Talk:Tourette syndrome/Archive 8

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Unvoluntary/involuntary

Although the term unvoluntary is well-defined in this article and in the literature, it is frequently changed to involuntary here, perhaps by well-meaning editors who believe it is a typo, and don't read the text.

Tics are described as semi-voluntary or "unvoluntary", because they are not strictly involuntary—they may be experienced as a voluntary response to an unwanted, premonitory urge.

Please restore it whenever it is removed, as it is the correct usage. I will add an inline note. Sandy (Talk) 16:39, 24 October 2006 (UTC)

Tourette syndrome #Classification currently says "involuntary", not "unvoluntary"; should that be changed as well? (Either way, does that "involuntary" need an HTML comment too?…) Eubulides (talk) 19:53, 29 February 2008 (UTC)

Mozart

This article's a rambling mess. If we're not sure Mozart had it, why is it even mentioned? 70.61.22.110 (talk) 19:12, 29 February 2008 (UTC)Newt

See WP:MEDMOS. SandyGeorgia (Talk) 19:15, 29 February 2008 (UTC)

Proposed replacement for Mozart paragraph

I don't think the article rambles or is a mess at all, not at all, but in rereading the Mozart discussion one thing jumped out at me: it spends too much time talking about the people who are disputing Mozart's diagnosis (Simkin, Sacks, their qualifications, etc.). This jumped out at me because I am currently looking at similar problems in Chiropractic (an article that is a rambling mess, and which goes on and on in the text about the WHO and the NCCAM and such-and-such eminent chiropractor's qualifications, in order to make that article more "persuasive"—but I digress.…) How about the following replacement for the Mozart paragraph, to address this issue? This replacement could be appended to the previous paragraph, which talks about Johnson.

Although it has been speculated that Mozart had Tourette's, no Tourette's expert or organization has presented credible evidence to show that this was the case, and there are problems with the available data.

Eubulides (talk) 19:49, 29 February 2008 (UTC)

Some authors have speculated that Mozart may have had Tourette's. Benjamin Simkin, a medical doctor, argued that Mozart had Tourette syndrome. Simkin is an endocrinologist—not a psychiatrist or a neurologist, the medical fields which specialize in the neurological disorder. His claim was picked up by newspapers worldwide, causing an international sensation, and internet websites have fueled the speculation. However, no Tourette's expert or organization has presented credible evidence to show that this was the case; other authors have found the evidence lacking and noted neurologist and author Oliver Sacks published an editorial disputing Simkin's claim.

Sorry, I have to see them side by side before I can opine. SandyGeorgia (Talk) 19:56, 29 February 2008 (UTC)

OK, looking at them side by side, two issues. First, read the FAC to see how I got stuck with all that wording (from a good reviewer) during the FAC, and see if you still think we can shorten. The reviwer considered that the image wasn't justified, and I had to explain how prevalent these rumors are. Then, if we do shorten, your wording looks fine, but you've got refs 2, 3 and 4, leaving off 5, 6 and 7; can we tack them back on to your wording (if that's the wording we use) to gain "insurance" against future speculative insertions, or expand a bit to encompass the concern raised at FAC ? SandyGeorgia (Talk) 20:04, 29 February 2008 (UTC)

Thanks, I didn't know the history.

• I tend to agree with the FAC reviewer that Mozart's image isn't appropriate here. The connection is just too weak. I suggest going with the shortened version of the text, but using Johnson's portrait instead; it's much better to place that portrait near the discussion of Johnson anyway. This would mean an image shortage in "Prognosis", which is bad, but overall it's better to live with an image shortage than to misplace images or to add too-weakly-connected images.
• If you prefer filling that gap in "Prognosis", how about this idea: put Image:Malraux.jpg under "Prognosis" with an an appropriate caption? That would be a better visual fit for "Prognosis", since someone with TS is currently far more likely to end up looking like Malraux's picture than like Johnson's.
• The shortened version didn't lose any refs; it just coalesced some of them, which caused them to get renumbered. But they're all there.

Eubulides (talk) 20:58, 29 February 2008 (UTC)

I need to dig back in history and figure something out: we used to have Malraux, but for some reason he got deleted. I thought it was Fair Use, but now I see the image tag says it's OK, so I need to figure out that missing step to make sure we're OK. I am concerned that the rumors about Mozart are so prevalent that they should be addressed (or we'll get constant driveby insertions), but that can be solved via a link over to that section in the daughter article, Sociological and cultural aspects of Tourette syndrome, so we don't have to include all the verbiage here. Let me look more into the image thingie before I make these changes. SandyGeorgia (Talk) 21:06, 29 February 2008 (UTC)

hmmmm .. turns out I removed Malraux myself, for some reason I was worried about its licensing, and it's still got an unclear tag. I'm going to ask someone who knows images to have a look.[1] (Or maybe it was because back then I hadn't found a solid source for his TS? Still checking.) SandyGeorgia (Talk) 21:45, 29 February 2008 (UTC)

Please see #Malraux image below for a followup. Eubulides (talk) 22:00, 29 February 2008 (UTC)

PS, and keep in mind that there's a dispatch coming out in the WP:Signpost next week, such that we could end up with this on the mainpage for April Fools, so we may need the detail. SandyGeorgia (Talk) 20:13, 29 February 2008 (UTC)

Sorry, I don't quite follow all that (I never heard of WP:Signpost until just now). My (admittedly uninformed) intuition is that we should try to improve the article without worrying too much about what other articles say or about what driveby editors will do in the future. On the other hand, this change can just as easily wait until April. Eubulides (talk) 21:05, 29 February 2008 (UTC)

Sorry :-) We have an April Fools' mainpage tradition at Wiki, and for some months now, I've been concerned that we are going to be linked to the mainpage via Lick me in the ass, so I was concerned that we were going to need all the accurate detail. That should be more clear in a week or two. Also, at one point, I read mention of yet another Mozart/Tourette documentary or movie or book (I can't remember) that was in the works, so I erred on the side of keeping all this detail. The notion that Mozart had Tourette's is, inaccurately, fairly entrenched by the popular media. Give me some time to dig back in and figure out where all this stands. At least, a link over to the daughter article may solve all of that and move it out of this article. SandyGeorgia (Talk) 21:12, 29 February 2008 (UTC)

Malraux image

If it helps, the Library of Congress has a very similar (but not identical) photograph available:

This image is available from the United States Library of Congress Prints and Photographs Division under the digital ID cph.3b26053
This tag does not indicate the copyright status of the attached work. A normal copyright tag is still required. See Wikipedia:Copyrights for more information.

This one looks like it was done as part of the same shoot. Usage of this one's postage-stamp size would be acceptable here, under fair use. I'd rather have the big one, though, of course. I love the LoC's "Rights status not evaluated".… Eubulides (talk) 22:00, 29 February 2008 (UTC)

Eubulides, I'm hopeless on images, but I trust ElCobbola, who reviews images at FAC. He says we can't use Malraux.[2] I don't know what to make of your link above, it shows a picture of Congress? SandyGeorgia (Talk) 23:44, 29 February 2008 (UTC)

Ah, sorry, you're supposed to click on the digital ID inside that box. Or you can just click here. Some more points:

• Assuming the LOC image looks good to you, I can upload it so that you needn't worry about the hassle of doing that.
• Just to be safe: what is the size limit for fair-use images for important historical figures? We're already using Image:Asperger_kl2.jpg (88×133) and nd Image:Kanner_kl2.jpg (99×135) in Autism, and they pass fair-use muster; what's the size limit for these postage-stamp images? The LOC image is 128×150 but can (and probably should) be cropped to around 110×130 to get rid of the legend and the gap on the right, so it'll get smaller. Is that small enough?
• Doesn't that mean Image:Malraux.jpg should be removed from Wikipedia?

Eubulides (talk) 00:26, 1 March 2008 (UTC)

I don't know any of those answers; I really don't speak images. I'll ask Elcobbola to look in here. SandyGeorgia (Talk) 00:29, 1 March 2008 (UTC)

The PD tag on Image:Malraux.jpg certainly doesn't hold up. One could make a case for fair use, though; Malraux is dead, Freund and her portraits are quite notable (maybe even iconic) and the image isn't exactly high-resolution. I'm no image expert, so that's just my two cents; I will, however, point a Commons admin to this discussion—the image should go over there. Fvasconcellos (t·c) 00:48, 1 March 2008 (UTC)

A fair use case for the Malraux article itself would almost certainly be easy and appropriate, but I don't believe WP:NFCC#8 would allow it to be used in the Tourette syndrome article. ЭLСОВВОLД _talk 01:35, 1 March 2008 (UTC)

@Eubulides: Low resolution, regardless of the image's subject, typically means no more than 300 pixels horizontally or vertically, so those are well under the "max" (going over is acceptable, iff there's an explaination why the extra resolution is needed).

It will need to be removed from Wikimedia Commons (I tagged it for deletion), as they can't have FU. It could, however, be hosted on Wikipedia with a proper (per above) FU. ЭLСОВВОLД _talk 01:45, 1 March 2008 (UTC)

The P&P image is tricky. The image’s page says “Rights status not evaluated”, which means only that P&P hasn’t done any footwork. There are different measures for determining PD status, depending on whether the image has been published. The P&P image says “Pantheon Books” (a division of Random House), so I’m inclined to believe it has been published. A published image becomes PD if it was: 1) Registered in the U.S. before 1923 or 2) Registered in the U.S. from and including 1923 through 1963, unless the copyright was renewed.

Given the date of 1935/6 (my eyes fail me), the latter may be valid. I searched at the Copyright Office, and didn’t see it registered/renewed. The caveat is that this really is a search one should do in person (anyone live in D.C.?) From a legal and/or policy standpoint, the uncertainty means it probably shouldn’t be used (I say that because I suspect such a publisher would be diligent about renewing). The lack of a reference in the archive, however, does seem to lend, if nothing else, a degree of "plausible deniability", so to speak. ЭLСОВВОLД _talk 01:35, 1 March 2008 (UTC)

I hate images; all Greek to me. So, what if we/I write to Jim Eisenreich or Tim Howard and ask them to submit an image? SandyGeorgia (Talk) 01:41, 1 March 2008 (UTC)

Actually ... is the Tim Howard image OK to use here? SandyGeorgia (Talk) 01:43, 1 March 2008 (UTC)

Yes, indeed! ЭLСОВВОLД _talk 01:47, 1 March 2008 (UTC)

Or if you're set on using Malraux ... ЭLСОВВОLД _talk 02:26, 1 March 2008 (UTC)

Nice, Elcobbola, thanks ... maybe we can use both. SandyGeorgia (Talk) 02:45, 1 March 2008 (UTC)

I don't have a Commons account. That image says it's lacking info about the photographer, which is given here. More here. SandyGeorgia (Talk) 03:14, 1 March 2008 (UTC)

Author updated. ЭLСОВВОLД _talk 03:25, 1 March 2008 (UTC)

Great ! OK, so if everyone agrees, I'll: remove the Mozart image, move the Johnson to where Mozart was (Cultural references), add Howard to Prognosis, and shorten the Mozart wording, making sure I combine all the refs and link over to the daughter article. Good? SandyGeorgia (Talk) 01:54, 1 March 2008 (UTC)

Done, how's that? SandyGeorgia (Talk) 04:22, 1 March 2008 (UTC)

Thanks, that was fast. I have done my bit by creating a new image Image:Malraux-Freund-1935.jpeg which I hope passes copyright muster, and by replacing all uses of the old Malraux portait with the new one. This no longer affects Tourette syndrome, though, since it uses a different image now. Eubulides (talk) 06:41, 1 March 2008 (UTC)

Well, now that we know about Image:ARC194219.png, we can't use Image:Malraux-Freund-1935.jpeg, Per WP:NFCC#1, "Non-free content is used only where no free equivalent is available". Use of Malraux-Freund looks to be just to illustrate the man, something the free version can do. Isn't FU fun? ;) ЭLСОВВОLД _talk 11:50, 1 March 2008 (UTC)

I don't think the free version illustrates the man, to be honest. It illustrates his context (which is fine for Tourette syndrome, in fact it's better) but not the man. I'll follow up at Talk:André Malraux #Is the group shot equivalent?, not that I expect much there; that article's kind of moribund. Eubulides (talk) 19:08, 1 March 2008 (UTC)

Confusing wording re Sydenham's chorea

Tourette syndrome #Diagnosis currently says this:

Other conditions that may manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders, and stereotypic movement disorder; other genetic conditions such as Huntington's disease, neuroacanthocytosis, Hallervorden-Spatz syndrome, idiopathic dystonia, Duchenne muscular dystrophy, Wilson's disease, Sydenham's chorea and tuberous sclerosis.

I'm finding it hard to parse that sentence because of its semicolon; was that intended to be a comma? Anyway, the sentence seems to be saying that Sydenham's chorea is one of the "other genetic conditions", but it's not genetic. Likewise for idiopathic dystonia; it might be genetic but might not. Conversely, the current wording can be read to imply that autism spectrum disorders are genetic; it's true that the mainstream opinion is that genetics are the most significant cause for ASD, but some rare cases do seem to be caused by environmental factors (see Causes of autism #Teratogens).

How about this rewrite?

Other conditions that may manifest tics or stereotyped movements include developmental disorders, autism spectrum disorders, and stereotypic movement disorder; Sydenham's chorea; idiopathic dystonia; and genetic conditions such as Huntington's disease, neuroacanthocytosis, Hallervorden-Spatz syndrome, Duchenne muscular dystrophy, Wilson's disease, and tuberous sclerosis.

Eubulides (talk) 07:56, 7 March 2008 (UTC)

Yes, something went obviously wrong in that sentence, and I'm not sure what, when or where. Let me go back in my sources and history to doublecheck what happened before we fix it. I'll get to it later today. SandyGeorgia (Talk) 16:22, 7 March 2008 (UTC)

Just found time to get back to this. I don't know when that got jumbled or how Sydenham's ended up as genetic; I'll put the proposed change in and then try to figure out if the article covers now the complete list in the Jankovic and other texts. SandyGeorgia (Talk) 23:55, 7 March 2008 (UTC)

Need help

Does anybody know how this template works? I see it's used in the article, but I'm trying to add several of these notes in another article, but it won't work. The first note works fine, but the rest don't redirect... Thank! ^A  ?? ^B  ?? --Phenylalanine (talk) 20:58, 9 March 2008 (UTC)

Let me know what you're trying to do where, and I'll help. You forgot to sign. SandyGeorgia (Talk) 20:58, 9 March 2008 (UTC)

I'm trying to use this template in the "global warming" article (see discussion page). --Phenylalanine (talk) 21:00, 9 March 2008 (UTC)

What template? Note labels? And what specifically do you want to do at global warming? Besides not being thrilled to wade in to that mess (although I will try to help), I can't read your mind :-) SandyGeorgia (Talk) 21:03, 9 March 2008 (UTC)

Yes, exactly, the note labels. The first one works fine, but not the rest. I haven't made any changes yet to the Global warming article... still previewing the changes. I can save my changes if prefer to see them. --Phenylalanine (talk) 21:06, 9 March 2008 (UTC)

Since the global warming article is so controversial, I don't want to invest time there until I know it won't be reverted. Let's move this conversation to that talk page (I posted there). SandyGeorgia (Talk) 21:10, 9 March 2008 (UTC)

Great! Thanks a lot! Now, I know where to ask to find quick help ;-) --Phenylalanine (talk) 21:12, 9 March 2008 (UTC)

By the way, you can probably find the answers you need in Gettysburg Address; that article has multiple notes, so provides a full example. SandyGeorgia (Talk) 21:13, 9 March 2008 (UTC)

Maze (film)

I suggest a link to Maze (film) which prominently portrays a character with Tourette syndrome Fholson 03:34, 23 March 2008 (UTC)

See WP:MEDMOS regarding issues that have made a lasting impression upon perception of the condition (Maze did not), and Sociological and cultural aspects of Tourette syndrome. SandyGeorgia (Talk) 03:41, 23 March 2008 (UTC)

I second that, as well as suggesting a link to The Tic Code and I Have Tourette's but Tourette's Doesn't Have Me. The film Maze was a good one and it portrayed accurate tics of the character the movie was based on but it did not really show how much more difficult his life really is- the person the character was based on, while his art is every bit as good, is not functioning on a level that the character in the movie did; relationships for him are very difficult to maintain and he has tics that make it difficult to be around babies, etc because he has poking and pinching tics. It also did not truly portray the difficulties he has functioning in society- being accosted by strangers who don't understand, being accused of being high or intoxicated, being asked to leave grocery stores and not return, etc. I would like to see a film that portrays it in all its reality, no matter how ugly and disturbing-- thats what people need to see. —Preceding unsigned comment added by 76.115.49.127 (talk) 11:32, 26 April 2008 (UTC)

Please see WP:MEDMOS, and these are already linked in the template at the bottom of the page, and included at Sociological and cultural aspects of Tourette syndrome. SandyGeorgia (Talk) 18:46, 26 April 2008 (UTC)

New review of TS available

Here's the citation:

Kenney C, Kuo SH, Jimenez-Shahed J. "Tourette's syndrome" Am Fam Physician 2008 Mar 1;77(5):651–8. PMID 18350763.

It looks high-quality, though I haven't read it carefully. It's aimed at GPs rather than at researchers or the general public. Eubulides (talk) 06:20, 9 April 2008 (UTC)

Thanks, Eubulides. I'll purchase it and dig through it over the next week, but without even glancing at the PMID yet, I can tell you that 1) none of those names are among the top-notch TS researchers, and 2) the Am Fam Physician ran an article that had lots of issues a few years ago (uncited inaccuracies, in fact). They just aren't at the same level as other sources used here. The last one they ran was a bit worn out and repeated some old, inaccurate info; I suspect they aim at the general GP (rather than specialist) level, and don't keep up with the most recent. Give me a week or so to purchase and get through it? SandyGeorgia (Talk) 16:31, 9 April 2008 (UTC)

Eek. Glanced at the PMID now. They're from Baylor. I hope I can get the article for free, because I'm not enthusiastic about paying to access this article or about its utility for our purposes, where we've already used top-notch research that enjoys consensus from the best researchers. SandyGeorgia (Talk) 16:44, 9 April 2008 (UTC)

Baylor? Isn't that a top-20 med school? Anyway, perhaps you can wait 6 months; I think it'll be free then. You're right that the audience is GPs rather than researchers. Eubulides (talk) 16:48, 9 April 2008 (UTC)

In general, yes Baylor is, but with TS, no it's not in the top, and there are issues. I'm working on getting a copy ... SandyGeorgia (Talk) 19:26, 9 April 2008 (UTC)

(And I have to remember to add Equine Tourette's, Pepper Belle the horse ... so busy with FAC.) SandyGeorgia (Talk) 19:27, 9 April 2008 (UTC)

New review of sensory phenomena and Tourette's available

This review is freely readable (yay!):

• Prado HS, Rosário MC, Lee J, Hounie AG, Shavitt RG, Miguel EC (2008). "Sensory phenomena in obsessive-compulsive disorder and tic disorders: a review of the literature". CNS Spectr. 13 (5): 425–32. PMID 18496480.{{cite journal}}: CS1 maint: multiple names: authors list (link)

I haven't read this review, but if it's reliable it strikes me that it should be used as a candidate to check and/or replace citations to several primary studies currently used in Tourette syndrome, including Cohen & Leckman 1992 (PMID 1517194), Bliss 1980 (PMID 6934713), Kwak et al. 2003 (PMID 14673893), Scahill et al. 1995 (PMID 7872145), Miguel et al. (PMID 10732667). Some of these studies are pretty old, and a recent reliable review would be preferable to them anyway as per WP:MEDRS.

Hope you don't mind my continuing suggestions for light bedtime reading. Eubulides (talk) 23:34, 27 May 2008 (UTC)

It looks promising, but I won't be able to read it until next week, as I'm going to be traveling, if you don't mind waiting for me. SandyGeorgia (Talk) 23:50, 27 May 2008 (UTC)

Thanks, there's no rush of course. Glad it looks promising. Eubulides (talk) 00:16, 28 May 2008 (UTC)

Printed and packed for airplane reading (the Brazilians are generally Yale trained, and are the tic-related OCD go-to group). SandyGeorgia (Talk) 00:18, 28 May 2008 (UTC) (P.S., quick scan, it looks pretty standard.) SandyGeorgia (Talk) 00:21, 28 May 2008 (UTC)

This is a fine overview, and we can use it as needed. SandyGeorgia (Talk) 18:12, 10 June 2008 (UTC)

OK, I added Prado,[3] but I did it by leaving the primary sources as well because in some cases they used direct quotes that contain key wording and the wording wasn't as tight in the Prado report. And because I hate to lose the excellent original sources. In one case, I'm not sure Prado can be used to replace the text: "Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though they are not included in the diagnostic criteria ..." Pls let me know what you think; glad to have a free source that describes some of this, although the primary sources provide more indepth coverage. SandyGeorgia (Talk) 20:25, 14 June 2008 (UTC)

Equine Tourette's

By the way, Eubulides, if you come across anything on equine Tourette's, we still need to add it (example, well known race horse, Pepper Belle). SandyGeorgia (Talk) 00:20, 28 May 2008 (UTC)

• Dodman NH, Normile JA, Shuster L, Rand W. "Equine self-mutilation syndrome (57 cases)". J Am Vet Med Assoc. 1994 Apr 15;204(8):1219–23. PMID 8014092
• Pharmacologic treatment of equine self-mutilation syndrome.
• Using animal models to develop therapeutics for Tourette Syndrome (Neal Swerdlow, worth getting hold of)
• Animal Models of Obsessive-Compulsive Behavior: a Neurobiological and Ethological Perspective.
• "Veterinary Topics: Puzzling behavior for a reason". Thoroughbred Times April 09, 2005. Retrieved on 2008-06-14.
• TSA newsletter

I briefly looked at it. It might be better to have a separate article on equine self-mutilation, and just briefly allude to it here. Although Dodman et al. 1994 (PMID 8014092) say equine self-mutilation appears to be similar to Tourette's, they could just as easily have said that it's similar to trichotillomania; that is, it's a stereotypy whose specific relationship to TS is a bit speculative. Anyway, here are a couple more citations that may help in that endeavor:

• McDonnell SM (2008). "Practical review of self-mutilation in horses". Anim Reprod Sci. doi:10.1016/j.anireprosci.2008.04.012. PMID 18541393. A 1st-class recent review.
• Yaryura-Tobias JA, Mancebo MC, Neziroglu FA (1999). "Clinical and theoretical issues in self-injurious behavior". Rev Bras Psiquiatr. 21 (3). doi:10.1590/S1516-44461999000300011.{{cite journal}}: CS1 maint: multiple names: authors list (link) Briefly mentions equine self-mutilation in the context of pathological self-injurious behavior (that is, via a different angle than TS). Freely readable.

Eubulides (talk) 00:47, 15 June 2008 (UTC)

I came to the same conclusion; I don't feel qualified to write the equine article, and don't think this article warrants more than one or two brief sentences, so I'm not sure if the section (per WP:MEDMOS) is justified. What do you think? SandyGeorgia (Talk) 00:50, 15 June 2008 (UTC)

Sorry, which section is "this section"? Hmm, perhaps we could add to Tourette syndrome #Classification something that puts human tic disorders in the more-general context of stereotypies in mammals? Eubulides (talk) 01:10, 15 June 2008 (UTC)

No, recently a change was enacted at WP:MEDMOS, adding a suggested section called In other animals. That's what made me think of the whole thing, but I'm not convinced it's worth a section given the tenuous connection. SandyGeorgia (Talk) 02:15, 15 June 2008 (UTC)

Lombroso Scahill

Another free review to work in:

• Lombroso PJ, Scahill L. "Tourette syndrome and obsessive-compulsive disorder". Brain Dev. 2008 Apr;30(4):231–7. PMID 17937978

SandyGeorgia (Talk) 17:57, 18 June 2008 (UTC)

More links

One link should be added: http://www.tourettes-action.org.uk/ <-this is the new TSA UK website (TSA UK has changed name to Tourettes Action now) —Preceding unsigned comment added by Furya (talk • contribs) 14:55, 9 July 2008 (UTC)

There are TSA organizations throughout the world, listing them all would violate WP:NOT, and they are already included in the DMOZ organizations link.

• *Tourette syndrome/Archive 8 at Curlie—Organizations

Notice that not even tsa-usa.org is listed separately in the External links section, and they are the most notable TS organization in the world. I encourage the TSA-UK to add their link to DMOZ. SandyGeorgia (Talk) 16:04, 9 July 2008 (UTC)

• Thanks for your answer. However I must say I find it a bit unreasonable not to add links to TSA in both countries as they are the places where you should go to get more information. I can also see that TSA US has its own article and I think this is even more silly.Thanks for the tip anyway. I'll add the link to the DMOZ —Preceding unsigned comment added by Furya (talk • contribs) 08:57, 17 July 2008 (UTC)

Survey Reliability

"A study of eight children, age 8–17, found that children with Tourette syndrome were quicker at processing certain mental grammar skills than are children without the condition. The abnormalities that lead to tics may also lead to "other rapid behaviors, including the cognitive processing of rule-governed forms in language and other types of procedural knowledge".[61]

Is this really a good source? How can you possibly make a conclusion on between 0.1% and 1% of the entire population (with Tourette's) of children by looking at 8? 82.17.136.199 (talk) 11:11, 19 July 2008 (UTC) (Sorry forgot to sign in Philipwhiuk (talk) 11:12, 19 July 2008 (UTC))

Changes to citation format?

This edit did things like changing "Arch Neurol." to "Archives of Neurology" (adding a wikilink, and spelling out the journal), and adding " (Review)" in places. Was this for consistency within this article only, or was it prompted by some change to some style guideline somewhere? (I ask because I mildly prefer abbreviations, non-wikilinked journal titles, and omitting "(Review)", and I hope I don't have to make similar changes to other articles. :-) Eubulides (talk) 04:17, 20 July 2008 (UTC)

No guideline change; I only did it for my purposes in the General References, and I don't plan to do make any changes to formatting on the footnotes/citations. Basically, I started down that path as I'm gearing up to review all the citations (per the MEDMOS discussion), and I was trying to discover the impact factor for each journal, which appears to be a hit-and-miss venture on Wiki ... that led me to see which journals we have articles on. Since they are still very sporadic, they aren't helpful in locating impact factors. By the way, Eubulides, what is considered a high or good impact factor? Our article doesn't discuss that. SandyGeorgia (Talk) 14:18, 20 July 2008 (UTC)

• Which MEDMOS discussion was that?
• Whether an impact factor is "high" depends heavily on the field. For TS I expect that multiple fields are involved; one can't reliably compare the impact factors of a journal in one field with that of another.
• I'm leery of ascribing much weight to the journal's impact factor. Although impact factor is a (crude) measure of the quality of a journal, it is neither designed for nor appropriate to estimating the quality of a journal article. For more on this please see: Seglen PO (1997). "Why the impact factor of journals should not be used for evaluating research". BMJ. 314 (7079): 498–502. PMC 2126010. PMID 9056804.
• Can you tell that I'm dubious of wikilinking to journal titles in citations? :-)

Eubulides (talk) 15:52, 20 July 2008 (UTC)

Yes, I've come to the same conclusion on the Impact factors, after digging around in this issue last night. As an example, we have the blatantly wrong definition of Tourette syndrome that was included in an NEJM review. If I went by impact factor alone, I'd cite that article; since it had inaccurate info, I'm finding impact factors not to be very useful. I suspect I'll have more questions as I get further into this, but it was the MEDMOS discussion about how to reflect replicated notable important primary sources vs. reviews; I'm just now starting through everything again, and I got off on the wrong track last night by thinking 1) that impact factors would be helpful, or 2) that I'd find impact factors in those links. SandyGeorgia (Talk) 16:06, 20 July 2008 (UTC)

Oliver Sacks

http://en.wikipedia.org/wiki/Oliver_Sacks - this guy has done some of the more formidible research in the disease. His work is referenced several times but not the man or his actual research which was pivotal to understanding and treating the condition, specifically with his case studies of "Witty Ticky Ray." Perhaps some inclusion? It's like having an article on Polio without mentioning Salk.

205.219.133.241 (talk) 20:53, 26 August 2008 (UTC)

Please produce some of this formidable research; numerous sources disagree and I'm not aware of any. Sacks is mentioned at Sociological and cultural aspects of Tourette syndrome, which is where his literary works are a better fit. SandyGeorgia (Talk) 20:55, 26 August 2008 (UTC)

At the same time, Sacks has faced criticism in the medical and disability studies communities. The details of some of his case studies have been questioned, and Arthur K. Shapiro—described as "the father of modern tic disorder research"—referring to Sacks celebrity status and that his literary publications received greater publicity than Shapiro's medical publications, said he is "a much better writer than he is a clinician". Howard Kushner's A Cursing Brain? : The Histories of Tourette Syndrome, says Shapiro "contrasted his own careful clinical work with Sacks's idiosyncratic and anecdotal approach to a clinical investigation". More sustained has been the critique of his political and ethical positions. Although many characterize Sacks as a "compassionate" writer and doctor, others feel he exploits his subjects. Sacks was called "the man who mistook his patients for a literary career" by British academic and disability-rights activist Tom Shakespeare, and one critic called his work "a high-brow freak show". Such criticism was echoed in the movie The Royal Tenenbaums, with Bill Murray's comic portrayal of "an Oliver Sacks-like neurologist who snickers openly at his weirdo subjects". Sacks himself has stated "I would hope that a reading of what I write shows respect and appreciation, not any wish to expose or exhibit for the thrill," he sighs, "but it's a delicate business."

Prognosis, saccades, etc.

The following text in Tourette syndrome #Prognosis cites two primary studies:

A controlled study on a small group of individuals with Tourette's found that young people with the syndrome have greater cognitive control over movements than their age-matched controls, possibly because the need to suppress tics results in a more efficient control over inhibitory movements, a skill that confers an advantage when switching between tasks. Children with Tourette's (in the absence of comorbid ADHD) performed more accurately on a goal-oriented eye-movement task, requiring active inhibition of automatic eye movements, and they made fewer errors than their unaffected peers, suggesting compensatory changes in the brain resulting in greater cognitive control. A subsequent study confirmed and extended the paradoxical result that individuals with Tourette's exhibit greater levels of cognitive control than age-matched healthy peers.

This research area has now been reviewed, by the following reliable secondary source:

Rommelse NN, Van der Stigchel S, Sergeant JA (2008). "A review on eye movement studies in childhood and adolescent psychiatry". Brain Cogn. doi:10.1016/j.bandc.2008.08.025. PMID 18835079.{{cite journal}}: CS1 maint: multiple names: authors list (link)

This review cites about 20 studies on pediatric TS and eye movements, all high-quality primary sources, including the two sources cited above. The studies cover antisaccades, visually guided saccades, memory guided saccades, and smooth pursuit eye movements. Almost all these studies report normal results in TS patients. Two studies (the two cited above, which are both by the same group) report above-average results. One study reports below-average. The review concludes:

Pediatric TS does not seem to be associated with dysfunctions in eye movements in the paradigms studied, suggesting the brain areas and cognitive processes involved in the various eye movement paradigms appear intact in TS. This is remarkable, given that studies on adult TS generally report on longer latencies, more anticipatory and intrusive saccades, and abnormal amplitudes in adult TS patients. The abnormal eye movement findings in adults with TS might be explained by the fact that individuals with tics persisting into adulthood may be an atypical group, since the symptoms of TS diminish substantially during adolescence and only 20% or fewer of children with TS continue to experience a moderate level of impairment by the age of 20.

This summary differs quite a bit from the impression that one gets from the abovequoted part of Tourette syndrome #Prognosis. I propose that we replace the above text with the following:

TS in children and adolescents does not seem to be associated with dysfunctions in eye movements. This is remarkable, as adults with TS have longer latencies, more anticipatory and intrusive saccades, and abnormal amplitudes in eye movements; this could be because individuals whose tics persist until adulthood are an atypical group.

Eubulides (talk) 05:16, 8 October 2008 (UTC)

I will have to read the article to be able to fully evaluate if it can be considered as debunking the previous studies, but anyway my first reaction, if the way you've described it is true, is to say that we shouldn't replace the current text we have with this new stuff (not the least because saying "TS in children and adolescents does not seem to be associated with dysfunctions in eye movements" will seem very awkward if we've removed the part of the article that brings up the connection between TS and eye movements), but rather add a sentence or two to the end of the current discussion, saying something like "these findings have been brought into question by a recent study by Rommelse et al."

Regardless, I think the new text you have proposed (beginning "TS in children and adolescents does not seem to be...") will have to be changed before it can put in the article. No offense intended, but it is awfully similar to the text that you've quoted from the Rommelse et al study, and putting it in the article may be construed by some as plagiarism.

Other than those issues, though, I do agree that it will be good to mention this new study in the article; I just don't think it should replace the existing literature. —Politizer^{( talk • contribs )} 05:28, 8 October 2008 (UTC)

• Sure, rewording it to avoid plagiarism concerns would be fine. I wrote it in a hurry.
• The review does not "debunk" the primary studies. It's a general review of all eye movement studies in childhood and adolescent psychiatry. It has no particular ax to grind here. I original read it because another section reviewed studies of eye movement in autism (basically, those results all reported no difference). I then noticed that the review had a similar section for TS, where it said something far more interesting, as quoted above. The review does cover the two primary studies in question; however, it places them in context, a context that Tourette syndrome currently omits.
• The WP:MEDRS guideline is that we should base articles on reliable reviews when possible, and we should not attempt to debunk those reviews with primary sources. If we merely insert the 51 words I am proposing, then Tourette syndrome would be devoting 51 words to the mainstream view that there's no eye-movement deficits in TS children but some in TS adults, along with the existing 120 words that summarize a theory promoted by just one research group (and summarize it inaccurately at that: they're talking only about pediatric TS). That sort of word count would raise an obvious WP:WEIGHT issue. Tourette syndrome should generally give the same weight to theories that mainstream reviews do.

Eubulides (talk) 06:40, 8 October 2008 (UTC)

I'm having difficulty understanding how the quoted material from the new review contradicts the quoted material from the article. They seem to me to be talking about different (although related) things. Could you clarify where the contradiction is? Looie496 (talk) 05:45, 8 October 2008 (UTC)

• The review is covering a broader area than the two primary studies. The review is covering antisaccades, visually guided saccades, memory guided saccades, and smooth pursuit eye movements. The two primary studies cover only antisaccades. The review spends a good detail of time on TS, and covers lots of studies. Here's what it says about the two primary studies in question:

Moreover, two studies reported that TS patients had a paradoxically greater level of cognitive control than controls, since TS patients had less difficulty than controls switching between prosaccades and AS within the same task.

• Another way to put it is that the review spends about 1200 words on eye-movement studies and TS, including the above-quoted 34 words on the two studies in question. In contrast, Tourette syndrome spends 120 words on the two studies in question, and zero words on everything else. This is way out of whack.
• The review also critically summarizes a single case report that reported a result where a TS patient got a zero score on antisaccades. The vast majority of studies report normal values for pediatric TS patients, though, and that's the bottom line of the review.

Eubulides (talk) 06:40, 8 October 2008 (UTC)

Thanks, Eubulides. I haven't read the new paper, but given that you've provided the gist of it, I don't think I need to spend the $31 for such a specialty topic. I suggest, now that we have a review of the primary studies, that we simply delete the text and not replace it with anything. First, the primary studies shouldn't be there anyway (as you know, I added some primary studies at one point based on faulty advice, and was working on replacing them before I got sidetracked by Johnson). Second, I think the new proposed text will go over the heads of our general readership, and provide undue weight to a rather unreported issue in TS. Third, since I have yet to see replication or discussion of the primary studies from the most reputable TS sources, I don't think the text belongs here anyway. I'm sorry I was slow in getting to it; now that Johnson is finally over with, I'll resume where I left off, updating older reviews to newer reviews. SandyGeorgia (Talk) 06:52, 8 October 2008 (UTC)

Removing the existing text would be OK too. What the review makes clear is that there's not much notable here. Similarly, I didn't modify Autism, because the review said that there wasn't much notable about eye movements and autism. Eubulides (talk) 07:18, 8 October 2008 (UTC)

The primary studies were on small samples, both from the same group, and for such an obscure topic in TS research, we certainly shouldn't get into dueling sources or undue weight of a topic our readers aren't likely to understand anyway, or using primary studies to refute reviews. We really should delete it; if reputable TS sources report on it in a review, we can re-include. Before I started working on Johnson in July, I was intending to delete that text anyway, and got sidetracked. SandyGeorgia (Talk) 07:26, 8 October 2008 (UTC)

OK, let's do that. While we're on the subject, the following text, which is all that would remain of that paragraph, seems to have similar problems:

A study of eight children, age 8–17, found that children with Tourette syndrome were quicker at processing certain mental grammar skills than are children without the condition. The abnormalities that lead to tics may also lead to "other rapid behaviors, including the cognitive processing of rule-governed forms in language and other types of procedural knowledge".

This gives relatively heavy weight to Walenksi et al. 2007 (PMID 17493643), one small primary study that has not yet (as far as I know) been reviewed or replicated. The text has little to do with Tourette syndrome #Prognosis, the section that contains it. The quote "other rapid behaviors ..." does not occur in the source (there are two similar quotes, but neither match exactly). Finally, and most important, that quote is pretty speculative; Tourette syndrome shouldn't be giving so much weight to a future-work hypothesis of a single primary source. Eubulides (talk) 08:16, 8 October 2008 (UTC)

After hearing your explanations, I agree with you two that the text regarding these studies should probably be removed, since it sounds like the studies mentioned in the article so far are primary, not replicated, and not really mainstream, and that they raise undue weight concerns as pointed out by Eubulides. And, like SandyGeorgia said, the review might be hard to bring down to laypersons' language...but, the one circumstance under which I would say it's worth mentioning anyway (and I'm not sure if this is the case or not) is if you feel there is a widespread public opinion that the results of a few fringe studies are the truth, then it might be nice to mention the review as a sort of "contrary to popular opinion" thing and summarize its conclusions in as simple terms as possible. —Politizer^{( talk • contribs )} 12:35, 8 October 2008 (UTC)

It is certainly folklore and anecdote within the TS community, but not wide enough "popular opinion" that it should be included here until/unless better studies replicate the result. Frankly, it was a bad WP:RECENTISM addition when I added it, in my earlier editing days. SandyGeorgia (Talk) 16:34, 8 October 2008 (UTC)

No further comment, so I removed it. Eubulides (talk) 18:55, 8 December 2008 (UTC)

School Project

I'm doing a school project on tourettes and so far ive only found stuff on George da le tourette (if thats how its spelt) can any one link more recent news on tourettes? it'd be be nice :D —Preceding unsigned comment added by Xaihn52 (talk • contribs) 16:10, 17 October 2008 (UTC)

Redundant paragraphs in Characteristics

It seems to me that the following two paragraphs (reproduced below) are each saying more or less the same things:

In contrast to the abnormal movements of other movement disorders (for example, choreas, dystonias, myoclonus, and dyskinesias), the tics of Tourette's are stereotypic, temporarily suppressible, nonrhythmic, and often preceded by a premonitory urge. Immediately preceding tic onset, most individuals with Tourette's are aware of an urge that is similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as a buildup of tension, pressure, or energy which they consciously choose to release, as if they "had to do it" to relieve the sensation or until it feels "just right". Examples of the premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. These urges and sensations, preceding the expression of the movement or vocalization as a tic, are referred to as "premonitory sensory phenomena". Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though they are not included in the diagnostic criteria.

Tics are described as semi-voluntary or "unvoluntary", because they are not strictly involuntary—they may be experienced as a voluntary response to the unwanted, premonitory urge. A unique aspect of tics, relative to other movement disorders, is that they are suppressible yet irresistible; they are experienced as an irresistible urge that must eventually be expressed. People with Tourette's are sometimes able to suppress their tics to some extent for limited periods of time, but doing so often results in an explosion of tics afterward. People with Tourette's may seek a secluded spot to release their symptoms, or there may be a marked increase in tics, after a period of suppression at school or at work.

I can merge the two paragraphs together, keeping the important stuff from each one (the "semi-voluntary/un-voluntary terminology from the second, the discussion of premonitory urges in the first, the possibility of suppression, etc.). I just wanted to check here first and make sure there wouldn't be anything wrong with that. —Politizer^{( talk • contribs )} 22:39, 17 October 2008 (UTC)

Would you mind putting the proposed merger here on talk, so we can rework it here if needed? Tony1 originally copyedited the article, Colin's also a great copyeditor, but both of them are a bit busy right now, so I'd like to take it slow if you don't mind. (Also, because I'm working to update the citations to newer reviews, I don't want to get tangled in older and newer versions.) SandyGeorgia (Talk) 23:14, 17 October 2008 (UTC)

Here it is. It's almost the same as before; after another read-through, I realized that it wouldn't be feasible to merge the two paragraphs, as they're actually about different but related things, and the appearance of redundancy was mostly just due to the fact that the connection between them was a little awkward, I think. So I made a few tiny changes, to the effect that the first paragraph is now entirely on premonitory urges (since those are what it takes to understand the voluntary/involuntary issue, I think) and the next paragraph basically about the consequences of that (the ability to suppress tics, the difference from other movement disorders, etc.). I also made some minor copyedits.

Immediately preceding tic onset, most individuals with Tourette's are aware of an urge that is similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as a buildup of tension, pressure, or energy which they consciously choose to release, as if they "had to do it" to relieve the sensation or until it feels "just right". Examples of the premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. These urges and sensations, preceding the expression of the movement or vocalization as a tic, are referred to as "premonitory sensory phenomena". Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though they are not included in the diagnostic criteria.

Because of the urges that precede them, tics are described as semi-voluntary or "unvoluntary", rather than specifically involuntary; they may be experienced as a voluntary, suppressible response to the unwanted premonitory urge. This makes the tics of Tourette's unique relative to other movement disorders (such choreas, dystonias, myoclonus, and dyskinesias). While individuals suffering from tics are sometimes able to suppress their tics for limited periods of time, doing so often results in an explosion of tics afterward. People with Tourette's may seek a secluded spot to release their symptoms, or there may be a marked increase in tics after a period of suppression at school or at work.

All the sources here are the same as in your latest revision of the main article, so I think sources should be ok. Let me know if there are any problems. —Politizer^{( talk • contribs )} 23:59, 17 October 2008 (UTC)

I'm glad you see the problem: the paragraphs are covering three different things: 1) differential diagnosis re what makes tics distinguishable from other conditions, 2) premonitory urges, and 3) involuntary/unvoluntary. I want to stick closer to the sources on one part (everything that distinguishes tics from other movement disorders, the Jankovic text). Also, what came from Jankovic vs. what came from other sources got a wee bit jumbled in the rework and the Jankovic differential diagnosis info was lost. Also, the flow is a bit off now (well, it was off before, too, as you noted :-) And, I had to remove the "suffering from" POV construct, which isn't accurate for most people with tics (impairment or distress is not part of the diagnosis), and is offensive to some. Also, with the rework, I think we can get it all in to one paragraph.

How about this:

In contrast to the abnormal movements of other movement disorders (for example, choreas, dystonias, myoclonus, and dyskinesias), the tics of Tourette's are stereotypic, temporarily suppressible, nonrhythmic, and often preceded by an unwanted premonitory urge. Immediately preceding tic onset, most individuals with Tourette's are aware of an urge, similar to the need to sneeze or scratch an itch. Individuals describe the need to tic as a buildup of tension, pressure, or energy which they consciously choose to release, as if they "had to do it" to relieve the sensation or until it feels "just right". Examples of the premonitory urge are the feeling of having something in one's throat, or a localized discomfort in the shoulders, leading to the need to clear one's throat or shrug the shoulders. The actual tic may be felt as relieving this tension or sensation, similar to scratching an itch. Another example is blinking to relieve an uncomfortable sensation in the eye. These urges and sensations, preceding the expression of the movement or vocalization as a tic, are referred to as "premonitory sensory phenomena" or premonitory urges. Because of the urges that precede them, tics are described as semi-voluntary or "unvoluntary", rather than specifically involuntary; they may be experienced as a voluntary, suppressible response to the unwanted premonitory urge. Published descriptions of the tics of Tourette's identify sensory phenomena as the core symptom of the syndrome, even though they are not included in the diagnostic criteria. While individuals with tics are sometimes able to suppress their tics for limited periods of time, doing so often results in an explosion of tics afterward. People with Tourette's may seek a secluded spot to release their symptoms, or there may be a marked increase in tics after a period of suppression at school or at work.

SandyGeorgia (Talk) 00:31, 18 October 2008 (UTC)

That rewrite looks fine to me. I apologize for my POV wording; "individuals suffering from X" is kind of the knee-jerk PC wording I've gotten used to from working in mental health for several years but, as you pointed out, distress or impairment is not a diagnostic criteria for Tourette's like it is for mental illnesses.

The only other thing is, since you mentioned that part of the reason for including the Jankovic test is for its value in differential diagnosis, should it also be repeated in the Diagnosis section? That section seems to have stuff about other possible causes of tics, but doesn't explicity discuss the differences between the tics themselves and tics that may occur in other disorders.

Anyway, I have no problems with the rewrite as you have written it now! —Politizer^{( talk • contribs )} 00:43, 18 October 2008 (UTC)

Let's put this piece in for now, and then figure that out. As you can see, it leads to a tricky flow issue of where to introduce what. SandyGeorgia (Talk) 00:45, 18 October 2008 (UTC)

Tetrabenazine

The following review was recently published on tetrabenazine and TS:

• Porta M, Sassi M, Cavallazzi M, Fornari M, Brambilla A, Servello D (2008). "Tourette's syndrome and role of tetrabenazine: review and personal experience". Clin Drug Investig. 28 (7): 443–59. PMID 18544005.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Alas, I lack easy access both to this review, and to Scahill et al. 2006 (PMID 16554257), which appears to be the best review on medication and TS that we have. In the U.S., tetrabenazine is an orphan drug approved for use in August (not for TS), making it more likely for the topic to come up here. Do Scahill et al. mention tetrabenazine? Either way, it looks like we should briefly mention it and cite Porta et al., assuming someone can dig it up in their library. (If it helps, my library will have access to Porta et al. 6 months after publication.) Eubulides (talk) 18:48, 8 December 2008 (UTC)

Sorry, Eubulides, I've been busy; I believe that paper is one that I have, and I will dig it out in a bit. SandyGeorgia (Talk) 02:01, 9 December 2008 (UTC)

From PMID 18544005, although we don't have the full article, I've never encountered any of these researchers, and this part of the abstract concerns me:

The authors' experience with 120 heavily co-medicated patients with TS confirms these findings. Long-term (mean 19 months) tetrabenazine treatment resulted in a Clinical Global Impressions of Change scale rating of 'improved' in 76% of patients. Such findings are promising and suggest that tetrabenazine may be suitable as add-on therapy in patients for whom additional suppression of tics is required.

1. I'm curious about this "Clinical Global Impressions of Change" scale rating, when the standard in TS research is the YGTSS (Yale Global Tic Severity Scale). I wish we knew more about the "improved" rating: I don't know this scale.
2. "120 heavily co-medicated patients ... " indicates that this might not be a population sample representative of most people with TS or commonplace treatment.
3. "... suitable as an add-on therapy ..." suggests that this might be something we could mention at Treatment of Tourette syndrome, where we deal with less mainstream treatment. It doesn't sound like something that applies to most people with TS.

Now, looking at Scahill et al. 2006 (PMID 16554257), I have a hard copy, printed when it was provided from the TSA website, so I hope it's the same version that appeared in the journal. I don't have it in a computer file, only hardcopy, so I can't do a ctrl-f: scanning the article for mention of tetrabenazine, pls excuse typos. Without counting the references, the paper is 14 pages. The section on "Non-antipsychotic medications" is one page. Within that, the info on tetrabenazine is a part of one paragraph. The main thrust of the article is to assess medications by the level of empirical support.

• Category A Good supportive evidence for short-term safety and efficacy, a least two randomized placebo-controlled trials.
• Category B Fair supportive data, one positive placebo-controlled study.
• Category C Minimial supportive evidence, such as clinical experience or open-label studies.

Tetrabenazine is listed in the chart of non-antipsychotics as Category C.

The text on tetrabenazine is:

Tetrabenazine is a dopamine-depleting drug which acts by inhibiting entral vesicular monoamine transporter type 2 (VMAT2). It is not on the market in the United States, and only two open-label studies have been published (Jankovic & Orman, 1988; Jankovic and Beach, 1997). Taken together, these two studies treated 64 patients with TS. Of these, approimately two thirds (n = 44) showed a moderate to marked reduction in tics on a clinician-rated global severity measure. Side effects included drowsiness, parkinsonism, depressed mood, insomnia, akathisia, and a few reports of dystonias.

Jankovic Orman is PMID 3279337

Jankovic Beach is PMID 9040721

All papers say pretty much the same. I checked the three most recent reviews (Gilbert PMID 16970870, Singer PMID 15721825, and Swain PMID 17667475). I do have journal PDFs on these, so could electronically scan. Gilbert's only mention is to list it in a chart as Category C. Singer has one sentence: Several studies have confirmed that tetrabenazine, a benzoquinolizine derivative that depletes the presynaptic stores of catecholamines and blocks postsynaptic dopamine receptors, is effective.151 (151 is Jankovic Orman) Swain says: Tetrabenazine is a nonantipsychotic dopamine antagonist, approved as an investigational drug. Available data suggest that tetrabenazine may be useful, but more study is needed (Sandor, 2003).

The 2006 Advances in Neurology volume 99 book mentions tetrabenazine on one page, the Dure Dewolfe "Treatment of Tics" paper cited in this article, p. 193 of the book. It says "demonstrated to be of benefit", nothing more, cites Sandor, 2003.

Sandor 2003 is PMID 12842230, just another review, so I don't think there's anything new there.

I also checked Robertson's 2000 paper (cited in this article) because that's UK, although Robertson's papers always make me uncomfortable as she tends to report her own observation and anecdote in review papers. She has an entire paragraph (this paper covers meds extensively). She cites the same studies as the others, and adds: "There have been some suggestions that tetrabenazine plus a dopamine antagonist, which acts post-synaptically, could be used together, as they may have a more lasting effect and fewer side-effects, because both drugs can be given in lower doses (Fog and Regeur, 1986). More commonly recognized side-effects of tetrabenazine incude depression, drowsiness, fatigue, parkinsonism, insomnia, nervousness, anxiety and akathisia. In its favour, it has not been reported to cause TD." [note, presumably she means tardive dyskinesia there]

That's it. SandyGeorgia (Talk) 03:57, 9 December 2008 (UTC)

"That's it"? Wow, that's a lot. "Clinical Global Impressions of Change" are simple unstructured instruments: basically, ask a clinician to rate change over the duration of a clinical trial. They are used in clinical trials for Alzheimer's, schizophrenia, depression, Parkinson's, etc. I'm no TS expert, but YGTSS sounds like a better measure. I tend to agree, given all the material mentioned above, that it's better to put this stuff in Treatment of Tourette syndrome. Not having access to Porta et al., I'm loath to do that myself. A more-careful reading of their abstract suggests that it may not be a review in the sense that I thought it was, but instead is more of a review of the authors' own work and maybe one other study, which is not the sort of source we're looking for. Sorry about the false alarm. Eubulides (talk) 06:56, 9 December 2008 (UTC)

I just checked Treatment of Tourette syndrome, and we've got one sentence there (under Treatment of tics); is that good enough? SandyGeorgia (Talk) 07:09, 9 December 2008 (UTC)

Sure. If someone ever gets a copy of Porta et al. (it probably won't be me :-) we can revisit this then. Eubulides (talk) 07:25, 9 December 2008 (UTC)

FYI: I have the PDF for Scahill et al. 2006 (PMID 16554257); email me if you want it. I have no electronic access to Clinical Drug Investigation (IF < 1), and by reading the abstract it's not something I'd bother reading let alone scanning. Xasodfuih (talk) 12:22, 22 January 2009 (UTC)

Tourettism vs sporadic

The text said

'In some cases, tics may not be inherited; these cases are identified as "sporadic" Tourette syndrome (also known as tourettism) because a genetic link is missing.'

There are two things wrong with this. First, there is a difference between something being inherited and something being heritable; a condition can be highly heritable but not inherited when it is the result of a de novo mutation in the child. As worded, the sentence makes it sound like a non-inherited tic is not caused by a genetic factor, but that's not the case. Second, whether a tic is sporadic (i.e., not inherited) is independent of whether it's tourettism. Tourettism means that the tic is the result of some other condition. As near as I can make out (I'm no TS expert) there is sporadic tourettism, and inherited tourettism, and sporadic TS, and inherited TS, so the article should not define sporadic to mean tourettism.

I attempted to fix the problem by replacing the text in question with:

'In some cases, Tourette's is sporadic, that is, it is not inherited from parents but may be the result of genetic copy number variations or other factors in the child. In other cases, tics are associated with disorders other than Tourette's, a phenomenon known as tourettism.'

The first sentence cites Kremer 2007 (PMID 18267268), a source that is not all that great but is the best I could find on the topic. Eubulides (talk) 22:44, 26 January 2009 (UTC)

Not yet certain the new text is quite right ... but without having the full text of Kremer 2007 (PMID 18267268), it's hard for me to sort (can you post the relevant pieces here?). I'm concerned about two factors:

1) "In some cases, Tourette's is sporadic, that is, it is not inherited from parents but may be the result of genetic copy number variations or other factors in the child."

This (I believe) is extremely rare: the text gives no indication of how rare or common this is, but lists it before the more common tourettism (which encompasses all secondary causes of tics), potentially leaving the impression that this is fairly common. Does the cited journal article address this at all ?

2) "In other cases, tics are associated with disorders other than Tourette's, a phenomenon known as tourettism"

The definition of tourettism (all secondary causes of tics) is lost; for example, from Mejia PMID 15867978 (which includes "sporadic" under tourettism):

• Although Tourette syndrome (TS) is the most frequent cause of tics, there are many other causes of tics, such as insults to the brain, particularly the basal ganglia, due to infection, stroke, or head trauma; certain toxins or drugs can also cause tics. A variety of sporadic, genetic, and neurodegenerative disorders may also exhibit tics. We review all cases of tics associated with other disorders (sometimes termed "tourettism") that have presented to our clinic, in a belief that a study of secondary cases of tics may provide insight into the pathogenesis of primary tics and TS.

SandyGeorgia (Talk) 23:38, 26 January 2009 (UTC)

• No, Kremer does not talk about how common copy number variations (CNVs) are in Tourette's. Kremer's last paragraph is about CNVs, and it is speculative. It ends with the sentence "Copy Number Variations appear to be associated with autism and they may play their role in Tourette syndrome." I could quote a bit more, but as it's only a 1.5-page paper I'm a bit loath to quote entire paragraphs. Basically, Kremer is saying that we may be having problems finding the cause of Tourette's because of difficulty delineating the phenotype, and because we need to consider novel genetic mechanisms such as CNVs, or such as dosage effects from secondary genes. However, if it's any reassurance, the connection between CNVs and Tourette's is a common speculation among reliable sources; see, for example, Keen-Kim & Freimer 2006 (PMID 16970867) and Cook & Scherer 2008 (PMID 18923514).
• Mejia & Jankovic 2005 (PMID 15867978) is not including "sporadic" under "tourettism". They write that "tourettism" is "tics associated with other disorders", which is correct. They also write that these other disorders may be "sporadic, genetic, and neurodegenerative", but their "and" is grammatically sloppy; it should be "or". The other disorders may or may not be sporadic, and tourettism is not always due to a sporadic disorder, just as it is not always due to a neurodegenerative disorder. For example, Mejia & Jankovic list PDD as being comorbid with tourettism, but PDD is not neurodegenerative and a reasonably high percentage of PDD is not sporadic.
• "The definition of tourettism (all secondary causes of tics) is lost" I tried to capture that definition in the phrase "tics are associated with disorders other than Tourette's, a phenomenon known as tourettism". Mejia & Jankovic define tourettism to be "tics associated with other disorders"; that is, they use the broader definition, in which only association with tics is necessary, not causation of tics.
• By the way, I see now that this topic came up in 2006, in Talk:Tourettism #Copied from MCOTW:, but appears to have fallen through the cracks. I suppose Tourettism's lead also needs fixing?

Eubulides (talk) 00:40, 27 January 2009 (UTC)

Yes, I know about the common speculation, but the most widely documented case (SLITRK1) was found in an extremely small subset (1 to 2%); we need to give some sense of how uncommon this is ... I'm concerned we're giving the wrong impression, although I'm not sure how the wording can be toned down if the source doesn't address it. I'm afraid the concept is undue weight. I don't have time to work on Tourettism or dig out other sources from my file drawer ... houseguest all week and pending travel ... so whatever you can do is great. Best, SandyGeorgia (Talk) 00:48, 27 January 2009 (UTC)

The SLITRK1 case is just one example; what we're talking about here is all the contribution of all the de novo CNVs, most of which is not known. In autism, Sebat et al. 2007 (PMID 17363630; a hugely influential paper) found de novo CNVs in 10% of cases. Beaudet 2007 (PMID 17479094) says it's highly likely that most of the de novo variants are the primary cause of the autism, since so few (1%) were found in controls. Beaudet speculates that the "10%" number may grow to 30–40% with further research. He also writes that de novo CNVs are unlikely to explain all of autism, as the (hypothesized) 60–70% unknown-cause autism will almost entirely be male, whereas the de novo mutations generally affect both sexes about equally. The connection between this and Tourette is almost all speculation, of course, but all the published speculation I've seen is that Tourette syndrome will turn out to be somewhat similar. As for wording, we could change "In some cases" to "In an unknown number of cases"; is that the sort of thing you're looking for? Eubulides (talk) 02:00, 27 January 2009 (UTC)

In the absence of any cited text (and I'm disinclined to believe the number will ever be high for TS), we just need to do something that isn't original research that doesn't mislead people into believing that TS isn't what it is: genetic most of the time, misdiagnosed as stereotypies or autism in other cases, but rarely a CNV. Whatever we can do: right now, the text gives us nothing (and I've never seen any research or paper leading me to believe this will change to the extent mentioned w/autism). SandyGeorgia (Talk) 02:14, 27 January 2009 (UTC)

But CNVs are genetic. And it's not known whether TS is rarely caused by CNVs. Hmmm, maybe we have a terminology problem here? Anyway, perhaps it'd be better not to mention CNVs at all, given that this stuff is so speculative. I made this change to do that. The best source I could find on sporadic TS was Asmus et al. 2005 (PMID 15627203). It's not that great (it's a primary study, not a review) but I don't think the existence of sporadic TS is at all controversial, so it should do until/unless we find a better source. Eubulides (talk) 04:05, 27 January 2009 (UTC)

I've just noticed that we do have my concern addressed a few sentences earlier, with "Genetic studies have shown that the overwhelming majority of cases of Tourette's are inherited ... ", so good enough! SandyGeorgia (Talk) 04:07, 27 January 2009 (UTC)