This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 | Archive 3 | → | Archive 5 |
In a few cases, complete remission occurs after adolescence, and in many cases total remission occurs after the age of 40.
I got a bit confused by this sentence: is there some technical difference between "complete remission" and "total remission" ? Perhaps the sentence should use only one of the terms. -- Ejrh 14:56, 21 Nov 2003 (UTC)
Is there any relation between aphasia and Tourette syndrome? EmRick 15:37, 24 Jun 2004 (UTC)
Being someone who has Tourette's syndrome, I think that the comparison of an urge to do a tic to an itch is not nearly as accurate as a comparison to the urge to yawn. I will make that modification, and if anyone disagrees with it, feel free to revert it. Cessen 19:58, 28 Nov 2004 (UTC)
I am suspicious of the sentence that begins "TS affects up to 1.13% of children with a wide range of severity..." There was a time when Tourette syndrome was only diagnosed when the symptoms were extreme and plainly unwanted by the patient. Lately it is a suspiciously convenient diagnosis for children, usually boys, who might sometimes enjoy swearing or self-conscious nervous habits. I am not a "spare the rod, spoil the child" type; I certainly think that adults should be patient with hyperactive children. But is Tourette syndrome really the right explanation for most of these cases? And how can it make sense to give the incidence to two decimal places; how can you know that it's up to 1.13%, and not up to 1.14% or up to 1.12%? It looks like some people are replacing parental common sense with bad science. -- Greg Kuperberg 13:46, 2 Dec 2004 (UTC)
My real concern is a drifting definition of Tourette syndrome that would weaken both Wikipedia and general public understanding. Without verifiable etiology, there can't be any consensus on how to define TS. It doesn't look like the etiology is ever confirmed, only the symptoms. In that case, just by changing the threshold of how bad the tics have to be, claiming a prevalence of 10% is as fair as claiming a prevalence of .1%. Any statement about prevalence should warn that it depends on the threshold used to define the disease.
On that note let me try to restate my previous objection. The paragraph in question goes on at length about popular misconceptions about Tourette syndrome. It has a "blame the media" tone which misses an important point: If there are popular misconceptions, they will also interfere with diagnosis. If bystanders believe that Tourette syndrome is defined as excessive swearing, then certainly there are parents who want this diagnosis in their children, and probably there are doctors who accede to these parents. The way that a condition is diagnosed does ultimately affect its definition. It is fair to say that bad movies have been irresponsible about TS. But the article should not imply that these movies stray from objective expertise, when the latter does not exist. -- Greg Kuperberg 15:26, 3 Dec 2004 (UTC)
I understand completely that Tourette syndrome exists. I have never doubted it. I believe in scientific explanations of the world and I have seen obvious cases of people with uncontrollable tics. It is only reasonable to call this Tourette syndrome. I also believe in basic human sympathy and I would be very glad if the medical community found an effective treatment for involuntary tics in general, or for specific classes of them. If you have Tourette syndrome, then really, you have my sympathy.
However, that does not mean that Tourette syndrome has a fixed, objective definition. Art, pornography, justice, and democracy also exist, but they have no fixed definition either. What would your reaction be if someone said that 1.13% of television programs are pornographic? I would hope that you would be skeptical. I would hope that you would be equally skeptical of claims that TV pornography is "underdiagnosed" or "overdiagnosed". Would that mean that you excuse pornography?
You say that, while you don't approve of overzealous parents who bend the definition of Tourette syndrome, you would prefer that to discrediting the disease entirely. How would you like both together? It is very unfortunate for sufferers of Tourette syndrome that its definition is malleable. People who try to bend the definition, often people who also deny that it can be bent, have unwittingly done the most to discredit diagnosis. Skeptics are not the problem, because there is no organized campaign against diagnosis.
For these reasons I would want the definition in Wikipedia to reflect common sense and limitations of knowledge, rather than to be officious or defensive.
-- Greg Kuperberg 15:20, 5 Dec 2004 (UTC)
I know this is an old discussion, but I just wanted to add these comments for new readers. Greg, there is one problem with your argument, which is that coprolalia is such a rare symptom, that it's not really the norm to find moms seeking diagnoses of children for swearing. (Although I also agree with you that there are far too many moms willing to attribute bad behavior to tics.) What is likely is to encounter families who have been to endless doctors, trying to understand if their child has asthma or allergies (due to coughing and sniffing), eye or vision problems (due to blinking), or epilepsy (blocking tics), as just a few examples. But, you do raise a concern shared by many about the diagnostic boundaries of the condition. Roger Freeman's blog, referenced in the article, contains a very good discussion of how "arbitrary" the definition of Tourette's is. [1] A person can have two motor tics, plus coprolalia, and be considered to have "severe" TS, because of the coprolalia. But, a person with twenty minor, less noticeable motor tics (abdominal tensing, leg tensing, slight eye blinking, small shoulder shrugs, etc.) -- but no vocal tic -- doesn't meet the diagnostic criteria. Makes no sense !! Sandy 23:08, 8 February 2006 (UTC)
In looking over this article, I did notice an emphasis on vocal tics when they're only half of the disorder; motor tics are also symptoms. They can be muscle spasms, involuntary hand gestures, or other things. I only know about this because I have Chronic Tic Disorder, which is very similar to TS, except I don't get vocal tics at all; I have involuntary muscle spasms in my upper body. I'm hesitant to make edits myself, but perhaps some information on the chronic tic disorders (which are, as my neurologist explained to me, TS, only missing one of the two types of tics, motor or vocal) and motor tics could be included.
-- a brand-new, harried and slightly confused Ealusaid
I have not been diagnosed with Tourette's Syndrome, although reading that I have done seems to indicate that I may have it. I definitely have motor tics and have in the past (and very occasionally the present) experienced motor tics -- mostly grunting, no obscenities. I was just noticing the urge-to-tic discussions, and I thought I would contribute. When I'm explaining what the tics and supression are like, I usually compare it to blinking of the eyes. You do it, but you don't know you're doing it most of the time. When you do notice it, you still do it, unless you make a conscious effort not to. In these cases, you generally follow that limited conscious-effort period with a rapid making-up-for-lost-time effect, when you blink that much more. Tics work much the same way, certainly in the motor case, and in my limited experience, the vocal as well. The yawning comparison used above is also valid, to an extent, except that one always knows when one is yawning. Oftentimes I am not aware that I am tic-cing, so I think the eye blinking comparison is the most valid that most people can relate to.
Rob
Shouldn't Howard Hughes be added to the 'famous people' list?
Some scientist think this is the genetic target that leads to the problem. [2]
The relevance of this finding is not yet clear, and there may have been some media hype surrounding the importance of the finding. [3]
Can something be decided about this site repeatedly being added to the Tourette Syndrome page? There are legions of sites using Tourette's as a joke on the internet. Should they all be added?
Hello, I just closed the AfD for "Tourette's Syndrome Plus" as a Delete, and removed links to it from this article. However, I note that it is mentioned several times in this article. Most voters in the AfD seemed to think the term was dubious and not widely accepted...if so, will someone with knowledge in this area please examine whether the references to "Tourette's Syndrome Plus" in this article are appropriate, and if not, please remove them? Thanks. Babajobu 06:45, 13 January 2006 (UTC) ---
I appreciate that you are using the talk page now. It would be helpful if you would refrain from making further major edits until consensus can be reached, as the entire article is now in dispute and out of compliance with NPOV and verifiablility. With respect to what websites should be referenced as sources, the Wikipedia offical verifiability policy may be helpful. On that basis, the TSDA website seems to comply. Although Babajobu accurately pointed out that the term "Tourette Syndrome Plus" is not widely accepted or recognized, the website itself is written by a reputable and practicing professional, and it does contain verifiably accurate medical information. The objection (with respect to Wikipedia verifiablility) is to websites not written by professionals or maintained by verifiable professional organizations or containing verifiably accurate medical information. With respect to your statements about persons and organizations (such as the TSA or individuals within the TSA), I urge you to review the Wikipedia policy on NPOV- Neutral Point of View, and the five pillars of Wikipedia. We can make better progress towards correcting this article with those policies in mind. 64.12.116.13 04:10, 3 February 2006 (UTC)
The Wikipedia entry for tics needs work, and has some information which is confusing and misleading relative to Tourette's and tic disorders. Perhaps this article can unlink from it until it improves?
It looks like a discussion is warranted. I cleaned up a lot of what was originally presented by 206.59.60.129 . I left the point the original author was making (some studies have shown some good results with Marijuana), but referenced the research, and corrected the terminology, misspellings, and grammar, while removing POV (e.g.; it is inaccurate to say the TSA did not participate in studies). But the POV is back, research links have been deleted, and the new article has numerous spelling and grammar problems along with the POV. I'm not sure if it will be helpful to try to clean it up again, or if I should revert to 17:53, 26 January 2006 .
Rxlist states about Marinol -- "This medication may cause dependence, especially if it has been used regularly for an extended period of time, or if it has been used in high doses. In such cases, if you suddenly stop this drug, withdrawal reactions may occur," and "Although it is very unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit-forming). Do not increase your dose, take it more frequently or use it for a longer period of time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted." This is but one example of information that needs to be corrected in a complete rewrite.
Kate Kompoliti is misquoted entirely. She was speaking of marijuana. The attack on her in particular is ad hominem.
The attack on the TSA is also ad hominem, baseless and unwarranted, as they did fund research and don't have the kind of control over all research funds the author implies. For example, much drug research is funded by the drug companies, and other research is often funded by the NIH. The TSA doesn't report research in its newsletters: it reports it in medical letters, and it did and does report on the marijuana research in the medical summaries.
Further, the information presented about marijuana and Marinol references the same studies. Can someone clarify what was being studied in each case? The controlled study was on cognition, not efficacy, and made no mention of efficacy. Some of the studies rely on self reports. All of the studies suffer from either small sample size, unblindedness, lack of controls, or lack of validated measurements (ie, anecdote). There are no large, controlled, blinded studies on efficacy.
The article is not written in encyclopedic tone, and the content is not proportionate. Tourette's is largely a disorder of childhood (multiple studies show that tics tend to remit as one passes through adolescence), and severe Tourette's in adulthood is an extreme rarity. While it is appreciated that an adult with severe Tourette's may claim benefit from marijuana or Marinol, it is not a useful treatment for the vast majority of persons (children) with Tourette's, and yet this information occupies a large part of the entire article. It needs to be put in proportion and encyclopedic perspective.
The article is not written in NPOV, and extends beyond relevance, as it seems to reflect more of a soapbox about marijuana than research usefulness. There is very little accurate, NPOV information in this article. Copy editing is needed. If the author is not willing to allow editing without reverts, and if these items can't be corrected without a war of reverts, then the article should be disputed.
Similar problems have been introduced by these recent edits into other sections of the Tourette Syndrome entry, so that other sections also have content which needs to be repaired or disputed.
Quite a few adults have Tourette's Syndrome. It does not go into remission for everyone. TS itself is a rarity. How do you know that Marinol is not effective for children? Do you have any evidence of that?
You are right, somebody does keep confusing the Marinol studies with the marijuana studies. I just deleted a reference to "controlled research on marijuana" that linked to two studies that were really about Marinol. There is not any controlled research on marijuana that I know of. I get the feeling the same people who claim Dr. Kompoliti was talking about marijuana (she was really talking about Marinol, just read!) are the same people getting the studies confused.
The Marinol/marijuana sections are a wild tangent of alternative medicine and the politics of illegal drugs. The material should be moved to the Marinol page and a medical marijuana page. The section should be reduced to a short statement that this is a proposed treatment of Tourette's syndrome, with links to the other pages.
I suppose that the whole treatment section simply dwells too much on on-going research and speculation. It would be a better article if the discussion started with the proven treatments, and then separately and briefly listed the unproven treatments.
Greg Kuperberg 18:34, 4 February 2006 (UTC)
Okay, I think a consensus has been reached. But for now, I won't delete the stuff on the talk page on Marinol.
Does anybody have a good reason to drastically change the paragraph on Marinol or move the paragraph to the Marinol article in the future?
(Please read my four points against drastic change and against moving the paragraph to the Marinol article before you answer the question!)
I don't think drastic changes are needed, here's why?:
The information does not belong in the Marinol article because:
Please do not continue altering the talk page. These changes significantly alter a conversation in which others have engaged, and changes the context. Sandy 20:56, 8 February 2006 (UTC)
The current entry, which started
on 26 Jan, and became an ad hominem issue about the TSA
on 28 Jan, is now in better shape, consolidated under Experimental treatments. I continue to concur with Greg, however, with respect to the Marinol entry. Neither marijuana nor Marinol are currently useful in the treatment of Tourette's, nor are they likely to become useful treatments in the near future. Reference, What Wikipedia is not -- a soapbox. The considerable contributions of Unsigned User can be moved to Marinol and marijuana. Here is my suggested wording to incorporate both Greg's and my concerns over the length and relevance of the Experimental treatments section.
Suggested wording
Nicotine showed preliminary promise in case reports, but these effects were not reproduced in well-controlled trials several years later.
[1] Studies of nicotine derivatives (
mecamylamine,
inversine) also showed that they were not effective as monotherapy for the symptoms of Tourette's.
[2]
Deep brain stimulation has been used in treating a few patients with severe Tourette's, but is regarded as an experimental and dangerous procedure that is unlikely to become widespread.
[3]
Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and
neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome.
[1]
[4] Case reports found that
marijuana helped reduce tics, but validation of these results requires longer, controlled studies on larger samples.
[5]
[6] Preliminary research on
Dronabinol, synthetic THC in pill form (brand name
Marinol®) as a treatment for Tourette's syndrome was promising, but there are concerns about the safety of Marinol, and longer, controlled studies on larger samples are needed.
[7]
[8]
[9]
Sandy 01:10, 16 February 2006 (UTC)
I deleted the following sentence as I can't understand what it says or means. "No one has proposed using the qualified criteria "the disturbance causes, or has caused, marked distress or significant impairment in social, occupational, or other important areas of functioning at some time in their life" as a compromise."
Also, the recent edits have blurred the line between symptoms and diagnosis, introducing elements of each into the other section.
The article needs a complete rewrite, as very little of what remains is an accurate medical reflection of Tourette's. It would be helpful if proposed changes were brought to the talk page for discussion.
The information above highlights the problem with unreliable sources.
So, we find current estimates ranging from 5 per 10,000 to 115 per 10,000 if we actually review the current research. All of these studies reflect different issues of methodology, clinical ascertainment, differing diagnostic criteria, and method of observation. Presenting an absolute number can be misleading in the face of so much difference. All of these, but in particular the large, community-based samples (Kurlan 2001 and Khalifa 2003) suggest that the prevalance of Tourette's is much higher than previously reported. Both Kurlan and Khalifa used DSM-IV, which included the significant impairment criteria, which has since been dropped. None of these sources used DSM-IV-TR, so actual numbers using the current diagnostic criteria could be even higher. Some "official" sources still quote the older numbers, based on older research, and some layperson's websites have parroted those numbers without reading the research. A full discussion of the newer data is warranted, particularly since it appears that none of the standard "official" sources are reporting these numbers on their webpages. Nonetheless, all of the current literature includes wording to the effect that Touertte's syndrome is no longer considered to be a rare disorder. Sandy 22:14, 3 February 2006 (UTC)
Malraux certainly had TS. Many books on Malraux say so... I put the link in to cite a biography that mentions his TS, but if the link is somehow offensive, feel free to delete it. But Malraux did have TS.
Perhaps what is wrong with this page is that the treatment section should be more in depth. I think a subsection on beta-blockers, and perhaps stimulants, are warrented.
If other people have something to add to the beta-blockers section, please do! The citation I used is an article from the Tourette's Foundation of Canada, so I don't think anybody will have a problem with that source.
This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page. |
Archive 1 | Archive 2 | Archive 3 | → | Archive 5 |
In a few cases, complete remission occurs after adolescence, and in many cases total remission occurs after the age of 40.
I got a bit confused by this sentence: is there some technical difference between "complete remission" and "total remission" ? Perhaps the sentence should use only one of the terms. -- Ejrh 14:56, 21 Nov 2003 (UTC)
Is there any relation between aphasia and Tourette syndrome? EmRick 15:37, 24 Jun 2004 (UTC)
Being someone who has Tourette's syndrome, I think that the comparison of an urge to do a tic to an itch is not nearly as accurate as a comparison to the urge to yawn. I will make that modification, and if anyone disagrees with it, feel free to revert it. Cessen 19:58, 28 Nov 2004 (UTC)
I am suspicious of the sentence that begins "TS affects up to 1.13% of children with a wide range of severity..." There was a time when Tourette syndrome was only diagnosed when the symptoms were extreme and plainly unwanted by the patient. Lately it is a suspiciously convenient diagnosis for children, usually boys, who might sometimes enjoy swearing or self-conscious nervous habits. I am not a "spare the rod, spoil the child" type; I certainly think that adults should be patient with hyperactive children. But is Tourette syndrome really the right explanation for most of these cases? And how can it make sense to give the incidence to two decimal places; how can you know that it's up to 1.13%, and not up to 1.14% or up to 1.12%? It looks like some people are replacing parental common sense with bad science. -- Greg Kuperberg 13:46, 2 Dec 2004 (UTC)
My real concern is a drifting definition of Tourette syndrome that would weaken both Wikipedia and general public understanding. Without verifiable etiology, there can't be any consensus on how to define TS. It doesn't look like the etiology is ever confirmed, only the symptoms. In that case, just by changing the threshold of how bad the tics have to be, claiming a prevalence of 10% is as fair as claiming a prevalence of .1%. Any statement about prevalence should warn that it depends on the threshold used to define the disease.
On that note let me try to restate my previous objection. The paragraph in question goes on at length about popular misconceptions about Tourette syndrome. It has a "blame the media" tone which misses an important point: If there are popular misconceptions, they will also interfere with diagnosis. If bystanders believe that Tourette syndrome is defined as excessive swearing, then certainly there are parents who want this diagnosis in their children, and probably there are doctors who accede to these parents. The way that a condition is diagnosed does ultimately affect its definition. It is fair to say that bad movies have been irresponsible about TS. But the article should not imply that these movies stray from objective expertise, when the latter does not exist. -- Greg Kuperberg 15:26, 3 Dec 2004 (UTC)
I understand completely that Tourette syndrome exists. I have never doubted it. I believe in scientific explanations of the world and I have seen obvious cases of people with uncontrollable tics. It is only reasonable to call this Tourette syndrome. I also believe in basic human sympathy and I would be very glad if the medical community found an effective treatment for involuntary tics in general, or for specific classes of them. If you have Tourette syndrome, then really, you have my sympathy.
However, that does not mean that Tourette syndrome has a fixed, objective definition. Art, pornography, justice, and democracy also exist, but they have no fixed definition either. What would your reaction be if someone said that 1.13% of television programs are pornographic? I would hope that you would be skeptical. I would hope that you would be equally skeptical of claims that TV pornography is "underdiagnosed" or "overdiagnosed". Would that mean that you excuse pornography?
You say that, while you don't approve of overzealous parents who bend the definition of Tourette syndrome, you would prefer that to discrediting the disease entirely. How would you like both together? It is very unfortunate for sufferers of Tourette syndrome that its definition is malleable. People who try to bend the definition, often people who also deny that it can be bent, have unwittingly done the most to discredit diagnosis. Skeptics are not the problem, because there is no organized campaign against diagnosis.
For these reasons I would want the definition in Wikipedia to reflect common sense and limitations of knowledge, rather than to be officious or defensive.
-- Greg Kuperberg 15:20, 5 Dec 2004 (UTC)
I know this is an old discussion, but I just wanted to add these comments for new readers. Greg, there is one problem with your argument, which is that coprolalia is such a rare symptom, that it's not really the norm to find moms seeking diagnoses of children for swearing. (Although I also agree with you that there are far too many moms willing to attribute bad behavior to tics.) What is likely is to encounter families who have been to endless doctors, trying to understand if their child has asthma or allergies (due to coughing and sniffing), eye or vision problems (due to blinking), or epilepsy (blocking tics), as just a few examples. But, you do raise a concern shared by many about the diagnostic boundaries of the condition. Roger Freeman's blog, referenced in the article, contains a very good discussion of how "arbitrary" the definition of Tourette's is. [1] A person can have two motor tics, plus coprolalia, and be considered to have "severe" TS, because of the coprolalia. But, a person with twenty minor, less noticeable motor tics (abdominal tensing, leg tensing, slight eye blinking, small shoulder shrugs, etc.) -- but no vocal tic -- doesn't meet the diagnostic criteria. Makes no sense !! Sandy 23:08, 8 February 2006 (UTC)
In looking over this article, I did notice an emphasis on vocal tics when they're only half of the disorder; motor tics are also symptoms. They can be muscle spasms, involuntary hand gestures, or other things. I only know about this because I have Chronic Tic Disorder, which is very similar to TS, except I don't get vocal tics at all; I have involuntary muscle spasms in my upper body. I'm hesitant to make edits myself, but perhaps some information on the chronic tic disorders (which are, as my neurologist explained to me, TS, only missing one of the two types of tics, motor or vocal) and motor tics could be included.
-- a brand-new, harried and slightly confused Ealusaid
I have not been diagnosed with Tourette's Syndrome, although reading that I have done seems to indicate that I may have it. I definitely have motor tics and have in the past (and very occasionally the present) experienced motor tics -- mostly grunting, no obscenities. I was just noticing the urge-to-tic discussions, and I thought I would contribute. When I'm explaining what the tics and supression are like, I usually compare it to blinking of the eyes. You do it, but you don't know you're doing it most of the time. When you do notice it, you still do it, unless you make a conscious effort not to. In these cases, you generally follow that limited conscious-effort period with a rapid making-up-for-lost-time effect, when you blink that much more. Tics work much the same way, certainly in the motor case, and in my limited experience, the vocal as well. The yawning comparison used above is also valid, to an extent, except that one always knows when one is yawning. Oftentimes I am not aware that I am tic-cing, so I think the eye blinking comparison is the most valid that most people can relate to.
Rob
Shouldn't Howard Hughes be added to the 'famous people' list?
Some scientist think this is the genetic target that leads to the problem. [2]
The relevance of this finding is not yet clear, and there may have been some media hype surrounding the importance of the finding. [3]
Can something be decided about this site repeatedly being added to the Tourette Syndrome page? There are legions of sites using Tourette's as a joke on the internet. Should they all be added?
Hello, I just closed the AfD for "Tourette's Syndrome Plus" as a Delete, and removed links to it from this article. However, I note that it is mentioned several times in this article. Most voters in the AfD seemed to think the term was dubious and not widely accepted...if so, will someone with knowledge in this area please examine whether the references to "Tourette's Syndrome Plus" in this article are appropriate, and if not, please remove them? Thanks. Babajobu 06:45, 13 January 2006 (UTC) ---
I appreciate that you are using the talk page now. It would be helpful if you would refrain from making further major edits until consensus can be reached, as the entire article is now in dispute and out of compliance with NPOV and verifiablility. With respect to what websites should be referenced as sources, the Wikipedia offical verifiability policy may be helpful. On that basis, the TSDA website seems to comply. Although Babajobu accurately pointed out that the term "Tourette Syndrome Plus" is not widely accepted or recognized, the website itself is written by a reputable and practicing professional, and it does contain verifiably accurate medical information. The objection (with respect to Wikipedia verifiablility) is to websites not written by professionals or maintained by verifiable professional organizations or containing verifiably accurate medical information. With respect to your statements about persons and organizations (such as the TSA or individuals within the TSA), I urge you to review the Wikipedia policy on NPOV- Neutral Point of View, and the five pillars of Wikipedia. We can make better progress towards correcting this article with those policies in mind. 64.12.116.13 04:10, 3 February 2006 (UTC)
The Wikipedia entry for tics needs work, and has some information which is confusing and misleading relative to Tourette's and tic disorders. Perhaps this article can unlink from it until it improves?
It looks like a discussion is warranted. I cleaned up a lot of what was originally presented by 206.59.60.129 . I left the point the original author was making (some studies have shown some good results with Marijuana), but referenced the research, and corrected the terminology, misspellings, and grammar, while removing POV (e.g.; it is inaccurate to say the TSA did not participate in studies). But the POV is back, research links have been deleted, and the new article has numerous spelling and grammar problems along with the POV. I'm not sure if it will be helpful to try to clean it up again, or if I should revert to 17:53, 26 January 2006 .
Rxlist states about Marinol -- "This medication may cause dependence, especially if it has been used regularly for an extended period of time, or if it has been used in high doses. In such cases, if you suddenly stop this drug, withdrawal reactions may occur," and "Although it is very unlikely to occur, this medication can also result in abnormal drug-seeking behavior (addiction/habit-forming). Do not increase your dose, take it more frequently or use it for a longer period of time than prescribed. Properly stop the medication when so directed. This will lessen the chances of becoming addicted." This is but one example of information that needs to be corrected in a complete rewrite.
Kate Kompoliti is misquoted entirely. She was speaking of marijuana. The attack on her in particular is ad hominem.
The attack on the TSA is also ad hominem, baseless and unwarranted, as they did fund research and don't have the kind of control over all research funds the author implies. For example, much drug research is funded by the drug companies, and other research is often funded by the NIH. The TSA doesn't report research in its newsletters: it reports it in medical letters, and it did and does report on the marijuana research in the medical summaries.
Further, the information presented about marijuana and Marinol references the same studies. Can someone clarify what was being studied in each case? The controlled study was on cognition, not efficacy, and made no mention of efficacy. Some of the studies rely on self reports. All of the studies suffer from either small sample size, unblindedness, lack of controls, or lack of validated measurements (ie, anecdote). There are no large, controlled, blinded studies on efficacy.
The article is not written in encyclopedic tone, and the content is not proportionate. Tourette's is largely a disorder of childhood (multiple studies show that tics tend to remit as one passes through adolescence), and severe Tourette's in adulthood is an extreme rarity. While it is appreciated that an adult with severe Tourette's may claim benefit from marijuana or Marinol, it is not a useful treatment for the vast majority of persons (children) with Tourette's, and yet this information occupies a large part of the entire article. It needs to be put in proportion and encyclopedic perspective.
The article is not written in NPOV, and extends beyond relevance, as it seems to reflect more of a soapbox about marijuana than research usefulness. There is very little accurate, NPOV information in this article. Copy editing is needed. If the author is not willing to allow editing without reverts, and if these items can't be corrected without a war of reverts, then the article should be disputed.
Similar problems have been introduced by these recent edits into other sections of the Tourette Syndrome entry, so that other sections also have content which needs to be repaired or disputed.
Quite a few adults have Tourette's Syndrome. It does not go into remission for everyone. TS itself is a rarity. How do you know that Marinol is not effective for children? Do you have any evidence of that?
You are right, somebody does keep confusing the Marinol studies with the marijuana studies. I just deleted a reference to "controlled research on marijuana" that linked to two studies that were really about Marinol. There is not any controlled research on marijuana that I know of. I get the feeling the same people who claim Dr. Kompoliti was talking about marijuana (she was really talking about Marinol, just read!) are the same people getting the studies confused.
The Marinol/marijuana sections are a wild tangent of alternative medicine and the politics of illegal drugs. The material should be moved to the Marinol page and a medical marijuana page. The section should be reduced to a short statement that this is a proposed treatment of Tourette's syndrome, with links to the other pages.
I suppose that the whole treatment section simply dwells too much on on-going research and speculation. It would be a better article if the discussion started with the proven treatments, and then separately and briefly listed the unproven treatments.
Greg Kuperberg 18:34, 4 February 2006 (UTC)
Okay, I think a consensus has been reached. But for now, I won't delete the stuff on the talk page on Marinol.
Does anybody have a good reason to drastically change the paragraph on Marinol or move the paragraph to the Marinol article in the future?
(Please read my four points against drastic change and against moving the paragraph to the Marinol article before you answer the question!)
I don't think drastic changes are needed, here's why?:
The information does not belong in the Marinol article because:
Please do not continue altering the talk page. These changes significantly alter a conversation in which others have engaged, and changes the context. Sandy 20:56, 8 February 2006 (UTC)
The current entry, which started
on 26 Jan, and became an ad hominem issue about the TSA
on 28 Jan, is now in better shape, consolidated under Experimental treatments. I continue to concur with Greg, however, with respect to the Marinol entry. Neither marijuana nor Marinol are currently useful in the treatment of Tourette's, nor are they likely to become useful treatments in the near future. Reference, What Wikipedia is not -- a soapbox. The considerable contributions of Unsigned User can be moved to Marinol and marijuana. Here is my suggested wording to incorporate both Greg's and my concerns over the length and relevance of the Experimental treatments section.
Suggested wording
Nicotine showed preliminary promise in case reports, but these effects were not reproduced in well-controlled trials several years later.
[1] Studies of nicotine derivatives (
mecamylamine,
inversine) also showed that they were not effective as monotherapy for the symptoms of Tourette's.
[2]
Deep brain stimulation has been used in treating a few patients with severe Tourette's, but is regarded as an experimental and dangerous procedure that is unlikely to become widespread.
[3]
Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and
neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome.
[1]
[4] Case reports found that
marijuana helped reduce tics, but validation of these results requires longer, controlled studies on larger samples.
[5]
[6] Preliminary research on
Dronabinol, synthetic THC in pill form (brand name
Marinol®) as a treatment for Tourette's syndrome was promising, but there are concerns about the safety of Marinol, and longer, controlled studies on larger samples are needed.
[7]
[8]
[9]
Sandy 01:10, 16 February 2006 (UTC)
I deleted the following sentence as I can't understand what it says or means. "No one has proposed using the qualified criteria "the disturbance causes, or has caused, marked distress or significant impairment in social, occupational, or other important areas of functioning at some time in their life" as a compromise."
Also, the recent edits have blurred the line between symptoms and diagnosis, introducing elements of each into the other section.
The article needs a complete rewrite, as very little of what remains is an accurate medical reflection of Tourette's. It would be helpful if proposed changes were brought to the talk page for discussion.
The information above highlights the problem with unreliable sources.
So, we find current estimates ranging from 5 per 10,000 to 115 per 10,000 if we actually review the current research. All of these studies reflect different issues of methodology, clinical ascertainment, differing diagnostic criteria, and method of observation. Presenting an absolute number can be misleading in the face of so much difference. All of these, but in particular the large, community-based samples (Kurlan 2001 and Khalifa 2003) suggest that the prevalance of Tourette's is much higher than previously reported. Both Kurlan and Khalifa used DSM-IV, which included the significant impairment criteria, which has since been dropped. None of these sources used DSM-IV-TR, so actual numbers using the current diagnostic criteria could be even higher. Some "official" sources still quote the older numbers, based on older research, and some layperson's websites have parroted those numbers without reading the research. A full discussion of the newer data is warranted, particularly since it appears that none of the standard "official" sources are reporting these numbers on their webpages. Nonetheless, all of the current literature includes wording to the effect that Touertte's syndrome is no longer considered to be a rare disorder. Sandy 22:14, 3 February 2006 (UTC)
Malraux certainly had TS. Many books on Malraux say so... I put the link in to cite a biography that mentions his TS, but if the link is somehow offensive, feel free to delete it. But Malraux did have TS.
Perhaps what is wrong with this page is that the treatment section should be more in depth. I think a subsection on beta-blockers, and perhaps stimulants, are warrented.
If other people have something to add to the beta-blockers section, please do! The citation I used is an article from the Tourette's Foundation of Canada, so I don't think anybody will have a problem with that source.