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Welcome

Friday, September 21, 2007

TOURETTE'S SYNDROME: A Novel, But Effective, Treatment

TOURETTE’S SYNDROME: A Novel, But Effective, Treatment

PART I

INTRODUCTION

A 12 year old boy presented with the typical symptoms of Tourette's Syndrome (TS). As I sat in my office, I could hear his very loud vocal almost continuous utterances as he and his mother walked into the waiting room for the first time. When I went to investigate the cause of the noises, I observed the severe motor tics of nose twitching, grimaces, neck stretching, and total body twisting. He was, in fact, the worst case of TS that I had ever seen.

This paper essentially describes the course of therapy which resulted in COMPLETE cessation of symptoms.

HISTORY

The first symptoms began when this boy was 2 ½ years old. Symptoms progressed and increased as he got older until symptoms got so bad requiring his removal from school about 2 ½ months previously. He was presently home-schooled.

He had been examined by numerous physicians including a psychiatrist, all of whom confirmed the diagnosis of TS. The psychiatrist placed the boy on medication. Eventually, by the time I saw him, he was taking 3 medications:

1. Celexa (citalopram hydrobromide) ( Forest ), 30 mg daily since age 5 ½

2. Ritalin LA (methylphenidate hydrochloride) (Novartis), 30 mg daily since age 6 ½ and

3. Focalin (dexmethylphenidate hydrochloride) (Novartis) , 5 mg daily for several months because he was not sleeping well..

He performed some usual exercise activities: swimming, biking, and baseball.

He had all the usual childhood immunizations at the required times. He was never allergy tested.


He had no major accidents or illnesses except at age one and one half and again at three he had ear tubes inserted bilaterally because of repeated recurrent otitis media (middle ear infections).

In response to a Food Allergy and Chemical Allergy Questionnaire the following questions were answered in the affirmative:

Do you or any family members have hay fever, asthma, hives, or chronic skin conditions?

Do you eat snacks frequently between meals: fruit, vegies, carbs.

Do you ever have itching of the skin?

Do you dislike or react to disinfectants, insecticides, sprays, ammonia, or moth balls?

Do you feel that you perform or feel better in natural lighting compared to fluorescent lighting?

FAMILY HISTORY

MOTHER: has hypertension, allergies and hay fever, and psoriasis.

FATHER: has sinus problems but was never allergy tested.

MOTHER'S PARENTS: both have hypertension, father has diabetes, prostate cancer, hypercholesterolemia, psoriasis, and a myocardial infarction.

FATHER'S PARENTS: both had high blood pressure and hypercholesterolemia, and father had MS.



PHYSICAL EXAMINATION

The boy was of normal stature and weight for his age. His physical examination was normal except for the symptoms of TS, all of which were described earlier.

Additionally, the boy verbalized how upset he was with his condition. He missed the companionship of other children and playing baseball because his mother had to remove him from school. He was a young adult experiencing the psychological ramifications of his disease.


LABORATORY ANALYSIS

His most recent hematology was within normal limits and a Vitamin B12 level was slightly higher than the upper limit of normal by only 4 micro g/ml,


THERAPY

I will not detail the therapy here on the website because each patient will have to be individualized depending upon his particular circumstances and the medications he is taking. I will say, however, that during the first week on a rather severe elimination diet, we reduced his medication by 50%. During the second week, they were reduced an additional 50%, that is, he was now taking 25% of his original doses. The third week, all medications were stopped completely.

I will, however, describe his response in the following PROGRESS reports.

PROGRESS

Two days: The mother called me saying that the boy was about the same during the day but appeared to sleep better at night.

Second Visit (one week later): From my office, I heard the mother come into the waiting room, but I did not hear the vocalizations I heard the time they came into the office. At first, I thought that the mother left her son home not bringing him to the office. But when I went into the waiting room, there was the boy smiling not uttering a sound. Over the next 20 minutes he exhibited very mild utterances characteristic of TS. Additionally, his motor tics were also considerably diminished to the point that they were difficult to discern. The difference between now and the first visit one week earlier was literally like night and day .

Third Visit (one week later): On his third visit one week later the boy was even better. During the 45 minutes while he was in he office, I observed a single grimace and one small almost imperceptible peep. It would have been a well trained individual to have observed that this boy was suffering from Tourette's.

Fourth Visit (one week later): When this young boy arrived at the office on the fourth week, he was even better. During the 45 minutes in the interview he did not make a single sound and the a very rare, but mild, facial movement which went hardly unnoticed.

His mother, who was a nurse, stated that he experienced mild symptoms when given vinegar ( a fermented product) at one meal. She started feeding him fresh corn which he tolerated without symptoms.

Fifth Visit (three weeks later): At this, the young man was even better. The mother noticed that one evening following eating a large amount of pizza, which was not on his diet at the time, the boy exhibited moderate symptoms for several hours. He had, at this point, been off his medications for three weeks, indicating he needed them no more, not that he needed them in the firs place because they were making him worse.

PART II, TOMORROW.

nicola michael c. Tauraso, M. D.
Director, Tauraso Medical Clinic
www.drtauraso.com

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