azithromycin: A semi-synthetic macrolide antibiotic structurally related to erythromycin. It has been used in the treatment of Mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis. [NIH] Aztreonam: A monocyclic beta-lactam antibiotic originally isolated from Chromobacterium violaceum. It is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. It may cause a superinfection with gram-positive organisms. [NIH] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bereavement: Refers to the whole process of grieving and mourning and is associated with a deep sense of loss and sadness. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Biochemical: Relating to biochemistry; characterized by, produced by, or involving chemical reactions in living organisms. [EU] Biphasic: Having two phases; having both a sporophytic and a gametophytic phase in the life cycle. [EU] Bismuth: A metallic element that has the atomic symbol Bi, atomic number 83 and atomic weight 208.98. [NIH]

Glossary 347

Bisoprolol: A cardioselective beta-1-adrenergic blocker. It is effective in the management of hypertension and angina pectoris. [NIH] Bleomycin: A complex of related glycopeptide antibiotics from Streptomyces verticillus consisting of bleomycin A2 and B2. It inhibits DNA metabolism and is used as an antineoplastic, especially for solid tumors. [NIH] Blepharitis: Inflammation of the eyelids. [EU] Blinking: Brief closing of the eyelids by involuntary normal periodic closing, as a protective measure, or by voluntary action. [NIH] Bronchitis: Inflammation of one or more bronchi. [EU] Bupropion: A unicyclic, aminoketone antidepressant. The mechanism of its therapeutic actions is not well understood, but it does appear to block dopamine uptake. The hydrochloride is available as an aid to smoking cessation treatment. [NIH] Bursitis: Inflammation of a bursa, occasionally accompanied by a calcific deposit in the underlying supraspinatus tendon; the most common site is the subdeltoid bursa. [EU] Candidiasis: Infection with a fungus of the genus Candida. It is usually a superficial infection of the moist cutaneous areas of the body, and is generally caused by C. albicans; it most commonly involves the skin (dermatocandidiasis), oral mucous membranes (thrush, def. 1), respiratory tract (bronchocandidiasis), and vagina (vaginitis). Rarely there is a systemic infection or endocarditis. Called also moniliasis, candidosis, oidiomycosis, and formerly blastodendriosis. [EU] Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Capillary: Any one of the minute vessels that connect the arterioles and venules, forming a network in nearly all parts of the body. Their walls act as semipermeable membranes for the interchange of various substances, including fluids, between the blood and tissue fluid; called also vas capillare. [EU]

Capsules: Hard or soft soluble containers used for the oral administration of medicine. [NIH] Captopril: A potent and specific inhibitor of peptidyl-dipeptidase A. It blocks the conversion of angiotensin I to angiotensin II, a vasoconstrictor and important regulator of arterial blood pressure. Captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin. [NIH] Carbidopa: A peripheral inhibitor of dopa decarboxylase. It is given in parkinsonism along with levodopa to inhibit the conversion of levodopa to


dopamine in the periphery, thereby reducing the peripheral adverse effects, increasing the amount of levodopa that reaches the central nervous system, and reducing the dose needed. It has no antiparkinson actions when given alone. [NIH] Carbohydrate: An aldehyde or ketone derivative of a polyhydric alcohol, particularly of the pentahydric and hexahydric alcohols. They are so named because the hydrogen and oxygen are usually in the proportion to form water, (CH2O)n. The most important carbohydrates are the starches, sugars, celluloses, and gums. They are classified into mono-, di-, tri-, poly- and heterosaccharides. [EU] Cardiac: Pertaining to the heart. [EU] Cardiogenic: Originating in the heart; caused by abnormal function of the heart. [EU] Cardiomyopathy: A general diagnostic term designating primary myocardial disease, often of obscure or unknown etiology. [EU] Cardiovascular: Pertaining to the heart and blood vessels. [EU] Carotene: The general name for a group of pigments found in green, yellow, and leafy vegetables, and yellow fruits. The pigments are fat-soluble, unsaturated aliphatic hydrocarbons functioning as provitamins and are converted to vitamin A through enzymatic processes in the intestinal wall. [NIH]

Catheter: A tubular, flexible, surgical instrument for withdrawing fluids from (or introducing fluids into) a cavity of the body, especially one for introduction into the bladder through the urethra for the withdraw of urine. [EU]

Cellulitis: An acute, diffuse, and suppurative inflammation of loose connective tissue, particularly the deep subcutaneous tissues, and sometimes muscle, which is most commonly seen as a result of infection of a wound, ulcer, or other skin lesions. [NIH] Cerebellar: Pertaining to the cerebellum. [EU] Cerebellum: Part of the metencephalon that lies in the posterior cranial fossa behind the brain stem. It is concerned with the coordination of movement. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU]

Cervical: Pertaining to the neck, or to the neck of any organ or structure. [EU] Chelation: Combination with a metal in complexes in which the metal is part of a ring. [EU]

Glossary 349

Chemotherapy: The treatment of disease by means of chemicals that have a specific toxic effect upon the disease - producing microorganisms or that selectively destroy cancerous tissue. [EU] Chlorhexidine: Disinfectant and topical anti-infective agent used also as mouthwash to prevent oral plaque. [NIH] Cholecalciferol: An antirachitic oil-soluble vitamin. [NIH] Cholesterol: The principal sterol of all higher animals, distributed in body tissues, especially the brain and spinal cord, and in animal fats and oils. [NIH] Cholinergic: Resembling acetylcholine in pharmacological stimulated by or releasing acetylcholine or a related compound. [EU]

action;

Chorea: The ceaseless occurrence of a wide variety of rapid, highly complex, jerky movements that appear to be well coordinated but are performed involuntarily. [EU] Chromosomal: Pertaining to chromosomes. [EU] Chronic: Persisting over a long period of time. [EU] Cimetidine: A histamine congener, it competitively inhibits histamine binding to H2 receptors. Cimetidine has a range of pharmacological actions. It inhibits gastric acid secretion, as well as pepsin and gastrin output. It also blocks the activity of cytochrome P-450. [NIH] Ciprofloxacin: A carboxyfluoroquinoline antimicrobial agent that is effective against a wide range of microorganisms. It has been successfully and safely used in the treatment of resistant respiratory, skin, bone, joint, gastrointestinal, urinary, and genital infections. [NIH] Cirrhosis: Liver disease characterized pathologically by loss of the normal microscopic lobular architecture, with fibrosis and nodular regeneration. The term is sometimes used to refer to chronic interstitial inflammation of any organ. [EU] Cisplatin: An inorganic and water-soluble platinum complex. After undergoing hydrolysis, it reacts with DNA to produce both intra and interstrand crosslinks. These crosslinks appear to impair replication and transcription of DNA. The cytotoxicity of cisplatin correlates with cellular arrest in the G2 phase of the cell cycle. [NIH] Clarithromycin: A semisynthetic macrolide antibiotic derived from erythromycin that is active against a variety of microorganisms. It can inhibit protein synthesis in bacteria by reversibly binding to the 50S ribosomal subunits. This inhibits the translocation of aminoacyl transfer-RNA and prevents peptide chain elongation. [NIH] Clindamycin: An antibacterial agent that is a semisynthetic analog of lincomycin. [NIH]


Clomipramine: A tricyclic antidepressant similar to imipramine that selectively inhibits the uptake of serotonin in the brain. It is readily absorbed from the gastrointestinal tract and demethylated in the liver to form its primary active metabolite, desmethylclomipramine. [NIH] Clonazepam: An anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. It is seldom effective in generalized tonic-clonic or partial seizures. The mechanism of action appears to involve the enhancement of gaba receptor responses. [NIH] Cochlear: Of or pertaining to the cochlea. [EU] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Coenzyme: An organic nonprotein molecule, frequently a phosphorylated derivative of a water-soluble vitamin, that binds with the protein molecule (apoenzyme) to form the active enzyme (holoenzyme). [EU] Colestipol: Highly crosslinked and insoluble basic anion exchange resin used as anticholesteremic. It may also may reduce triglyceride levels. [NIH] Colic: Paroxysms of pain. This condition usually occurs in the abdominal region but may occur in other body regions as well. [NIH] Colloidal: Of the nature of a colloid. [EU] Coloboma: Congenital anomaly in which some of the structures of the eye are absent due to incomplete fusion of the fetal intraocular fissure during gestation. [NIH] Colorectal: Pertaining to or affecting the colon and rectum. [EU] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjunctivitis: Inflammation of the conjunctiva, generally consisting of conjunctival hyperaemia associated with a discharge. [EU] Constipation: Infrequent or difficult evacuation of the faeces. [EU] Contraceptive: conception. [EU]

An agent that diminishes the likelihood of or prevents

Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cutaneous: Pertaining to the skin; dermal; dermic. [EU] Cyclophosphamide: Precursor of an alkylating nitrogen mustard antineoplastic and immunosuppressive agent that must be activated in the liver to form the active aldophosphamide. It is used in the treatment of lymphomas, leukemias, etc. Its side effect, alopecia, has been made use of in defleecing sheep. Cyclophosphamide may also cause sterility, birth defects,

Glossary 351

mutations, and cancer. [NIH] Cycloserine: Antibiotic substance produced by Streptomyces garyphalus. It may be used in the treatment of resistant tuberculosis as part of a multi-drug regimen. It has also been used in urinary tract infections. [NIH] Cytogenetics: A branch of genetics which deals with the cytological and molecular behavior of genes and chromosomes during cell division. [NIH] Daunorubicin: Very toxic anthracycline aminoglycoside antibiotic isolated from Streptomyces peucetius and others, used in treatment of leukemias and other neoplasms. [NIH] Degenerative: Undergoing degeneration : tending to degenerate; having the character of or involving degeneration; causing or tending to cause degeneration. [EU] Dementia: An acquired organic mental disorder with loss of intellectual abilities of sufficient severity to interfere with social or occupational functioning. The dysfunction is multifaceted and involves memory, behavior, personality, judgment, attention, spatial relations, language, abstract thought, and other executive functions. The intellectual decline is usually progressive, and initially spares the level of consciousness. [NIH] Dermatitis: Inflammation of the skin. [EU] Detoxification: Treatment designed to free an addict from his drug habit. [EU]

Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Diarrhea: Passage of excessively liquid or excessively frequent stools. [NIH] Diffusion: The process of becoming diffused, or widely spread; the spontaneous movement of molecules or other particles in solution, owing to their random thermal motion, to reach a uniform concentration throughout the solvent, a process requiring no addition of energy to the system. [EU] Diltiazem: A benzothiazepine derivative with vasodilating action due to its antagonism of the actions of the calcium ion in membrane functions. It is also teratogenic. [NIH] Diuretics, Thiazide: Diuretics characterized as analogs of 1,2,4benzothiadiazine-1,1-dioxide. All have a common mechanism of action and differ primarily in the dose required to produce a given effect. They act directly on the kidney to increase the excretion of sodium chloride and water


and also increase excretion of potassium ions. [NIH] Dizziness: An imprecise term which may refer to a sense of spatial disorientation, motion of the environment, or lightheadedness. [NIH] Dorsal: 1. pertaining to the back or to any dorsum. 2. denoting a position more toward the back surface than some other object of reference; same as posterior in human anatomy; superior in the anatomy of quadrupeds. [EU] Doxorubicin: Antineoplastic antibiotic obtained from Streptomyces peucetics. It is a hydroxy derivative of daunorubicin and is used in treatment of both leukemia and solid tumors. [NIH] Dysarthria: Imperfect articulation of speech due to disturbances of muscular control which result from damage to the central or peripheral nervous system. [EU] Dyskinesia: Impairment of the power of voluntary movement, resulting in fragmentary or incomplete movements. [EU] Dysmenorrhea: Painful menstruation. [NIH] Dysphagia: Difficulty in swallowing. [EU] Dystonia: Disordered tonicity of muscle. [EU] Echinacea: A genus of perennial herbs used topically and internally. It contains echinacoside, glycosides, inulin, isobutyl amides, resin, and sesquiterpenes. [NIH] Eczema: A pruritic papulovesicular dermatitis occurring as a reaction to many endogenous and exogenous agents, characterized in the acute stage by erythema, edema associated with a serous exudate between the cells of the epidermis (spongiosis) and an inflammatory infiltrate in the dermis, oozing and vesiculation, and crusting and scaling; and in the more chronic stages by lichenification or thickening or both, signs of excoriations, and hyperpigmentation or hypopigmentation or both. Atopic dermatitis is the most common type of dermatitis. Called also eczematous dermatitis. [EU] Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electromyography: Recording of the changes in electric potential of muscle by means of surface or needle electrodes. [NIH] Emphysema: A pathological accumulation of air in tissues or organs; applied especially to such a condition of the lungs. [EU] Enalapril: An angiotensin-converting enzyme inhibitor that is used to treat hypertension. [NIH] Encephalopathy: Any degenerative disease of the brain. [EU] Endocarditis: Exudative and proliferative inflammatory alterations of the endocardium, characterized by the presence of vegetations on the surface of

Glossary 353

the endocardium or in the endocardium itself, and most commonly involving a heart valve, but sometimes affecting the inner lining of the cardiac chambers or the endocardium elsewhere. It may occur as a primary disorder or as a complication of or in association with another disease. [EU] Endogenous: Developing or originating within the organisms or arising from causes within the organism. [EU] Endometriosis: A condition in which tissue more or less perfectly resembling the uterine mucous membrane (the endometrium) and containing typical endometrial granular and stromal elements occurs aberrantly in various locations in the pelvic cavity; called also adenomyosis externa and endometriosis externa. [EU] Energetic: Exhibiting energy : strenuous; operating with force, vigour, or effect. [EU] Enzyme: A protein molecule that catalyses chemical reactions of other substances without itself being destroyed or altered upon completion of the reactions. Enzymes are classified according to the recommendations of the Nomenclature Committee of the International Union of Biochemistry. Each enzyme is assigned a recommended name and an Enzyme Commission (EC) number. They are divided into six main groups; oxidoreductases, transferases, hydrolases, lyases, isomerases, and ligases. [EU] Epidemic: Occurring suddenly in numbers clearly in excess of normal expectancy; said especially of infectious diseases but applied also to any disease, injury, or other health-related event occurring in such outbreaks. [EU] Epirubicin: An anthracycline antibiotic which is the 4'-epi-isomer of doxorubicin. The compound exerts its antitumor effects by interference with the synthesis and function of DNA. Clinical studies indicate activity in breast cancer, non-Hodgkin's lymphomas, ovarian cancer, soft-tissue sarcomas, pancreatic cancer, gastric cancer, small-cell lung cancer and acute leukemia. It is equal in activity to doxorubicin but exhibits less acute toxicities and less cardiotoxicity. [NIH] Equisetum: A genus of plants closely related to ferns. Some species have medicinal use and some are poisonous. [NIH] Erythema: A name applied to redness of the skin produced by congestion of the capillaries, which may result from a variety of causes, the etiology or a specific type of lesion often being indicated by a modifying term. [EU] Etodolac: A nonsteroidal anti-inflammatory agent with potent analgesic and antiarthritic properties. It has been shown to be effective in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, and in the alleviation of postoperative pain. [NIH] Evacuation: An emptying, as of the bowels. [EU]


Exhibitionism: A disorder in which fantasies about or the act of exposing the genitals to an unsuspecting stranger produces sexual excitement with no attempt at further sexual activity with the stranger. [NIH] Exocrine: 1. secreting outwardly, via a duct;. [EU] Exocytosis: Cellular release of material within membrane-limited vesicles by fusion of the vesicles with the cell membrane. [NIH] Extrapyramidal: Outside of the pyramidal tracts. [EU] Facial: Of or pertaining to the face. [EU] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH] Fibrosis: The formation of fibrous tissue; fibroid or fibrous degeneration [EU] Filariasis: Infections with nematodes of the superfamily filarioidea. The presence of living worms in the body is mainly asymptomatic but the death of adult worms leads to granulomatous inflammation and permanent fibrosis. Organisms of the genus Elaeophora infect wild elk and domestic sheep causing ischaemic necrosis of the brain, blindness, and dermatosis of the face. [NIH] Fissure: Any cleft or groove, normal or otherwise; especially a deep fold in the cerebral cortex which involves the entire thickness of the brain wall. [EU] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Fluoxetine: The first highly specific serotonin uptake inhibitor. It is used as an antidepressant and often has a more acceptable side-effects profile than traditional antidepressants. [NIH] Fluphenazine: A phenothiazine used in the treatment of psychoses. Its properties and uses are generally similar to those of chlorpromazine. [NIH] Fluvoxamine: A selective serotonin reuptake inhibitor. It is effective in the treatment of depression, obsessive-compulsive disorders, anxiety, panic disorders, and alcohol amnestic disorders. [NIH] Frostbite: Damage to tissues as the result of low environmental temperatures. [NIH] GABA: The most common inhibitory neurotransmitter in the central nervous system. [NIH] Gadolinium: Gadolinium. An element of the rare earth family of metals. It has the atomic symbol Gd, atomic number 64, and atomic weight 157.25. Its oxide is used in the control rods of some nuclear reactors. [NIH] Ganglia: Clusters of multipolar neurons surrounded by a capsule of loosely

Glossary 355

organized connective tissue located outside the central nervous system. [NIH] Gastritis: Inflammation of the stomach. [EU] Gemfibrozil: A lipid-regulating agent that lowers elevated serum lipids primarily by decreasing serum triglycerides with a variable reduction in total cholesterol. These decreases occur primarily in the VLDL fraction and less frequently in the LDL fraction. Gemfibrozil increases HDL subfractions HDL2 and HDL3 as well as apolipoproteins A-I and A-II. Its mechanism of action has not been definitely established. [NIH] Gingivitis: Inflammation of the gingivae. Gingivitis associated with bony changes is referred to as periodontitis. Called also oulitis and ulitis. [EU] Glipizide: An oral hypoglycemic agent which is rapidly absorbed and completely metabolized. [NIH] Glucose: D-glucose, a monosaccharide (hexose), C6H12O6, also known as dextrose (q.v.), found in certain foodstuffs, especially fruits, and in the normal blood of all animals. It is the end product of carbohydrate metabolism and is the chief source of energy for living organisms, its utilization being controlled by insulin. Excess glucose is converted to glycogen and stored in the liver and muscles for use as needed and, beyond that, is converted to fat and stored as adipose tissue. Glucose appears in the urine in diabetes mellitus. [EU] Glyburide: An antidiabetic sulfonylurea derivative with actions similar to those of chlorpropamide. [NIH] Glycyrrhiza: A genus of leguminous herbs or shrubs whose roots yield glycyrrhetinic acid and its derivatives, carbenoxolone for example. Licorice toxicity is manifested as hypokalemia, low blood potassium. Licorice is used as flavoring and aromatic in pharmaceuticals and as candy. [NIH] Gonadal: Pertaining to a gonad. [EU] Gout: Hereditary metabolic disorder characterized by recurrent acute arthritis, hyperuricemia and deposition of sodium urate in and around the joints, sometimes with formation of uric acid calculi. [NIH] Guanfacine: A centrally acting antihypertensive agent. The drug lowers both systolic and diastolic blood pressure by activating the central nervous system alpha-2 adrenoreceptors, which results in reduced sympathetic outflow leading to reduced vascular tone. Its adverse reactions include dry mouth, sedation, and constipation. [NIH] Heartburn: Substernal pain or burning sensation, usually associated with regurgitation of gastric juice into the esophagus. [NIH] Hemorrhoids: Varicosities of the hemorrhoidal venous plexuses. [NIH] Heparin: Heparinic acid. A highly acidic mucopolysaccharide formed of


equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts. [NIH] Hepatitis: Inflammation of the liver. [EU] Histamine: 1H-Imidazole-4-ethanamine. A depressor amine derived by enzymatic decarboxylation of histidine. It is a powerful stimulant of gastric secretion, a constrictor of bronchial smooth muscle, a vasodilator, and also a centrally acting neurotransmitter. [NIH] Hoarseness: An unnaturally deep or rough quality of voice. [NIH] Homogeneous: Consisting of or composed of similar elements or ingredients; of a uniform quality throughout. [EU] Hormones: Chemical substances having a specific regulatory effect on the activity of a certain organ or organs. The term was originally applied to substances secreted by various endocrine glands and transported in the bloodstream to the target organs. It is sometimes extended to include those substances that are not produced by the endocrine glands but that have similar effects. [NIH] Hydralazine: A direct-acting vasodilator that is used as an antihypertensive agent. [NIH] Hydrogen: Hydrogen. The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hypersensitivity: A state of altered reactivity in which the body reacts with an exaggerated immune response to a foreign substance. Hypersensitivity reactions are classified as immediate or delayed, types I and IV, respectively, in the Gell and Coombs classification (q.v.) of immune responses. [EU] Hypothalamus: Ventral part of the diencephalon extending from the region of the optic chiasm to the caudal border of the mammillary bodies and forming the inferior and lateral walls of the third ventricle. [NIH] Hypothermia: A low body temperature, as that due to exposure in cold weather or a state of low temperature of the body induced as a means of decreasing metabolism of tissues and thereby the need for oxygen, as used in various surgical procedures, especially on the heart, or in an excised organ being preserved for transplantation. [EU] Hypothyroidism: Deficiency of thyroid activity. In adults, it is most common in women and is characterized by decrease in basal metabolic rate,

Glossary 357

tiredness and lethargy, sensitivity to cold, and menstrual disturbances. If untreated, it progresses to full-blown myxoedema. In infants, severe hypothyroidism leads to cretinism. In juveniles, the manifestations are intermediate, with less severe mental and developmental retardation and only mild symptoms of the adult form. When due to pituitary deficiency of thyrotropin secretion it is called secondary hypothyroidism. [EU] Ibuprofen: A nonsteroidal anti-inflammatory agent with analgesic properties used in the therapy of rheumatism and arthritis. [NIH] Idarubicin: An orally administered anthracycline antibiotic. The compound has shown activity against breast cancer, lymphomas and leukemias, together with potential for reduced cardiac toxicity. [NIH] Idiopathic: Of the nature of an idiopathy; self-originated; of unknown causation. [EU] Incontinence: Inability to control excretory functions, as defecation (faecal i.) or urination (urinary i.). [EU] Indapamide: A sulfamyl diuretic with about 16x the effect of furosemide. It has also been shown to be an effective antihypertensive agent in the clinic. [NIH]

Indinavir: A potent and specific HIV protease inhibitor that appears to have good oral bioavailability. [NIH] Infantile: Pertaining to an infant or to infancy. [EU] Infertility: The diminished or absent ability to conceive or produce an offspring while sterility is the complete inability to conceive or produce an offspring. [NIH] Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Influenza: An acute viral infection involving the respiratory tract. It is marked by inflammation of the nasal mucosa, the pharynx, and conjunctiva, and by headache and severe, often generalized, myalgia. [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Innervation: 1. the distribution or supply of nerves to a part. 2. the supply of nervous energy or of nerve stimulus sent to a part. [EU] Insomnia: Inability to sleep; abnormal wakefulness. [EU] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulindependent diabetes mellitus. [NIH]


Intestinal: Pertaining to the intestine. [EU] Intoxication: Poisoning, the state of being poisoned. [EU] Intrathecal: Within a sheath. [EU] Intravenous: Within a vein or veins. [EU] Iodine: A nonmetallic element of the halogen group that is represented by the atomic symbol I, atomic number 53, and atomic weight of 126.90. It is a nutritionally essential element, especially important in thyroid hormone synthesis. In solution, it has anti-infective properties and is used topically. [NIH]

Ipecac: A syrup made from the dried rhizomes of two different species, Cephaelis ipecacuanha and C. acuminata, belonging to the rubiaciae family. They contain emetine, cephaeline, psychotrine and other isoquinolines. Ipecac syrup is used widely as an emetic acting both locally on the gastric mucosa and centrally on the chemoreceptor trigger zone. [NIH] Iris: The most anterior portion of the uveal layer, separating the anterior chamber from the posterior. It consists of two layers - the stroma and the pigmented epithelium. Color of the iris depends on the amount of melanin in the stroma on reflection from the pigmented epithelium. [NIH] Isoniazid: Antibacterial agent used primarily as a tuberculostatic. It remains the treatment of choice for tuberculosis. [NIH] Isosorbide: 1,4:3,6-Dianhydro D-glucitol. Chemically inert osmotic diuretic used mainly to treat hydrocephalus; also used in glaucoma. [NIH] Jews: An ethnic group with certain cultural and religious traditions. [NIH] Juniper: A slow growing coniferous evergreen tree or shrub, genus Juniperus. The Juniper is cultivated for its berries, which take up to three years to ripen. The resinous, sweetly flavored berries are borne only by the female juniper, and can be found in various stages of ripeness on the same plant. [NIH] Kanamycin: Antibiotic complex produced by Streptomyces kanamyceticus from Japanese soil. Comprises 3 components: kanamycin A, the major component, and kanamycins B and C, the minor components. [NIH] Kava: Dried rhizome and roots of Piper methysticum, a shrub native to Oceania and known for its anti-anxiety and sedative properties. Heavy usage results in some adverse effects. It contains alkaloids, lactones, kawain, methysticin, mucilage, starch, and yangonin. Kava is also the name of the pungent beverage prepared from the plant's roots. [NIH] Ketoprofen: An ibuprofen-type anti-inflammatory analgesic and antipyretic. It is used in the treatment of rheumatoid arthritis and osteoarthritis. [NIH] Labetalol: Blocker of both alpha- and beta-adrenergic receptors that is used

Glossary 359

as an antihypertensive. [NIH] Larva: Wormlike or grublike stage, following the egg in the life cycle of insects, worms, and other metamorphosing animals. [NIH] Laryngectomy: Total or partial excision of the larynx. [NIH] Laryngitis: Inflammation of the larynx, a condition attended with dryness and soreness of the throat, hoarseness, cough and dysphagia. [EU] Laryngoscopy: Examination, therapy or surgery of the interior of the larynx performed with a specially designed endoscope. [NIH] Larynx: An irregularly shaped, musculocartilaginous tubular structure, lined with mucous membrane, located at the top of the trachea and below the root of the tongue and the hyoid bone. It is the essential sphincter guarding the entrance into the trachea and functioning secondarily as the organ of voice. [NIH] Lesion: Any pathological or traumatic discontinuity of tissue or loss of function of a part. [EU] Lethargy: Abnormal drowsiness or stupor; a condition of indifference. [EU] Levodopa: The naturally occurring form of dopa and the immediate precursor of dopamine. Unlike dopamine itself, it can be taken orally and crosses the blood-brain barrier. It is rapidly taken up by dopaminergic neurons and converted to dopamine. It is used for the treatment of parkinsonism and is usually given with agents that inhibit its conversion to dopamine outside of the central nervous system. [NIH] Lidocaine: A local anesthetic and cardiac depressant used as an antiarrhythmia agent. Its actions are more intense and its effects more prolonged than those of procaine but its duration of action is shorter than that of bupivacaine or prilocaine. [NIH] Limbic: Pertaining to a limbus, or margin; forming a border around. [EU] Lip: Either of the two fleshy, full-blooded margins of the mouth. [NIH] Lisinopril: An orally active angiotensin-converting enzyme inhibitor that has been used in the treatment of hypertension and congestive heart failure. [NIH]

Localization: 1. the determination of the site or place of any process or lesion. 2. restriction to a circumscribed or limited area. 3. prelocalization. [EU] Locomotion: Movement or the ability to move from one place or another. It can refer to humans, vertebrate or invertebrate animals, and microorganisms. [NIH] Locomotor: Of or pertaining to locomotion; pertaining to or affecting the locomotive apparatus of the body. [EU] Lumbar: Pertaining to the loins, the part of the back between the thorax and


the pelvis. [EU] Lymphoma: Any neoplastic disorder of the lymphoid tissue, the term lymphoma often is used alone to denote malignant lymphoma. [EU] Lysine: An essential amino acid. It is often added to animal feed. [NIH] Macrolides: A group of organic compounds that contain a macrocyclic lactone ring linked glycosidically to one or more sugar moieties. [NIH] Malformation: A morphologic defect resulting from an intrinsically abnormal developmental process. [EU] Manic: Affected with mania. [EU] Mebendazole: A nematocide in humans and animals. It acts by interfering with the carbohydrate metabolism and associated energy production of the parasite. [NIH] Mecamylamine: A nicotinic antagonist that is well absorbed from the gastrointestinal tract and crosses the blood-brain barrier. Mecamylamine has been used as a ganglionic blocker in treating hypertension, but, like most ganglionic blockers, is more often used now as a research tool. [NIH] Mediator: An object or substance by which something is mediated, such as (1) a structure of the nervous system that transmits impulses eliciting a specific response; (2) a chemical substance (transmitter substance) that induces activity in an excitable tissue, such as nerve or muscle; or (3) a substance released from cells as the result of the interaction of antigen with antibody or by the action of antigen with a sensitized lymphocyte. [EU] Membrane: A thin layer of tissue which covers a surface, lines a cavity or divides a space or organ. [EU] Meningitis: Inflammation of the meninges. When it affects the dura mater, the disease is termed pachymeningitis; when the arachnoid and pia mater are involved, it is called leptomeningitis, or meningitis proper. [EU] Menopause: Cessation of menstruation in the human female, occurring usually around the age of 50. [EU] Menorrhagia: Excessive uterine bleeding occurring at the regular intervals of menstruation, the period of flow being of greater than usual duration. [EU] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mentors: Senior professionals who provide guidance, direction and support to those persons desirous of improvement in academic positions, administrative positions or other career development situations. [NIH] Methotrexate: An antineoplastic antimetabolite with immunosuppressant properties. It is an inhibitor of dihydrofolate reductase and prevents the formation of tetrahydrofolate, necessary for synthesis of thymidylate, an

Glossary 361

essential component of DNA. [NIH] Methylphenidate: A central nervous system stimulant used most commonly in the treatment of attention-deficit disorders in children and for narcolepsy. Its mechanisms appear to be similar to those of dextroamphetamine. [NIH] Metoprolol: Adrenergic beta-1-blocking agent with no stimulatory action. It is less bound to plasma albumin than alprenolol and may be useful in angina pectoris, hypertension, or cardiac arrhythmias. [NIH] Midwifery: The practice of assisting women in childbirth. [NIH] Minocycline: A semisynthetic antibiotic effective against tetracyclineresistant staphylococcus infections. [NIH] Mitomycin: An antineoplastic antibiotic produced by Streptomyces caespitosus. It acts as a bi- or trifunctional alkylating agent causing crosslinking of DNA and inhibition of DNA synthesis. [NIH] Mitoxantrone: An anthracenedione-derived antineoplastic agent. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Monotherapy: A therapy which uses only one drug. [EU] Mupirocin: A topically used antibiotic from a strain of Pseudomonas fluorescens. It has shown excellent activity against gram-positive staphylococci and streptococci. The antibiotic is used primarily for the treatment of primary and secondary skin disorders, nasal infections, and wound healing. [NIH] Mutism: Inability or refusal to speak. [EU] Myasthenia: Muscular debility; any constitutional anomaly of muscle. [EU] Nadolol: A non-selective beta-adrenergic antagonist with a long half-life, used in cardiovascular disease to treat arrhythmias, angina pectoris, and hypertension. Nadolol is also used for migraine and for tremor. [NIH] Naloxone: A specific opiate antagonist that has no agonist activity. It is a competitive antagonist at mu, delta, and kappa opioid receptors. [NIH] Naltrexone: Derivative of noroxymorphone that is the N-cyclopropylmethyl congener of naloxone. It is a narcotic antagonist that is effective orally, longer lasting and more potent than naloxone, and has been proposed for the treatment of heroin addiction. The FDA has approved naltrexone for the treatment of alcohol dependence. [NIH] Naproxen: An anti-inflammatory agent with analgesic and antipyretic properties. Both the acid and its sodium salt are used in the treatment of rheumatoid arthritis and other rheumatic or musculoskeletal disorders, dysmenorrhea, and acute gout. [NIH]


Neomycin: Antibiotic complex produced by Streptomyces fradiae. It is composed of neomycins A, B, and C. It acts by inhibiting translation during protein synthesis. [NIH] Neural: 1. pertaining to a nerve or to the nerves. 2. situated in the region of the spinal axis, as the neutral arch. [EU] Neuralgia: Paroxysmal pain which extends along the course of one or more nerves. Many varieties of neuralgia are distinguished according to the part affected or to the cause, as brachial, facial, occipital, supraorbital, etc., or anaemic, diabetic, gouty, malarial, syphilitic, etc. [EU] Neuroanatomy: Study of the anatomy of the nervous system as a specialty or discipline. [NIH] Neuroleptic: A term coined to refer to the effects on cognition and behaviour of antipsychotic drugs, which produce a state of apathy, lack of initiative, and limited range of emotion and in psychotic patients cause a reduction in confusion and agitation and normalization of psychomotor activity. [EU] Neurology: A medical specialty concerned with the study of the structures, functions, and diseases of the nervous system. [NIH] Neuromuscular: Pertaining to muscles and nerves. [EU] Neuronal: Pertaining to a neuron or neurons (= conducting cells of the nervous system). [EU] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A general term denoting functional disturbances and/or pathological changes in the peripheral nervous system. The etiology may be known e.g. arsenical n., diabetic n., ischemic n., traumatic n.) or unknown. Encephalopathy and myelopathy are corresponding terms relating to involvement of the brain and spinal cord, respectively. The term is also used to designate noninflammatory lesions in the peripheral nervous system, in contrast to inflammatory lesions (neuritis). [EU] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurophysiology: The scientific discipline concerned with the physiology of the nervous system. [NIH] Neurosurgery: A surgical specialty concerned with the treatment of diseases and disorders of the brain, spinal cord, and peripheral and sympathetic nervous system. [NIH] Neurotransmitter:

Any of a group of substances that are released on

Glossary 363

excitation from the axon terminal of a presynaptic neuron of the central or peripheral nervous system and travel across the synaptic cleft to either excite or inhibit the target cell. Among the many substances that have the properties of a neurotransmitter are acetylcholine, norepinephrine, epinephrine, dopamine, glycine, y-aminobutyrate, glutamic acid, substance P, enkephalins, endorphins, and serotonin. [EU] Niacin: Water-soluble vitamin of the B complex occurring in various animal and plant tissues. Required by the body for the formation of coenzymes NAD and NADP. Has pellagra-curative, vasodilating, and antilipemic properties. [NIH] Nicotine: Nicotine is highly toxic alkaloid. It is the prototypical agonist at nicotinic cholinergic receptors where it dramatically stimulates neurons and ultimately blocks synaptic transmission. Nicotine is also important medically because of its presence in tobacco smoke. [NIH] Nifedipine: A potent vasodilator agent with calcium antagonistic action. It is a useful anti-anginal agent that also lowers blood pressure. The use of nifedipine as a tocolytic is being investigated. [NIH] Nitrofurantoin: A urinary anti-infective agent effective against most grampositive and gram-negative organisms. Although sulfonamides and antibiotics are usually the agents of choice for urinary tract infections, nitrofurantoin is widely used for prophylaxis and long-term suppression. [NIH]

Nitroglycerin: A highly volatile organic nitrate that acts as a dilator of arterial and venous smooth muscle and is used in the treatment of angina. It provides relief through improvement of the balance between myocardial oxygen supply and demand. Although total coronary blood flow is not increased, there is redistribution of blood flow in the heart when partial occlusion of coronary circulation is effected. [NIH] Norepinephrine: Precursor of epinephrine that is secreted by the adrenal medulla and is a widespread central and autonomic neurotransmitter. Norepinephrine is the principal transmitter of most postganglionic sympathetic fibers and of the diffuse projection system in the brain arising from the locus ceruleus. It is also found in plants and is used pharmacologically as a sympathomimetic. [NIH] Obsession: A recurrent, persistent thought, image, or impulse that is unwanted and distressing (ego-dystonic) and comes involuntarily to mind despite attempts to ignore or suppress it. Common obsessions involve thoughts of violence, contamination, and self-doubt. [EU] Oligosaccharides: Carbohydrates consisting of between two and ten monosaccharides connected by either an alpha- or beta-glycosidic link. They are found throughout nature in both the free and bound form. [NIH]


Ophthalmic: Pertaining to the eye. [EU] Osteoarthritis: Noninflammatory degenerative joint disease occurring chiefly in older persons, characterized by degeneration of the articular cartilage, hypertrophy of bone at the margins, and changes in the synovial membrane. It is accompanied by pain and stiffness, particularly after prolonged activity. [EU] Osteogenesis: The histogenesis of bone including ossification. It occurs continuously but particularly in the embryo and child and during fracture repair. [NIH] Overdose: 1. to administer an excessive dose. 2. an excessive dose. [EU] Oxytocin: A nonapeptide posterior pituitary hormone that causes uterine contractions and stimulates lactation. [NIH] Paclitaxel: Antineoplastic agent isolated from the bark of the Pacific yew tree, Taxus brevifolia. Paclitaxel stabilizes microtubules in their polymerized form and thus mimics the action of the proto-oncogene proteins C-mos. [NIH] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the islets of langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Panic: A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function. [NIH] Paralysis: Loss or impairment of motor function in a part due to lesion of the neural or muscular mechanism; also by analogy, impairment of sensory function (sensory paralysis). In addition to the types named below, paralysis is further distinguished as traumatic, syphilitic, toxic, etc., according to its cause; or as obturator, ulnar, etc., according to the nerve part, or muscle specially affected. [EU] Parasitic: Pertaining to, of the nature of, or caused by a parasite. [EU] Parenteral: Not through the alimentary canal but rather by injection through some other route, as subcutaneous, intramuscular, intraorbital, intracapsular, intraspinal, intrasternal, intravenous, etc. [EU] Paroxetine: A serotonin uptake inhibitor that is effective in the treatment of depression. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pediatrics: A medical specialty concerned with maintaining health and providing medical care to children from birth to adolescence. [NIH] Pelvic: Pertaining to the pelvis. [EU] Pemoline:

A central nervous system stimulant used in fatigue and

Glossary 365

depressive states and to treat hyperkinetic disorders in children. [NIH] Penicillamine: 3-Mercapto-D-valine. The most characteristic degradation product of the penicillin antibiotics. It is used as an antirheumatic and as a chelating agent in Wilson's disease. [NIH] Peptic: Pertaining to pepsin or to digestion; related to the action of gastric juices. [EU] Pergolide: A long-acting dopamine agonist which is effective in the treatment of Parkinson's disease and hyperprolactinemia. It has also been observed to have antihypertensive effects. [NIH] Perphenazine: An antipsychotic phenothiazine derivative with actions and uses similar to those of chlorpromazine. [NIH] Pharyngitis: Inflammation of the pharynx. [EU] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory gaba subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phenotype: The outward appearance of the individual. It is the product of interactions between genes and between the genotype and the environment. This includes the killer phenotype, characteristic of yeasts. [NIH] Phenylalanine: An aromatic amino acid that is essential in the animal diet. It is a precursor of melanin, dopamine, noradrenalin, and thyroxine. [NIH] Phenylpropanolamine: A sympathomimetic that acts mainly by causing release of norepinephrine but also has direct agonist activity at some adrenergic receptors. It is most commonly used as a nasal vasoconstrictor and an appetite depressant. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an anti-arrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Phobia: A persistent, irrational, intense fear of a specific object, activity, or situation (the phobic stimulus), fear that is recognized as being excessive or unreasonable by the individual himself. When a phobia is a significant source of distress or interferes with social functioning, it is considered a mental disorder; phobic disorder (or neurosis). In DSM III phobic disorders are subclassified as agoraphobia, social phobias, and simple phobias. Used


as a word termination denoting irrational fear of or aversion to the subject indicated by the stem to which it is affixed. [EU] Phonation: The process of producing vocal sounds by means of vocal cords vibrating in an expiratory blast of air. [NIH] Photosensitivity: An abnormal cutaneous response involving the interaction between photosensitizing substances and sunlight or filtered or artificial light at wavelengths of 280-400 mm. There are two main types : photoallergy and photoxicity. [EU] Plague: An acute infectious disease caused by yersinia pestis that affects humans, wild rodents, and their ectoparasites. This condition persists due to its firm entrenchment in sylvatic rodent-flea ecosystems throughout the world. Bubonic plague is the most common form. [NIH] Plantago: Three different species of Plantago or plantain, P. psyllium, P. ovata and P. indica. The seeds swell in water and are used as laxatives. [NIH] Plicamycin: A tricyclic pentaglycosidic antibiotic from Streptomyces strains that inhibits RNA and protein synthesis by adhering to DNA. It is used as a fluorescent dye and as an antineoplastic agent, especially in bone and testicular tumors. Plicamycin is also used to reduce hypercalcemia, especially that due to malignancies. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polyneuritis: Inflammation of many nerves at once; multiple or disseminated, neuritis. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH] Praziquantel: An anthelmintic used in most schistosome and many cestode infestations. [NIH] Prazosin: A selective adrenergic alpha-1 antagonist used in the treatment of heart failure, hypertension, pheochromocytoma, Raynaud's syndrome, prostatic hypertrophy, and urinary retention. [NIH] Predisposition: A latent susceptibility to disease which may be activated under certain conditions, as by stress. [EU] Preeclampsia: A toxaemia of late pregnancy characterized by hypertension, edema, and proteinuria, when convulsions and coma are associated, it is called eclampsia. [EU] Premenstrual: Occurring before menstruation. [EU]

Glossary 367

Presynaptic: Situated proximal to a synapse, or occurring before the synapse is crossed. [EU] Prevalence: The total number of cases of a given disease in a specified population at a designated time. It is differentiated from incidence, which refers to the number of new cases in the population at a given time. [NIH] Probenecid: The prototypical uricosuric agent. It inhibits the renal excretion of organic anions and reduces tubular reabsorption of urate. Probenecid has also been used to treat patients with renal impairment, and, because it reduces the renal tubular excretion of other drugs, has been used as an adjunct to antibacterial therapy. [NIH] Proctitis: Inflammation of the rectum. [EU] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prolapse: 1. the falling down, or sinking, of a part or viscus; procidentia. 2. to undergo such displacement. [EU] Propoxyphene: A narcotic analgesic structurally related to methadone. Only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect. [NIH] Propranolol: A widely used non-cardioselective beta-adrenergic antagonist. Propranolol is used in the treatment or prevention of many disorders including acute myocardial infarction, arrhythmias, angina pectoris, hypertension, hypertensive emergencies, hyperthyroidism, migraine, pheochromocytoma, menopause, and anxiety. [NIH] Prostate: A gland in males that surrounds the neck of the bladder and the urethra. It secretes a substance that liquifies coagulated semen. It is situated in the pelvic cavity behind the lower part of the pubic symphysis, above the deep layer of the triangular ligament, and rests upon the rectum. [NIH] Psoriasis: A common genetically determined, chronic, inflammatory skin disease characterized by rounded erythematous, dry, scaling patches. The lesions have a predilection for nails, scalp, genitalia, extensor surfaces, and the lumbosacral region. Accelerated epidermopoiesis is considered to be the fundamental pathologic feature in psoriasis. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychopathology: The study of significant causes and processes in the development of mental illness. [NIH]


Psychopharmacology: The study of the effects of drugs on mental and behavioral activity. [NIH] Psychophysiology: The study of the physiological basis of human and animal behavior. [NIH] Psychosomatic: Pertaining to the mind-body relationship; having bodily symptoms of psychic, emotional, or mental origin; called also psychophysiologic. [EU] Psychotherapy: A generic term for the treatment of mental illness or emotional disturbances primarily by verbal or nonverbal communication. [NIH]

Pulmonary: Pertaining to the lungs. [EU] Quadriplegia: Severe or complete loss of motor function in all four limbs which may result from brain diseases; spinal cord diseases; peripheral nervous system diseases; neuromuscular diseases; or rarely muscular diseases. The locked-in syndrome is characterized by quadriplegia in combination with cranial muscle paralysis. Consciousness is spared and the only retained voluntary motor activity may be limited eye movements. This condition is usually caused by a lesion in the upper brain stem which injures the descending cortico-spinal and cortico-bulbar tracts. [NIH] Quercetin: Aglucon of quercetrin, rutin, and other glycosides. It is widely distributed in the plant kingdom, especially in rinds and barks, clover blossoms, and ragweed pollen. [NIH] Quinidine: An optical isomer of quinine, extracted from the bark of the Cinchona tree and similar plant species. This alkaloid dampens the excitability of cardiac and skeletal muscles by blocking sodium and potassium currents across cellular membranes. It prolongs cellular action potential, and decreases automaticity. Quinidine also blocks muscarinic and alpha-adrenergic neurotransmission. [NIH] Quinolones: Quinolines which are substituted in any position by one or more oxo groups. These compounds can have any degree of hydrogenation, any substituents, and fused ring systems. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Ramipril: A long-acting angiotensin-converting enzyme inhibitor. It is a prodrug that is transformed in the liver to its active metabolite ramiprilat. [NIH]

Receptor: 1. a molecular structure within a cell or on the surface characterized by (1) selective binding of a specific substance and (2) a specific physiologic effect that accompanies the binding, e.g., cell-surface receptors for peptide hormones, neurotransmitters, antigens, complement fragments, and immunoglobulins and cytoplasmic receptors for steroid

Glossary 369

hormones. 2. a sensory nerve terminal that responds to stimuli of various kinds. [EU] Rectal: Pertaining to the rectum (= distal portion of the large intestine). [EU] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Reflex: 1; reflected. 2. a reflected action or movement; the sum total of any particular involuntary activity. [EU] Reishi: A mushroom, Ganoderma lucidum, of the aphyllophorales order of basidomycetous fungi. It has long been used in traditional Chinese medicine in various forms. Contains sterols, coumarin, mannitol, polysaccharides, and triterpenoids. [NIH] Remission: A diminution or abatement of the symptoms of a disease; also the period during which such diminution occurs. [EU] Reserpine: An alkaloid found in the roots of Rauwolfia serpentina and R. vomitoria. Reserpine inhibits the uptake of norepinephrine into storage vesicles resulting in depletion of catecholamines and serotonin from central and peripheral axon terminals. It has been used as an antihypertensive and an antipsychotic as well as a research tool, but its adverse effects limit its clinical use. [NIH] Retinopathy: 1. retinitis (= inflammation of the retina). 2. retinosis (= degenerative, noninflammatory condition of the retina). [EU] Riboflavin: Nutritional factor found in milk, eggs, malted barley, liver, kidney, heart, and leafy vegetables. The richest natural source is yeast. It occurs in the free form only in the retina of the eye, in whey, and in urine; its principal forms in tissues and cells are as FMN and FAD. [NIH] Rigidity: Stiffness or inflexibility, chiefly that which is abnormal or morbid; rigor. [EU] Risperidone: A selective blocker of dopamine D2 and serotonin-5-HT-2 receptors that acts as an atypical antipsychotic agent. It has been shown to improve both positive and negative symptoms in the treatment of schizophrenia. [NIH] Schizophrenia: A severe emotional disorder of psychotic depth characteristically marked by a retreat from reality with delusion formation, hallucinations, emotional disharmony, and regressive behavior. [NIH] Sclerosis: A induration, or hardening; especially hardening of a part from inflammation and in diseases of the interstitial substance. The term is used chiefly for such a hardening of the nervous system due to hyperplasia of the connective tissue or to designate hardening of the blood vessels. [EU] Secretion: 1. the process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific


substance of the blood to the elaboration of a new chemical substance. 2. any substance produced by secretion. [EU] Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Selenium: An element with the atomic symbol Se, atomic number 34, and atomic weight 78.96. It is an essential micronutrient for mammals and other animals but is toxic in large amounts. Selenium protects intracellular structures against oxidative damage. It is an essential component of glutathione peroxidase. [NIH] Senna: Preparations of Cassia senna L. and C. angustifolia of the Leguminosae. They contain sennosides, which are anthraquinone type cathartics and are used in many different preparations as laxatives. [NIH] Sertraline: A selective serotonin uptake inhibitor that is used in the treatment of depression. [NIH] Serum: The clear portion of any body fluid; the clear fluid moistening serous membranes. 2. blood serum; the clear liquid that separates from blood on clotting. 3. immune serum; blood serum from an immunized animal used for passive immunization; an antiserum; antitoxin, or antivenin. [EU] Sinusitis: Inflammation of a sinus. The condition may be purulent or nonpurulent, acute or chronic. Depending on the site of involvement it is known as ethmoid, frontal, maxillary, or sphenoid sinusitis. [EU] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Sneezing: Sudden, forceful, involuntary expulsion of air from the nose and mouth caused by irritation to the mucous membranes of the upper respiratory tract. [NIH] Sotalol: An adrenergic beta-antagonist that is used in the treatment of lifethreatening arrhythmias. [NIH] Spasmodic: Of the nature of a spasm. [EU] Spastic: 1. of the nature of or characterized by spasms. 2. hypertonic, so that the muscles are stiff and the movements awkward. 3. a person exhibiting spasticity, such as occurs in spastic paralysis or in cerebral palsy. [EU] Spasticity: A state of hypertonicity, or increase over the normal tone of a muscle, with heightened deep tendon reflexes. [EU] Spectrum: A charted band of wavelengths of electromagnetic vibrations obtained by refraction and diffraction. By extension, a measurable range of

Glossary 371

activity, such as the range of bacteria affected by an antibiotic (antibacterial s.) or the complete range of manifestations of a disease. [EU] Sporadic: Neither endemic nor epidemic; occurring occasionally in a random or isolated manner. [EU] Stenosis: Narrowing or stricture of a duct or canal. [EU] Steroid: A group name for lipids that contain a hydrogenated cyclopentanoperhydrophenanthrene ring system. Some of the substances included in this group are progesterone, adrenocortical hormones, the gonadal hormones, cardiac aglycones, bile acids, sterols (such as cholesterol), toad poisons, saponins, and some of the carcinogenic hydrocarbons. [EU] Stimulant: 1. producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. an agent or remedy that produces stimulation. [EU] Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Strabismus: Deviation of the eye which the patient cannot overcome. The visual axes assume a position relative to each other different from that required by the physiological conditions. The various forms of strabismus are spoken of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia, and hypotropia. Called also cast, heterotropia, manifest deviation, and squint. [EU] Sunburn: An injury to the skin causing erythema, tenderness, and sometimes blistering and resulting from excessive exposure to the sun. The reaction is produced by the ultraviolet radiation in sunlight. [NIH] Symptomatic: 1. pertaining to or of the nature of a symptom. 2. indicative (of a particular disease or disorder). 3. exhibiting the symptoms of a particular disease but having a different cause. 4. directed at the allying of symptoms, as symptomatic treatment. [EU] Symptomatology: 1. that branch of medicine with treats of symptoms; the systematic discussion of symptoms. 2. the combined symptoms of a disease. [EU]

Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Synergistic: Acting together; enhancing the effect of another force or agent. [EU]

Syphilis: A contagious venereal disease caused by the spirochete treponema pallidum. [NIH] Systemic: Pertaining to or affecting the body as a whole. [EU] Tardive:

Marked by lateness, late; said of a disease in which the


characteristic lesion is late in appearing. [EU] Taurine: 2-Aminoethanesulfonic acid. A conditionally essential nutrient, important during mammalian development. It is present in milk but is isolated mostly from ox bile and strongly conjugates bile acids. [NIH] Tendinitis: Inflammation of tendons and of tendon-muscle attachments. [EU] Teniposide: A semisynthetic derivative of podophyllotoxin that exhibits antitumor activity. Teniposide inhibits DNA synthesis by forming a complex with topoisomerase II and DNA. This complex induces breaks in double stranded DNA and prevents repair by topoisomerase II binding. Accumulated breaks in DNA prevent cells from entering into the mitotic phase of the cell cycle, and lead to cell death. Teniposide acts primarily in the G2 and S phases of the cycle. [NIH] Teratogens: An agent that causes the production of physical defects in the developing embryo. [NIH] Testolactone: An antineoplastic agent that is a derivative of progesterone and used to treat advanced breast cancer. [NIH] Tetracycline: An antibiotic originally produced by Streptomyces viridifaciens, but used mostly in synthetic form. It is an inhibitor of aminoacyl-tRNA binding during protein synthesis. [NIH] Thermoregulation: Heat regulation. [EU] Thrombocytosis: Increased numbers of platelets in the peripheral blood. [EU] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Timolol: A beta-adrenergic antagonist similar in action to propranolol. The levo-isomer is the more active. Timolol has been proposed as an antihypertensive, antiarrhythmic, antiangina, and antiglaucoma agent. It is also used in the treatment of migraine and tremor. [NIH] Tinnitus: A noise in the ears, as ringing, buzzing, roaring, clicking, etc. Such sounds may at times be heard by others than the patient. [EU] Tobramycin: An aminoglycoside, broad-spectrum antibiotic produced by Streptomyces tenebrarius. It is effective against gram-negative bacteria, especially the Pseudomonas species. It is a 10% component of the antibiotic complex, nebramycin, produced by the same species. [NIH] Tomography: The recording of internal body images at a predetermined plane by means of the tomograph; called also body section roentgenography. [EU]

Topotecan: An antineoplastic agent used to treat ovarian cancer. It works by inhibiting DNA topoisomerase. [NIH] Torticollis: Wryneck; a contracted state of the cervical muscles, producing

Glossary 373

twisting of the neck and an unnatural position of the head. [EU] Transdermal: Entering through the dermis, or skin, as in administration of a drug applied to the skin in ointment or patch form. [EU] Tremor: An involuntary trembling or quivering. [EU] Triamterene: A pteridine that is used as a mild diuretic. [NIH] Trichinosis: A disease due to infection with trichinella spiralis. It is caused by eating undercooked meat, usually pork. [NIH] Trichotillomania: Compulsion to pull out one's hair. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU] Tryptophan: An essential amino acid that is necessary for normal growth in infants and for nitrogen balance in adults. It is a precursor serotonin and niacin. [NIH] Tyramine: An indirect sympathomimetic. Tyramine does not directly activate adrenergic receptors, but it can serve as a substrate for adrenergic uptake systems and monoamine oxidase so it prolongs the actions of adrenergic transmitters. It also provokes transmitter release from adrenergic terminals. Tyramine may be a neurotransmitter in some invertebrate nervous systems. [NIH] Tyrosine: A non-essential amino acid. In animals it is synthesized from phenylalanine. It is also the precursor of epinephrine, thyroid hormones, and melanin. [NIH] Uricosuric: 1. pertaining to, characterized by, or promoting uricosuria (= the excretion of uric acid in the urine). 2. an agent that promotes uricosuria. [EU] Urinary: Pertaining to the urine; containing or secreting urine. [EU] Uveitis: An inflammation of part or all of the uvea, the middle (vascular) tunic of the eye, and commonly involving the other tunics (the sclera and cornea, and the retina). [EU] Vagal: Pertaining to the vagus nerve. [EU] Vaginal: 1. of the nature of a sheath; ensheathing. 2. pertaining to the vagina. 3. pertaining to the tunica vaginalis testis. [EU] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vancomycin: Antibacterial obtained from Streptomyces orientalis. It is a glycopeptide related to ristocetin that inhibits bacterial cell wall assembly and is toxic to kidneys and the inner ear. [NIH] Veins: The vessels carrying blood toward the heart. [NIH]


Ventral: 1. pertaining to the belly or to any venter. 2. denoting a position more toward the belly surface than some other object of reference; same as anterior in human anatomy. [EU] Verapamil: A calcium channel blocker that is a class IV anti-arrhythmia agent. [NIH] Vertigo: An illusion of movement; a sensation as if the external world were revolving around the patient (objective vertigo) or as if he himself were revolving in space (subjective vertigo). The term is sometimes erroneously used to mean any form of dizziness. [EU] Vesicular: 1. composed of or relating to small, saclike bodies. 2. pertaining to or made up of vesicles on the skin. [EU] Vestibular: Pertaining to or toward a vestibule. In dental anatomy, used to refer to the tooth surface directed toward the vestibule of the mouth. [EU] Viral: Pertaining to, caused by, or of the nature of virus. [EU] Visceral: , from viscus a viscus) pertaining to a viscus. [EU] Vitex: A genus of trees in the lamiaceae family containing assorted flavonoids with possible analgesic and antineoplastic properties. The fruit of these trees is used in herbal preparations. [NIH] Warfarin: An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide. [NIH] Warts: Benign epidermal proliferations or tumors; some are viral in origin. [NIH]

General Dictionaries and Glossaries While the above glossary is essentially complete, the dictionaries listed here cover virtually all aspects of medicine, from basic words and phrases to more advanced terms (sorted alphabetically by title; hyperlinks provide rankings, information and reviews at Amazon.com): ·

Dictionary of Medical Acronymns & Abbreviations by Stanley Jablonski (Editor), Paperback, 4th edition (2001), Lippincott Williams & Wilkins Publishers, ISBN: 1560534605, http://www.amazon.com/exec/obidos/ASIN/1560534605/icongroupinterna

·

Dictionary of Medical Terms : For the Nonmedical Person (Dictionary of Medical Terms for the Nonmedical Person, Ed 4) by Mikel A. Rothenberg,

Glossary 375

M.D, et al, Paperback - 544 pages, 4th edition (2000), Barrons Educational Series, ISBN: 0764112015, http://www.amazon.com/exec/obidos/ASIN/0764112015/icongroupinterna ·

A Dictionary of the History of Medicine by A. Sebastian, CD-Rom edition (2001), CRC Press-Parthenon Publishers, ISBN: 185070368X, http://www.amazon.com/exec/obidos/ASIN/185070368X/icongroupinterna

·

Dorland’s Illustrated Medical Dictionary (Standard Version) by Dorland, et al, Hardcover - 2088 pages, 29th edition (2000), W B Saunders Co, ISBN: 0721662544, http://www.amazon.com/exec/obidos/ASIN/0721662544/icongroupinterna

·

Dorland’s Electronic Medical Dictionary by Dorland, et al, Software, 29th Book & CD-Rom edition (2000), Harcourt Health Sciences, ISBN: 0721694934, http://www.amazon.com/exec/obidos/ASIN/0721694934/icongroupinterna

·

Dorland’s Pocket Medical Dictionary (Dorland’s Pocket Medical Dictionary, 26th Ed) Hardcover - 912 pages, 26th edition (2001), W B Saunders Co, ISBN: 0721682812, http://www.amazon.com/exec/obidos/ASIN/0721682812/icongroupinterna /103-4193558-7304618

·

Melloni’s Illustrated Medical Dictionary (Melloni’s Illustrated Medical Dictionary, 4th Ed) by Melloni, Hardcover, 4th edition (2001), CRC PressParthenon Publishers, ISBN: 85070094X, http://www.amazon.com/exec/obidos/ASIN/85070094X/icongroupinterna

·

Stedman’s Electronic Medical Dictionary Version 5.0 (CD-ROM for Windows and Macintosh, Individual) by Stedmans, CD-ROM edition (2000), Lippincott Williams & Wilkins Publishers, ISBN: 0781726328, http://www.amazon.com/exec/obidos/ASIN/0781726328/icongroupinterna

·

Stedman’s Medical Dictionary by Thomas Lathrop Stedman, Hardcover 2098 pages, 27th edition (2000), Lippincott, Williams & Wilkins, ISBN: 068340007X, http://www.amazon.com/exec/obidos/ASIN/068340007X/icongroupinterna

·

Tabers Cyclopedic Medical Dictionary (Thumb Index) by Donald Venes (Editor), et al, Hardcover - 2439 pages, 19th edition (2001), F A Davis Co, ISBN: 0803606540, http://www.amazon.com/exec/obidos/ASIN/0803606540/icongroupinterna


INDEX A Abdominal..............45, 278, 284, 350, 364 Aberrant.................................................83 Abortion .......................................275, 343 Acne ............................................275, 343 Adolescence ..............15, 22, 92, 343, 364 Agonist......57, 64, 82, 145, 275, 285, 320, 343, 361, 363, 365 Albuterol ......................................275, 343 Alkaloid ........145, 171, 286, 363, 368, 369 Amygdala.................................81, 90, 344 Analgesic ....169, 171, 280, 282, 283, 288, 320, 350, 353, 357, 358, 361, 367, 374 Anesthesia...........................169, 187, 345 Anorexia ................................48, 275, 344 Anthelmintic .................................171, 366 Anticonvulsant ...............23, 285, 350, 365 Antidepressant.......23, 277, 347, 350, 354 Antihypertensive .....14, 64, 170, 171, 281, 283, 287, 355, 356, 357, 359, 365, 369, 372 Anxiety....... 14, 24, 48, 64, 96, 110, 283, 286, 354, 358, 364, 367 Aphasia................................................111 Aphidicolin ...........................................296 Apnea ....................................................97 Aromatic ..............189, 281, 285, 355, 365 Arrhythmia ...................276, 288, 345, 374 Assay.....................................................84 Ataxia...........................110, 111, 113, 137 Atrophy ........................................113, 137 Atypical ............................56, 65, 109, 369 Aura .....................................................109 Autonomic..............................24, 110, 363 B Bacteria ...... 25, 278, 287, 290, 349, 371, 372 Bereavement .......................................112 Bile.................................93, 287, 371, 372 Biochemical .....................................16, 46 Bleomycin ....................................169, 347 Blinking ............................................11, 44 C Capsules..............................................293 Carbohydrate.........64, 170, 292, 355, 360 Cardiac ....... 93, 170, 275, 280, 284, 286, 343, 353, 357, 359, 361, 368, 371 Cardiogenic .........................................109 Catheter ...........................................52, 54 Cerebellar ............................................107 Cerebellum ..................................115, 348

Cerebral ...... 77, 98, 101, 102, 110, 117, 125, 127, 354, 370, 371 Cerebrospinal ....................................... 53 Cerebrovascular ......................... 107, 110 Cervical ............................... 106, 127, 372 Cholesterol.... 93, 280, 290, 292, 355, 371 Cholinergic .................................. 145, 363 Chorea ........................................ 107, 110 Chromosomal ........................... 16, 73, 79 Chronic..... 11, 15, 32, 33, 53, 54, 58, 70, 72, 74, 97, 112, 125, 278, 279, 286, 287, 296, 332, 349, 352, 367, 370 Cisplatin ...................................... 320, 349 Clomipramine........................................ 14 Clonazepam.......................................... 14 Cochlear.............................................. 113 Coloboma........................................ 82, 84 Congestion.................................. 280, 353 Constipation .................................. 64, 355 Cortex ........................... 76, 127, 219, 354 Cutaneous................... 277, 285, 347, 366 Cytogenetics ......................................... 79 D Degenerative ...... 15, 115, 284, 287, 291, 352, 364, 369 Dermatitis.................... 279, 319, 345, 352 Detoxification ...................................... 195 Dextroamphetamine ............................. 14 Diarrhea .............................. 276, 290, 346 Diffusion ................................................ 76 Dizziness....... 14, 107, 111, 112, 118, 374 Dorsal.................................................... 75 Doxorubicin ................................. 170, 353 Dysarthria.................................... 106, 107 Dyskinesia............................... 14, 77, 113 Dysmenorrhea ............................ 320, 361 Dysphagia ................................... 283, 359 Dystonia ................ 77, 106, 111, 112, 113 E Electrolyte ................................... 171, 366 Electromyography................................. 45 Encephalopathy .................................. 110 Endocarditis ................................ 277, 347 Endogenous.......................... 78, 279, 352 Endometriosis ............................. 280, 353 Enzyme .. 97, 98, 278, 283, 286, 350, 353, 359, 368 Epidemic ....................................... 25, 371 Erythema..................... 279, 287, 352, 371 Evacuation .......................... 101, 279, 350 Exhibitionism......................................... 96

Index 377

Exocrine...............................109, 284, 364 Exocytosis .............................................84 Extrapyramidal.......................................77 F Facial ......11, 14, 44, 107, 110, 125, 284, 362 Fatigue.................14, 23, 24, 97, 345, 364 Fibrosis ........................278, 280, 349, 354 Fissure...........................................90, 350 Flumazenil .............................................52 Fluoxetine ..............................................14 Fluvoxamine ..........................................55 G Ganglia ............................................76, 80 Glucose ...................46, 64, 282, 355, 357 Gonadal ...................................80, 93, 371 Gout .............................................320, 361 Guanfacine ............................................57 H Histamine.....................................278, 349 Hoarseness .........................106, 283, 359 Homogeneous .......................................73 Hormones ...... 65, 80, 93, 276, 344, 368, 371 Hydrogen ...... 78, 91, 275, 320, 343, 348, 356 Hypersensitivity ...........................275, 344 Hypothalamus........................................81 Hypothyroidism............................281, 357 I Idiopathic .......................................77, 110 Inflammation ....... 39, 276, 278, 280, 282, 287, 288, 345, 348, 349, 354, 357, 369, 373 Inhalation .....................................285, 366 Innervation.............................................75 Insomnia ..........................................14, 97 Insulin ............................64, 282, 355, 357 Intestinal ..............................278, 290, 348 Intoxication ..................................110, 296 Intravenous............................51, 171, 364 Iris ................................................282, 358 J Juniper .........................................283, 358 K Kanamycin...................................170, 358 L Laryngectomy ......................................113 Laryngoscopy ......................................106 Larynx ..........................106, 116, 283, 359 Lesion .....24, 25, 116, 117, 280, 353, 359, 364, 368, 372 Lethargy...............................109, 281, 357 Levodopa.............................277, 297, 347 Limbic ......................................81, 90, 344 Lip ..........................................11, 106, 113

Locomotion ........................... 92, 107, 359 Locomotor ................................. 81, 83, 84 Lumbar.................................................. 51 Lymphoma .................................. 283, 360 M Manic .................................................... 29 Mecamylamine.................................... 296 Membrane....... 81, 84, 91, 116, 279, 280, 284, 285, 351, 353, 354, 359, 364, 365 Meningitis.................................... 283, 360 Menopause ................................. 286, 367 Mental .. 23, 24, 30, 31, 63, 65, 74, 92, 96, 98, 112, 117, 120, 145, 174, 176, 281, 286, 334, 351, 354, 357, 365, 367, 368 Mentors ................................................. 80 Methylphenidate ............................. 74, 75 Midwifery............................................. 100 Molecular ... 65, 77, 79, 91, 130, 134, 136, 281, 288, 351, 356, 368, 373 Monotherapy ....................................... 296 Mutism ........................................ 105, 113 Myasthenia.......................... 106, 107, 110 N Naloxone............................. 171, 296, 361 Naltrexone................................... 171, 361 Neural ..................... 70, 76, 110, 116, 364 Neuralgia..................................... 284, 362 Neuroanatomy .................................... 107 Neuroleptic.................... 13, 14, 56, 70, 77 Neurology........................................ 34, 81 Neurons ... 81, 91, 92, 109, 145, 283, 354, 359, 362, 363 Neuropathy ......................................... 110 Neurophysiology ......................... 106, 107 Neurotransmitter ...... 24, 64, 82, 84, 281, 321, 354, 356, 363, 373 Niacin .................................................. 291 Nicotine ....................... 169, 295, 298, 344 Nifedipine .................................... 284, 363 Nitrofurantoin .............................. 284, 363 Norepinephrine .... 12, 24, 63, 81, 82, 171, 343, 363, 369 O Oligosaccharides ................................ 315 Osteoarthritis .............. 280, 283, 353, 358 Osteogenesis ...................................... 100 Overdose ............................................ 291 Oxytocin ................................................ 80 P Pancreas..................................... 282, 357 Panic ................................. 15, 64, 96, 354 Paralysis ...... 98, 107, 110, 116, 117, 125, 364, 368, 370 Paroxetine............................................. 14 Paroxysmal ... 77, 109, 115, 276, 345, 346 Pelvic .......................... 280, 286, 353, 367


Pemoline................................................14 Pergolide ...............................................56 Phenotype ...........79, 83, 85, 92, 105, 365 Phobia ...........................................98, 365 Phonation ............................................107 Plague .........................................120, 366 Potassium...170, 281, 286, 292, 352, 355, 368 Predisposition ........................................14 Premenstrual .........................................96 Presynaptic........................24, 82, 84, 363 Prevalence...........................................105 Progressive......................29, 64, 113, 351 Psoriasis ......................286, 319, 345, 367 Psychiatry ..............................79, 112, 181 Psychic ..........24, 117, 286, 360, 368, 370 Psychology ..........................112, 190, 195 Psychopathology ...........................52, 104 Psychosomatic ....................................182 Psychotherapy.................14, 89, 181, 194 Pulmonary ...................................288, 374 Q Quadriplegia ........................107, 117, 368 Quinidine .....................................275, 343 R Receptor .....23, 64, 80, 82, 285, 350, 354, 365 Recurrence ............................................16 Reflex ..................................................185 Remission..........................15, 20, 24, 369 Riboflavin.............................................290 Rigidity...................................................14 Risperidone ...........................................56 S Schizophrenia..................29, 65, 296, 369 Sclerosis ....... 29, 81, 102, 106, 107, 110, 125, 137 Secretion ....278, 281, 282, 287, 349, 356, 357, 370 Seizures....... 23, 92, 109, 117, 285, 350, 364, 365, 370 Selenium..............................................292 Senna ..........................................172, 370 Sertraline ...............................................14 Serum ..........275, 280, 287, 344, 355, 370 Sinusitis .......................................287, 370 Skull .....................................................109

Sneezing ............................................. 108 Spasmodic .................................. 111, 125 Spastic .................................... 96, 98, 370 Spasticity............................... 98, 113, 370 Spectrum.. 19, 55, 70, 75, 79, 96, 97, 105, 275, 287, 344, 372 Sporadic................................................ 15 Steroid............. 65, 80, 153, 276, 344, 368 Stimulant ...... 20, 23, 24, 74, 76, 92, 281, 351, 356, 361, 364 Stomach...................................... 280, 355 Strabismus .................................. 127, 371 Symptomatic ................................. 93, 371 Symptomatology ................................... 52 Syncope ...................................... 109, 110 Synergistic ............................................ 74 Syphilis................................................ 110 Systemic ..... 275, 277, 288, 344, 347, 374 T Teratogens.......................................... 109 Tetracycline................................. 284, 361 Thermoregulation................................ 290 Thyroxine ............................................ 292 Tinnitus ....................................... 111, 113 Tomography.............................. 13, 52, 54 Torticollis............................................. 125 Transdermal........................................ 295 Tremor . 14, 107, 113, 137, 284, 287, 361, 372 Trichotillomania..................................... 48 Tricyclic ......... 23, 171, 276, 345, 350, 366 Tryptophan............................................ 97 Tyrosine ................................................ 76 U Uricosuric .................................... 171, 367 Urinary ...... 169, 278, 282, 284, 286, 349, 351, 357, 363, 366 V Vagal................................................... 110 Vaginal ................................................ 125 Vancomycin ........................................ 165 Veins ............................................. 64, 358 Ventral................................................... 76 Vertigo................................. 109, 118, 374 Vestibular ............................................ 111 Viral............. 282, 288, 319, 345, 357, 374

Index 379


Index 381


The Official Parent's Sourcebook on Tourette Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Sjgren's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Sjgren's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Williams Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Goodpasture Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Reye's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Cushing's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Williams Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Plica Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Rett Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Plica Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Cushing's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Goodpasture Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Botulism: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Genital Candidiasis: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Ataxia Telangiectasia: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Shigellosis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Brainerd Diarrhea: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Adrenoleukodystrophy: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Balantidiasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Coccidioidomycosis: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Toxocariasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Intraocular Melanoma: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Opsoclonus Myoclonus: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Shingles: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Penile Cancer: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Hansen's Disease: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Cerebral Atrophy: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Prolactinoma: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Tourette Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Sjgren's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Sjgren's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Williams Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Goodpasture Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Reye's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Cushing's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Williams Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Plica Syndrome: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Rett Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Plica Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Cushing's Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Goodpasture Syndrome: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Botulism: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Genital Candidiasis: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Ataxia Telangiectasia: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Shigellosis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Brainerd Diarrhea: A Revised and Updated Directory for the Internet Age

The Official Parent's Sourcebook on Adrenoleukodystrophy: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Balantidiasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Coccidioidomycosis: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Psoriasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Toxocariasis: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Intraocular Melanoma: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Opsoclonus Myoclonus: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Shingles: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Penile Cancer: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Hansen's Disease: A Revised and Updated Directory for the Internet Age

The Official Patient's Sourcebook on Cerebral Atrophy: A Revised and Updated Directory for the Internet Age

The 2002 Official Patient's Sourcebook on Prolactinoma: A Revised and Updated Directory for the Internet Age

Recommend Documents