Instruct: Given a question, retrieve documents that answer the question.
Query: Is there a cure for Tourettes?
Tourette syndrome (also Tourette's syndrome or TS) is an inherited neuropsychiatric disorder with onset in childhood, characterized by the presence of motor and phonic tics. Treatment of Tourette syndrome has the goal of managing symptoms to achieve optimum functioning, rather than eliminating symptoms; not all persons with Tourette's require treatment, and there is no cure or universally effective medication. Explanation and reassurance alone are often sufficient treatment; education is an important part of any treatment plan.
An incident of disinformation about coprolalia and Tourette's involved Dr. Laura Schlessinger. According to the former Tourette Syndrome Association (name changed to Tourette Association of America in 2015), she berated a caller inquiring whether a child with TS should attend a family wedding, declaring that a majority of those with the condition exhibited coprolalia and should be excluded from many social situations, provoking an avalanche of angry calls about the misinformation. Garrison Keillor, radio show host of NPR's "A Prairie Home Companion", produced a segment in 2006, titled "Broadway Tourette's", about segregating people with stereotypical TS from other passengers on a cruise ship, prompting a press release from the Tourette Syndrome Association.
Findings reported in published studies of Tourette syndrome since 1999 have advanced TS science in the areas of genetics, neuroimaging, neurophysiology, and neuropathology. The TAA supports a clinical database that may help identify genes involved in Tourette syndrome, and the TSA International Genetic Consortium has collected a database on large extended families for future studies. Novel neuroimaging studies are being employed to study tic expression and functional or cognitive deficits in TS patients. Studies of Tourette's neurophysiology and neuropathology are attempting to link deficits in Tourette's to specific brain mechanisms, and have taken advantage of a brain bank sponsored by the TSA. Clinical trials have focused on understanding tic suppression, comorbid conditions, novel treatment approaches such as botulinum toxin, and targeted behavioral therapies. Controversy remains in the areas of deep brain stimulation and PANDAS.
Although there is no such thing as a "typical" case of Tourette syndrome, the condition follows a fairly reliable course in terms of the age of onset and the history of the severity of symptoms. Tics may appear up to the age of eighteen, but the most typical age of onset is from five to seven. A 1998 study published by Leckman and colleagues from the Yale Child Study Center showed that the ages of highest tic severity are eight to twelve (average ten), with tics steadily declining for most patients as they pass through adolescence. The most common, first-presenting tics are eye blinking, facial movements, sniffing and throat clearing. Initial tics present most frequently in midline body regions where there are many muscles, usually the head, neck and facial region. This can be contrasted with the stereotyped movements of other disorders (such as stims and stereotypies of the autism spectrum disorders), which typically have an earlier age of onset, are more symmetrical, rhythmical and bilateral, and involve the extremities (e.g., flapping the hands). Tics that appear early in the course of the condition are frequently confused with other conditions, such as allergies, asthma, and vision problems: pediatricians, allergists and ophthalmologists are typically the first to see a child with tics.
There is no cure for Tourette's and no medication that works universally for all individuals without significant adverse effects. Knowledge, education and understanding are uppermost in management plans for tic disorders. The management of the symptoms of Tourette's may include pharmacological, behavioral and psychological therapies. While pharmacological intervention is reserved for more severe symptoms, other treatments (such as supportive psychotherapy or cognitive behavioral therapy) may help to avoid or ameliorate depression and social isolation, and to improve family support. Educating a patient, family, and surrounding community (such as friends, school, and church) is a key treatment strategy, and may be all that is required in mild cases.
Medication is available to help when symptoms interfere with functioning. The classes of medication with the most proven efficacy in treating tics—typical and atypical neuroleptics including risperidone (trade name Risperdal), ziprasidone (Geodon), haloperidol (Haldol), pimozide (Orap) and fluphenazine (Prolixin)—can have long-term and short-term adverse effects. The antihypertensive agents clonidine (trade name Catapres) and guanfacine (Tenex) are also used to treat tics; studies show variable efficacy, but a lower side effect profile than the neuroleptics. Stimulants and other medications may be useful in treating ADHD when it co-occurs with tic disorders. Drugs from several other classes of medications can be used when stimulant trials fail, including guanfacine (trade name Tenex), atomoxetine (Strattera) and tricyclic antidepressants. Clomipramine (Anafranil), a tricyclic, and SSRIs—a class of antidepressants including fluoxetine (Prozac), sertraline (Zoloft), and fluvoxamine (Luvox)—may be prescribed when a Tourette's patient also has symptoms of obsessive–compulsive disorder. Several other medications have been tried, but evidence to support their use is unconvincing.
Isotretinoin is a teratogen; there is about a 20–35% risk for congenital defects in infants exposed to the drug "in utero", and about 30–60% of children exposed to isotretinoin prenatally have been reported to show neurocognitive impairment. Because of this, there are strict controls on prescribing isotretinoin to women who may become pregnant and women who become pregnant while taking isotretinoin are strongly advised to terminate their pregnancies.
Denturism is defined as the practice by denturists of examining oral health, planning treatment, making artificial dentures including other removable oral appliances and fitting them to patients. It is a recognized profession throughout the world and currently utilized in many countries including Australia, New zealand, United States, United Kingdom and Canada. In the United States, denturism is only legislated and practiced in 7 states (Maine, Arizona, Idaho, Montana, Washington, Oregon, and Colorado). However, in Australia, the United Kingdom and Canada, all states, provinces and territories recognize the profession.
Compared to other countries, tonsillectomy rates have always been high in the Netherlands and remain one of the highest in the world, which according to Dutch ENT specialist Anne Schilder is because of cultural reasons. In 1964 a Dutch ENT specialist commented that once a child has benefited from the procedure, its parents often urge to have the procedure done on their other children, even without any medical indication, and that doctors should strongly resist that urge. According to a document written in 2008 by the umbrella organization of ten health insurers in The Netherlands, many unnecessary tonsillectomies are still performed because of parental demand.
Serge Toussaint is an artist and muralist. He was born in Haiti, grew up in Carrefour, Haiti until the age of 12. He then moved to Corona, Queens, New York with his father. Here he went to high school and graduated with his high school diploma. He worked in New York for some time working often on his own artwork and earning a wage from jobs such as being a busboy at Sizzler. He and his family took a vacation to Florida one winter and it was during this vacation he decided to stay in Miami and work on his career as an artist. Serge currently resides (2010) in Miami, Florida, and states he is unsure how many signs and murals he has done although it is surely in the hundreds if not the thousands. He claims he was an artist at age 12 and the only lessons in art he had were during his required art class in high school. Serge Toussaint has four children. His mother, died in 2009. Serge states that he had a past of doing things wrong, however he states he is now married and spends him time painting and enjoys spending his time doing rara lakay.
In a case reported only due to its rarity, triplegia was reported following a tonsillectomy (surgical removal of the tonsils). An eight-year-old male patient was sent to Willard Parker Hospital on August 12, 1929 and had been diagnosed with poliomyelitis. After an unrelated, and routine, tonsillectomy there was complete flaccid paralysis and loss of feeling in both the legs, right arm, and muscles in the trunk.
The National Autistic Society said in 2008 that it was "extremely concerned" about possible harmful effects of the devices upon people with autism. Since autism causes auditory hypersensitivity, individuals with this disability can have more intense reactions to this sound, especially if they are also under 25. Since autism can also affect communication skills, some individuals may not be able to communicate their discomfort to caregivers. A supermarket in Longridge, England, removed a mosquito device in 2008 after a campaign by a 19-year-old Paul Brookfield, who has autism. Brookfield contended that the device was causing him pain due to his disability.
Isotretinoin, also known as 13-"cis"-retinoic acid (and colloquially referred to by its former brand name Accutane or Roaccutane), is a medication primarily used to treat severe acne. Rarely, it is also used to prevent certain skin cancers (squamous-cell carcinoma), and in the treatment of other cancers. It is used to treat harlequin-type ichthyosis, a usually lethal skin disease, and lamellar ichthyosis. It is a retinoid, meaning it is related to vitamin A, and is found in small quantities naturally in the body. Its isomer, tretinoin, is also an acne drug.
As a result of the crisis, all Tylenol capsules were discontinued, as were capsules of other brand names. Retained by McNeil's president, Joseph Chiesa, new product consultant Martin Calle of management strategist Calle & Company conceived the world's first tamper-resistant gelatin-enrobed capsule called "Tylenol Gelcaps", which proved to resuscitate the 92% of capsule-segment sales lost to the recall. The tamper-resistant, triple-sealed safety containers were placed on the shelves of retailers 10 weeks after the withdrawal, and other manufacturers followed suit. The crisis cost the company more than $100 million, but Tylenol regained 100% of the market share it had before the crisis. The Tylenol murderer was never found, and a $100,000 reward offered by Johnson & Johnson remains unclaimed.
Bis-choline tetrathiomolybdate (or tiomolibdate USAN, trade name Decuprate), is a salt of tetrathiomolybdate (TTM, MoS) and choline currently under investigation as a therapy against Wilson's disease, a rare and potentially fatal disease in which the body cannot regulate copper. Wilson's disease is an autosomal recessive genetic disorder that is manifested by serious hepatic, neurologic or psychiatric symptoms. The disease is fatal if left undiagnosed and untreated. It is estimated that approximately 1 individual in every 30,000 worldwide have Wilson's disease, corresponding to approximately 15,000 individuals in the European Union and approximately 11,000 in the United States.
In 1897, Toulet received a copy of "The Great God Pan" by Arthur Machen from a friend and he translated it the following year, as "Le Grand Dieu Pan". It was published in "La Plume" in 1901 but went unnoticed except for Maeterlinck's reaction "...combining the traditional and scientific fantastic genres, it hits both our memories and hopes". Toulet engaged a correspondence with Machen and visited him in London.
Wilson Therapeutics' lead product, Decuprate, is the proprietary bis-choline salt of tetrathiomolybdate. Decuprate is initially being developed as a novel treatment for Wilson's disease, a rare genetic disease that affects approximately 1 in 30,000, causing copper overload in the liver, brain and other tissues and resulting in organ damage and dysfunction. Decuprate has been granted orphan drug designation for the treatment of Wilson's disease in both Europe and the United States.. Wilson Therapeutics presented during the 10th Kempen & Co Life Sciences Conference 2017 and showed the world the result with the drug Decuprate. The company also presented during the international investmentconference Bioequity Europe in Paris, France, on May 23rd 2017 and showed some promising result.
"O. tsutsugamushi" causes a complex and dangerous infection scrub typhus. Infection starts when chiggers bite on the skin during their feeding. The bacteria are deposited at the site of feeding (inoculation), where they multiply. They cause progressive tissue damage (necrosis). Necrosis progresses to inflammation of the blood vessels called vasculitis. This in turn causes inflammation of the lymph nodes, called lymphadenopathy. Within a few days, vasculitis extends to various organs including liver, brain, kidney, meninges and the lung. The disease is responsible for nearly a quarter of all the febrile (high fever) illness in endemic areas. Mortality in severe case or due to improper treatment or misdiagnosis may be as high as 30-70%. About 6% of infected people die untreated, and 1.4% of the patients die even with medical treatment. Moreover, death rate can be as high as 13% where medical treatment is not properly handled. In cases of misdiagnosis and failure of treatment, systemic complications rapidly develop including acute respiratory distress syndrome, acute kidney failure, encephalitis, gastrointestinal bleeding, hepatitis, meningitis, myocarditis, pancreatitis, pneumonia, septic shock, sub-acute thyroiditis, and multi-organ dysfunctions. Harmful symptoms involving multiple organ failure and neurological impairment are difficult to treat, and can be lifelong debilitation or directly fatal. The central nervous system is often affected and result in various complications including cerebellitis, cranial nerve palsies, meningoencephalitis, plexopathy, transverse myelitis, neuroleptic malignant syndrome, and Guillan-Barré syndrome. Death rates due to complications can be up to 14% in brain infections, and 24% with multiple organ failure. It is the major cause of acute encephalitis syndrome in India, where viral infection Japanese encephalitis has been regarded as the main factor.
The immediate symptoms of this type are treated with antihistamines, epinephrine and airway support. Taking antihistamines prior to exercise may be effective. Ketotifen is acknowledged to stabilise mast cells and prevent histamine release, and has been effective in treating this hives disorder. Avoiding exercise or foods that cause the mentioned symptoms is very important. In particular circumstances, tolerance can be brought on by regular exercise, but this must be under medical supervision.
Acute disease might include infections such as oesophagitis, trauma caused ingestion of corrosive substances, or rupture of veins such as oesophageal varices, Boerhaave syndrome or Mallory-Weiss tears. Chronic diseases might include congenital diseases such as Zenker's diverticulum and esophageal webbing, and oesophageal motility disorders including the nutcracker oesophagus, achalasia, diffuse oesophageal spasm, and oesophageal stricture.
Little evidence is available on the use of medications to treat scrupulosity. Although serotonergic medications are often used to treat OCD, studies of pharmacologic treatment of scrupulosity in particular have produced so few results that even tentative recommendations cannot be made.
"O. tsutsugamushi" is naturally maintained in the mite population by transmission from female to its eggs (transovarial transmission), and from the eggs to larvae and then to adults (transtadial transmission). The mite larvae, called chiggers, are natural ectoparasites of rodents. Humans get infected upon accidental contact with infected chiggers. A scar-like scab called eschar is a good indicator of infection, but is not ubiquitous. The bacterium is endemic to the so-called Tsutsugamushi Triangle, a region covering the Russian Far East in the north, Japan in the east, northern Australia in the south, and Afghanistan in the west. One million infections are estimated to occur annually. Antibiotics such as azithromycin and doxycycline are the main prescription drugs; chloramphenicol and tetracyclin are also effective. Diagnosis of the infection is difficult and requires laborious techniques such as Weil–Felix test, rapid immunochromatographic test, immunofluorescence assays, and polymerase chain reaction. There is no working vaccine.
The procedure is invasive and expensive, and requires long-term expert care. Benefits for severe Tourette's are not conclusive, considering less robust effects of this surgery seen in the Netherlands. Tourette's is more common in pediatric populations, tending to remit in adulthood, so in general this would not be a recommended procedure for use on children. Because diagnosis of Tourette's is made based on a history of symptoms rather than analysis of neurological activity, it may not always be clear how to apply DBS for a particular person. Due to concern over the use of DBS in Tourette syndrome treatment, the Tourette Association of America convened a group of experts to develop recommendations guiding the use and potential clinical trials of DBS for TS.
Regardless of symptom severity, individuals with Tourette's have a normal life span. Although the symptoms may be lifelong and chronic for some, the condition is not degenerative or life-threatening. Intelligence is normal in those with Tourette's, although there may be learning disabilities. Severity of tics early in life does not predict tic severity in later life, and prognosis is generally favorable, although there is no reliable means of predicting the outcome for a particular individual. The gene or genes associated with Tourette's have not been identified, and there is no potential "cure". A higher rate of migraines than the general population and sleep disturbances are reported.
Several documentaries have attempted to portray Tourette's syndrome accurately and to advocate for greater understanding of persons with Tourette's, while others focus on sensationalizing coprolalia. The Emmy Award-winning television documentary film "I Have Tourette's but Tourette's Doesn't Have Me" was produced by HBO in conjunction with the Tourette Syndrome Association, featuring children between the ages of six and 13. It was described by the "Cincinnati Enquirer" as "the best simple overview yet of Tourette's". "John's Not Mad" (1989) and "The Boy Can't Help It" (2000) are documentaries about a young man from Scotland, who has severe Tourette's and coprolalia. "Twitch and Shout" examines a society that is quick to judge a person who strays outside the limits of conventional behavior and was nominated for an Emmy. A 2007 British documentary, "Tourette De France", followed a group of teenagers with Tourette's on a trip to Paris; many of the teenagers featured in the program had coprolalia. "Movements and Madness: Gusti Ayu" is a documentary about the struggles of a young woman with severe Tourette's in a small village in Indonesia. A 2011 BBC documentary, "Tourettes: I Swear I Can Sing", followed aspiring musician Ruth Ojadi as she explains her experience of TS and her struggle to find self-confidence in her singing.
Not everyone with Tourette's wants treatment or a "cure", especially if that means they may "lose" something else in the process. Researchers Leckman and Cohen, and former US Tourette Syndrome Association (TSA) national board member Kathryn Taubert, believe that there may be latent advantages associated with an individual's genetic vulnerability to developing Tourette syndrome, such as a heightened awareness and increased attention to detail and surroundings that may have adaptive value. There is evidence to support the clinical lore that children with "TS-only" (Tourette's in the absence of comorbid conditions) are unusually gifted: neuropsychological studies have identified advantages in children with TS-only. Children with TS-only are faster than the average for their age group on timed tests of motor coordination.
Notable individuals with Tourette syndrome are found in all walks of life, including musicians, athletes, media figures, teachers, physicians, and authors. The best-known example of a person who may have used obsessive–compulsive traits to advantage is Samuel Johnson, the 18th-century English man of letters, who likely had Tourette syndrome as evidenced by the writings of James Boswell. Johnson wrote "A Dictionary of the English Language" in 1747, and was a prolific writer, poet, and critic. Tim Howard, described by the "Chicago Tribune" as the "rarest of creatures – an American soccer hero" and by the TSA as the "most notable individual with Tourette Syndrome around the world" says that his neurological makeup gave him an enhanced perception and an ability to hyper-focus that contributed to his success on the field.