Talk:Tourette syndrome: Difference between revisions

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	:::::::: No assumptions here. I don't know your name, but need to call your something, since you don't sign your entries, and that's what your IP address gives me. I made no statements about your agreement or not with Comings. You made statements about the TSA which are easily checked and refuted by reading Comings' second book, where he describes the conflict in his own words and includes all of the referenced literature. But I got copies of the literature myself, just to be sure. I don't believe that Lowe has served on the MAB for several years, and I urge you not to make this about personalities, rather stick to the actual research. (I may agree with you on Lowe ... but personalities should have no place in this discussion :-) Please try to account for the strength in numbers on the MAB and SAB: even though some individuals, policies, and politics can certainly be problematic, it's a large advisory board, which increases the chance they'll get some things right. Occasionally. ] 02:24, 4 February 2006 (UTC)		:::::::: No assumptions here. I don't know your name, but need to call your something, since you don't sign your entries, and that's what your IP address gives me. I made no statements about your agreement or not with Comings. You made statements about the TSA which are easily checked and refuted by reading Comings' second book, where he describes the conflict in his own words and includes all of the referenced literature. But I got copies of the literature myself, just to be sure. I don't believe that Lowe has served on the MAB for several years, and I urge you not to make this about personalities, rather stick to the actual research. (I may agree with you on Lowe ... but personalities should have no place in this discussion :-) Please try to account for the strength in numbers on the MAB and SAB: even though some individuals, policies, and politics can certainly be problematic, it's a large advisory board, which increases the chance they'll get some things right. Occasionally. ] 02:24, 4 February 2006 (UTC)
	:::::::::I don't want to make this about personalities. Still, I don't think we should be scared to mention the name of an expert like Dr. Comings or Dr. Lowe just because you and I may disagree with them. Don't you think the article should say that there are some experts who still think you should not perscribe stimulants? For the sake of being neutral?		:::::::::I don't want to make this about personalities. Still, I don't think we should be scared to mention the name of an expert like Dr. Comings or Dr. Lowe just because you and I may disagree with them. Don't you think the article should say that there are some experts who still think you should not perscribe stimulants? For the sake of being neutral?
			::::::::::I think this article is getting too long, and if we want to talk about personalities or beliefs, perhaps you will feel free to make entries to my talk page instead of here? Maybe that will help us come to consensus sooner? When we get to fixing the treatment section, absolutely, the controversy about stimulants will be mentioned, in the context of the research, not the personalities. I would never do otherwise.

	::I added a link to the Tourette's Syndrome Spectrum Disorder Association. I don't think anybody will object to this, since it is an organization.		::I added a link to the Tourette's Syndrome Spectrum Disorder Association. I don't think anybody will object to this, since it is an organization.

Revision as of 02:41, 4 February 2006

I took the link to the nicotine page to read about this substance as this article on Tourette Syndrome says that physicians caution against using it to treat Tourette's because of its carcinogenic traits. However, the nicotine page states in its introduction that the substance is not carcinogenic. An inconsistency of 'fact'-stating that perhaps should be cleared up?

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)

Both are treated very accessibly in The man who mistook his wife for a hat. I recommend this book, especially if you're interested in either of those conditions. I don't think Dr. Sacks mentioned any connection, but I may have missed it.--Polyparadigm 22:35, 12 Mar 2005 (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)

Thank you! This is the sort of contribution that makes Misplaced Pages invaluable. Welcome to Misplaced Pages. -- Karada 21:50, 28 Nov 2004 (UTC)

Well, it seems that people with TS have different descriptions for their Tics. As someone from the trenchs :) (having TS too) I would rather describe it as an urge to blinking the eyes, you can do with a yawn, but you can't do with a blink, I remember when being a shild, my first tic has been excessive blinking.

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)

I can't say I care for your point of view on the matter - whether or not you agree with doctors' diagnoses, or people's parenting methods, has really no bearing on this article or its merits whatsoever. However, you do raise a legitimate point - the figure of 1.13% does sound suspiciously precise to be altogether correct. I'm no statistician, but I don't think I've ever heard of a medical condition being pinpointed down to two decimal places in diagnosis. Can anybody verify/correct this figure based on recent evidence please? - Vaelor 14:37, 3 Dec 2004 (UTC)

My real concern is a drifting definition of Tourette syndrome that would weaken both Misplaced Pages 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)

Greg, I can't even begin to relate to this opinion, so forgive me if I don't address it directly for fear I'd just end up saying something ignorant and offensive and possibly starting a flame war. In short though, granted, the only way at this time to diagnose Tourette's is per assessment of the symptoms, and as a result, this can lead to incorrect diagnoses, to both ends of the scale.

The phrase "incorrect diagnosis" implies that there is some way to decide, in principle, whether or not a diagnosis is correct. There isn't. People are no closer to deciding what is or is not Tourette syndrome than they are to deciding what is or is not art, what is or is not pornography, or what is or is not justice. Maybe one day people will give "Tourette syndrome" a relatively precise meaning; or maybe not. --Greg Kuperberg 17:15, 4 Dec 2004 (UTC)

It sounds to me like you're not so much concerned about the information in this article about Tourette's Syndrome being accurate, but more that apparently, because a scientific method of officially diagnosing TS - something concrete, like a CAT scan or x-ray, some kind of hard evidence - hasn't been discovered yet, that must mean Tourette's doesn't exist. I'm no doctor or scientist, but as far as I'm concerned, they know what causes TS, they know what the symptoms of TS are, they know how to medicate it, and as of February, it looks like they now know how to cure it. So frankly, though a more concrete method of proving a diagnosis might make for more reliable information on the syndrome being available to the public and help counteract the unusually high levels of ignorance surrounding the syndrome compared to say, Down Syndrome or Parkinson's Disease, I don't see from where I stand that coming up with a more scientific way of diagnosing the syndrome on paper is anywhere as important as coming up with effective means to combat the symptoms.

Personally, from where I'm standing, if I had to choose between research dollars going towards scientifically proving that I have Tourette's Syndrome on paper, or not almost biting off my own tongue in the morning when my tics go into overdrive after having been dormant for the few hours sleep I managed to get in, I'd choose the latter. Because whether one would require a certain "level of symptoms" to be present in order to be "officially diagnosed" with TS, or whether one doctor calls it Tourette's when another would call it something else, or whether there really is no such thing as TS and the symptoms are just the result of a combination of other problems, whatever the case may be, the symptoms are real, and they can be very disruptive. Believe me, I don't approve of overzealous parents claiming their kid has Tourette's just because he actually has ADHD and won't stop yelling swear words, but in my humble opinion, better that than have the syndrome discredited entirely, and have thousands of people who need treatment be told that they're just schizophrenic, or attention seekers, or need "the Devil driven out of them". Remember, there was a time when we didn't know how to scientifically identify cancer, or Multiple Sclerosis, or Alzheimer's Disease, or prove that the world actually isn't flat, and the sun doesn't revolve around it, but these things were studied and proven with time. Just because mankind hasn't discovered something yet, doesn't mean it's undiscoverable. - Vaelor 14:31, 5 Dec 2004 (UTC)

In my extensive experience though, I've found that more doctors are inclined to misdiagnose that somebody does not have Tourette's Syndrome when in fact they do, than vice versa. However, this could of course be different in other parts of the world. As for the article, it states that some movies imply that the only symptom of TS is coprolalia, which is not the case, hence I see nothing incorrect about the statement. If you have contrasting factual information to provide, then please feel free to edit the article - that's what Misplaced Pages is all about, after all. - Vaelor 16:06, 4 Dec 2004 (UTC)

Tourette syndrome does exist, but...

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 Misplaced Pages to reflect common sense and limitations of knowledge, rather than to be officious or defensive.

--Greg Kuperberg 15:20, 5 Dec 2004 (UTC)

Oh, on that point, I couldn't agree with you more. I said from the first moment you brought the point of the statistic up here that I agreed it seemed suspicious, and if you or anybody else can find a more accurate way to word that sentence, I for one would appreciate it. I didn't think much of it when I first came across it, but 1.13% does sound to me like a number somebody just made up.

I agree with you on the definitions issue also, but as I said, these things take time. Art, pornography, justice, democracy - these are subjective concepts, and will doubtless always remain open to opinion and interpretation. Though I see the connection you're trying to draw, I think that putting Tourette's Syndrome in the same category is a little inaccurate. One might phrase the question, "What is art?" and get a dozen highly contrasting answers from as many people, as diverse as if you asked the question "How do you measure/define art?". However, the question "What is Tourette's Syndrome?" is a simple black and white question with a straight answer available - although there will still be the grey area when you come to "How do you measure/define Tourette's Syndrome?". What Tourette's Syndrome is, is no more a matter of opinion than what cancer is, or what diabetes is. However, a definitive scientific way of measuring and solidly identifying the syndrome in the human body has not been discovered yet. Neither has a cure for cancer, but that doesn't mean the medical community is going to give up and concede that there's no such thing. Unlike art, pornography, justice, democracy, and other such subjective concepts, a scientific method of definitively identifying Tourette's Syndrome in the human brain will be discovered eventually, I'm sure. However, until that has been done, you're right, information on Tourette's Syndrome such as this Misplaced Pages article probably shouldn't make claims as to statistics of diagnoses without some form of proof or explanation as to what method of measurement produced that figure. - Vaelor 14:05, 6 Dec 2004 (UTC)

I did some hunting and some Googling, and I can't seem to find that 1.13% figure anywhere.

The fact sheet from NIH has a much more realistic estimate of the number affected, and I'm going to update it in a bit to reflect that figure instead.

Carrie 16:40, 5 Feb 2005 (UTC)

Motor tics and Chronic Tic Disorders?

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 agree that we could stand to expand on the motor tics involved. The article's getting a bit top-heavy, though -- perhaps a new section explaining the types of tics and dividing it into vocal, motor, and complex?

Carrie 7 July 2005 23:01 (UTC)

Shouldn't Howard Hughes be added to the 'famous people' list?

I thought he had OCD, not TS. The wiki for Howard Hughes makes no mention of TS. If you have proof he had it, sure it can be added in.

Carrie 7 July 2005 23:01 (UTC)

No, Howard Hughes had OCD Obsessive compulsive disorder it's closely related (they both share the obsessive aspect), but they are not the same syndrom.

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

Yes as someone with TS, I would qualify the urge to Tic exactly the same way. It can be compared to blinking, although I would say that Ticing is oftem more conscious that blinking. Oddly and at least for me, Ticing IS voluntary, I can supress it (for a limited amount of time), although this require a lot of mental effort from me.

chromosome 13, SLITRK1 gene the cause?

Some scientist think this is the genetic target that leads to the problem.

The relevance of this finding is not yet clear, and there may have been some media hype surrounding the importance of the finding.

tourettes guy

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?

"Tourette's Syndrome Plus"

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) ---

Tourette's Syndrome Plus is an informative website on Tourette's Syndrome plus its' many comorbid conditions. I am going to put a link to it in the external links section.

Please use the colon to separate your comments from the previous comments of others. Also, please stop deleting previous talk entries. The talk page is used to reach consensus and to discuss entries, and by deleting previous talk entries, consensus becomes more difficult. The TS plus website is an informative website, but its addition seems to open the door to Wiki becoming a DMOZ category. Should every personal website about TS be added? The "TS Plus" site is one of very few personal websites which is actually written by a practicing professional. In the same vein, should every "famous person" who ever claimed that an outburst was Tourettic be added?

I did not delete any previous talk entries on this topic. However, you are not my master.

It appears that you may have, indadvertently or otherwise, overwritten previous talk comments, which have now been restored. 152.163.100.13 15:51, 3 February 2006 (UTC)

There should be links to other organizations, not just the Tourette's Syndrome Association. The TSA does not own this article or this website! They are also not the only charity for TS!

The TS Plus website is mostly written by one individual, but the information is basically accurate. It is not an advertisement of her services, it just has good information! It is absurd to limit links only to websites maintained by organizations! It is better to link to websites which have accurate information.

There should not be links to personal websites written by laypersons who do not maintain updated websites, which include POV and which use dubious credentials. For example, a link to a site signed by a "PhD" which is not a legitimate accredited PhD could mislead readers. Wiki is an encyclopedia, not a search engine. I believe that adding links to sites written by actual practicing professionals could be a reasonable compromise. So, if you agree, we can delete the Tourette's Disorder website, and leave the TS Plus website.

No they should both be posted. The TSA does not control this website, and the TSA has had a dubious past. It is a well known fact that the TSA denied the fact that ADHD and OCD were comorbid conditions for as long as they possibly could. They tried to unsuccessfully discredit Dr. Comings. The TSA does not ike people who disagree with them. The TSA is NOT an OBJECTIVE resource on TS!

Faults aside, the TSA (and its Medical Advisory Board) is the prevailing authority on Tourette's syndrome. The TSA did not deny that ADHD and/or OCD were comorbid conditions. Comorbid does not equal genetic linkage. Valid research by Tourette Syndrome researchers shows that the hypothesized genetic linkage between ADHD and TS is controversial and unclear, while the linkage to OCD is more widely recognized. Many researchers disputed Comings' claims about linkage to other disorders, symptoms, and conditions. I concur that the TSA was wrong to have involved itself in that scientific controversy. 152.163.100.13 15:51, 3 February 2006 (UTC)

These are all arbitrary statements that you have not backed up with any references at all! If you really want to get into the debate over ADHD and/or the debate about the use of stimulants in treating Tourette's, that's another can of worms! That debate itself could warrent another section in the article!

It would not be hard to state the facts as known. There is some evidence that some forms of TS may be associated with ADHD, and there is some evidence that TS is not genetically linked to ADHD at all. There is no clear consensus in either direction, and controversy remains. Easy. While there remains some concern about using stimulants in the treatment of tic disorders, there is abundant, replicated medical evidence supporting the use of stimulants in the presence of tic disorders, and showing that stimulants do not increase tics any more than placebo does. However, the issue with Comings was quite different, as he extended the boundaries of Tourette's beyond the common co-occurring conditions of ADHD and OCD, to include such items as sexual deviation. Sandy 22:26, 3 February 2006 (UTC)

Sandy, you make a lot of assumptions. First of all, why do you assume my name is Toluca? Second, why do you assume I agree with Dr. Comings? I beleive Dr. Comings was a pioneer is proving that OCD and ADHD are typical comorbid conditions, and that it is okay to use stimulants for people who have TS and ADHD. I also agree that Dr. Comings stretched the comorbid thing too far. I especially agree with you on the stimulants issue. Unfortunately, some TS experts, like Dr. Thomas Lowe, on the TSA MAB, still think you should never perscribe stimulates to people with Tourette's. But it looks like we have found something that we agree on!

No assumptions here. I don't know your name, but need to call your something, since you don't sign your entries, and that's what your IP address gives me. I made no statements about your agreement or not with Comings. You made statements about the TSA which are easily checked and refuted by reading Comings' second book, where he describes the conflict in his own words and includes all of the referenced literature. But I got copies of the literature myself, just to be sure. I don't believe that Lowe has served on the MAB for several years, and I urge you not to make this about personalities, rather stick to the actual research. (I may agree with you on Lowe ... but personalities should have no place in this discussion :-) Please try to account for the strength in numbers on the MAB and SAB: even though some individuals, policies, and politics can certainly be problematic, it's a large advisory board, which increases the chance they'll get some things right. Occasionally. Sandy 02:24, 4 February 2006 (UTC)

I don't want to make this about personalities. Still, I don't think we should be scared to mention the name of an expert like Dr. Comings or Dr. Lowe just because you and I may disagree with them. Don't you think the article should say that there are some experts who still think you should not perscribe stimulants? For the sake of being neutral?

I think this article is getting too long, and if we want to talk about personalities or beliefs, perhaps you will feel free to make entries to my talk page instead of here? Maybe that will help us come to consensus sooner? When we get to fixing the treatment section, absolutely, the controversy about stimulants will be mentioned, in the context of the research, not the personalities. I would never do otherwise.

I added a link to the Tourette's Syndrome Spectrum Disorder Association. I don't think anybody will object to this, since it is an organization.

Being a valid organization is not a reason to add a link. Does it contribute new information to the topic? Misplaced Pages is not a suppository of website links. 152.163.100.13 15:51, 3 February 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 Misplaced Pages 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 Misplaced Pages 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 Misplaced Pages policy on NPOV- Neutral Point of View, and the five pillars of Misplaced Pages. We can make better progress towards correcting this article with those policies in mind. 64.12.116.13 04:10, 3 February 2006 (UTC)

"tics"

The Misplaced Pages 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?

Marinol

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 .

It seems that the POV is confusing Marijuana for Marinol, and even misquoted Dr. Kompoliti. Therefore two subsections on Marijuana and Marinol are needed.

And I disagree with the person who claims this topic only warrents two or three sentences -- the same person who tried to delete the entire section on THC and Tourette's!

Thankfully, a sysop RoyBoy, reposted that section!

I think someone is intentionally spreading misinformation. I just deleted a reference that claimed a study showed that marijuana increased tension in TS patients; when the study cited was actually a study on treating TS with Methadone! Methadone is not the same thing as Marijuana or Marinol.

Please do not delete previous talk entries, as that defeats the purpose of the talk page. Also, please include colons to delineate your comments from others' comments. I am hoping the original author of the first marijuana entry will read the Wiki guidelines about writing an NPOV article and using the talk page for reaching consensus. Several edits were made to preserve the point being made about marijuana while doing some necessary editing to the information presented, which as presented, was very hard to follow. If there is any confusion or misinformation, it may be because the original information presented was difficult to follow. This entry has grown beyond an encyclopedic entry. When multiple attempts at editing and requests to use the talk page are met with no response, a revert is the expected outcome. It would be very helpful if the original author would use the talk page to reach consensus. The article now has so much POV that the page could be disputed.

Reading the simplified Wiki ruleset may be helpful. In particular, assume good faith (rather than assuming someone is intentionally spreading misinformation.)

I do not think anybody objects to the current edits to the Marinol information. It seems fine to just put the marijuana studies in the treatment section.

I can't concur with the above statement. The entire section needs a rewrite, to bring it back into compliance with NPOV, verifiability, importance, encyclopedic content, relevance, and it needs copy editing. As stands, the recent edits to the Tourette's entry have taken the page out of compliance with Misplaced Pages pillars. However, I have temporarily given up on trying to edit the article, but am encouraged that the talk page is now being used, so that hopefully consensus can be reached before any more major edits are made. 64.12.116.13 04:16, 3 February 2006 (UTC)

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.

There is a difference between addiction and dependance. Here is the link to rxlist, I will let people read it themselves, once again!

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.

No, Kate Kompoliti was NOT speaking about marijuana, she was speaking about Marinol! Just follow the link to the newsletter and read it for yourself!

Here is the exact quote: "Anecdotal reports, a retrospective survey and a pilot study have suggested a beneficial influence of smoking marijuana on tics and associated behavioral disorders in TS. Most of the reported findings are very preliminary, and need to be confirmed in a much larger and more rigorously designed study. Additionally, this substance is addictive and we suspect that its chronic use causes cognitive impairment, and may be harmful to executive functions and cause selective short-term memory deficits." I urge you to refrain from further editing of the article until a neutral party and copy editor can review and contribute. 205.188.112.22 17:23, 3 February 2006 (UTC)

You are quoting her out of context. Here is the link. Let people read it for themselves!

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?

When you contribute an entry to Misplaced Pages, the burden is on you to provide the research to back it up. Do you have evidence that Marinol is effective for children, or even for adults? No, because there is none, yet. 205.188.112.22 17:23, 3 February 2006 (UTC)

I believe the article does link to several preliminary studies on the effectiveness of Marinol. Let people read the links themselves!

You made the claim that Marinol is "not effective in children" so the burden of proof is on you. The article does not claim Marinol is useful for TS.

I see no statement made above that "Marinol is not effective in children." There are no large, long-term, well-controlled studies showing efficacy in children or adults. If the claim is not being made that Marinol is useful for Tourette's, than exactly what is the controversy and conversation about ? Sandy 22:19, 3 February 2006 (UTC)

TS itself is not rare. It is a fairly common disorder occurring in childhood, and current prevalence estimates do not show it to be rare. It was once thought to be rare. That is no longer the case. Yes, quite a few adults do have severe TS, and the point you are attempting to make about marijuana and past mistakes by the TSA is appreciated. However, you are not going about making your point in the correct way. Attacking the TSA and individuals within the TSA, and editing without consensus, is not the Wiki way to make your point. 205.188.112.22 17:36, 3 February 2006 (UTC)

Neither the TSA nor any individual in the TSA being attacked! One person on the TSA Medical Advisory Board is being quoted. Here's the link again! Let people read it for themselves!

In the article's current form, this is correct. Your previous entries about the TSA and individuals in the TSA were deleted on prior edits by others. I'm glad to see you are talking about the entry, and I'm sure we can come to consensus. There is appreciation of the point you want to make about marijuana and the TSA, but the information needs to conform with Misplaced Pages and encyclopedic standards and pillars. 152.163.100.13 19:30, 3 February 2006 (UTC)

Why do you assume others made the edits? Again, this is not about the TSA or about marijuana, it is about Marinol!

I know that I personally edited a number of ad hominem entries about the TSA and individuals in the TSA, trying to bring the article into compliance with Misplaced Pages pillars. I'm an "other". There were several soapbox entries about marijuana and the TSA, which I edited along with major copy editing. But that's water under the bridge. Can we get a simple summary of what you want to accomplish with this entry, so we can try to move forward? Do we agree that there are no good studies upon which to base statements about the efficacy of either marijuana or Marinol? Do we agree that larger, controlled studies are needed all round? Can we agree that, based on the RxList information about Marinol, the safe use of it as treatment for TS has been overstated here? Can we start by trying to understand what you want to say, and finding points of agreement, and then try to clean up the confusing research entries in order to substantiate your statements, without ad hominem references to people or organizations? 205.188.117.73 21:17, 3 February 2006 (UTC)

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.

Assume good faith. The information you have presented has been so confusing, that attempts to edit and clarify have been difficult at best. Now that you are using the talk page, perhaps consensus can be reached. But since you presented the information, it is up to you to substantiate it. 205.188.112.22 17:23, 3 February 2006 (UTC)

You also need to assume good faith.

I have not seen evidence of bad faith in the editing of your entries. There were attempts to bring the content into encyclopedic and Misplaced Pages compliance. There was one delete and revert after several requests that you bring your edits to the talk page. If you have a bone to pick with the TSA about marijuana, a personal website is a more appropriate place for that content.

This is not about the TSA or about marijuana! It is about Marinol!

The entries are yours. The distinction has not been made clear. In either case, there are no good controlled studies on adquate sample sizes. And, the safety of Marinol has been somewhat misrepresented. Please don't assume that people are undercutting your work. It just needs to be presented in accordance with Misplaced Pages standards, and with clarity. 152.163.100.13 19:30, 3 February 2006 (UTC)

I did not say that others are undercutting my work! I made those edits that you keep thinking others made! The studies in the Marinol section are about Marinol only. That is made very clear and anybody can follow the links to those studies and read them for themselves.

Beta blocker subsection

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.

Can we please prioritize treatment as to the most common? I appreciate your contribution, but I still think the entire section needs to be reworked, revamped, and beefed up. Can clonidine -- which is the most common, first line treatment -- be moved to the top of the treatment section rather than the bottom? I also feel that the article would be more NPOV if you refrained from referring to specific doctors, and reported on the research instead. I don't see a need to introduce such a controversial figure as David Comings into the article. 205.188.117.73 22:54, 3 February 2006 (UTC)

Major Cleanup and ReWrite Needed

Wow. Last time I checked in on this entry, it was not great, but it was passable. Now it’s a trainwreck. Since there seem to have been some editing wars, I will include a discussion of things that need to be addressed before making editing changes myself. The entire article is alarming, and I hesitate to edit in the presence of editing controversy.

As mentioned above, the link to the article on tics isn’t particularly helpful for the context of Tourette’s.

The phrase “that occur repeatedly in the same way” is confusing and needs repair. Movements that "occur repeatedly in the same way" are suggestive of stereotypies or stims. The hallmark of tics is that they constantly change in number, severity, frequency, and anatomical location. The basic definition of Tourette’s needs to be reworked.

SYMPTOMS

Does not even include a good, basic definition of tics. This should include a working description of motor and phonic tics, descriptions and definitions of each, simple vs. complex tics, and examples. Suppressability and premonitory urge are not adequately explained, especially as they relate to other movement disorders. There is more emphasis on sensory phenomena (coprolalia, echolalia, etc.) than more common tics; yet, even these subjects are not well examined. There is no discussion of simple versus complex tics. A discussion of the spectrum of tic disorders (transient tics, chronic tics, and Tourette's) should also be included and expanded. In summary, the essential information defining Tourette’s is not well addressed.

Rage attacks are mentioned as a symptom. There is no such diagnostic entity as a rage attack, and it is a term that has been used colloquially by many different people with many different diagnoses to mean many different things. Different people may be describing different issues when they use the term. The only thing that has been shown and replicated by many multiple research sources is that “rage attacks” are not part of Tourette’s, rather related to co-occurring conditions which may be present in some persons who also have tics or Tourette's. References to rage attacks should be deleted, as they are not a symptom of Tourette’s. This terminology brings the article into dispute.

Does it bring the article into dispute, or can you just delete the references to rage attacks? Don't assume that only one person has written what you are objecting to.

The tone of some statements is not appropriate for Misplaced Pages or for an entry about a medical condition. Examples are “a person with Tourette's can feel as if their Tourette's Syndrome has totally taken control of their body, and they almost feel as if they are standing outside of themselves” and “doing so is like putting a lid on a boiling pot of water.”

There is a lot of overlap between the sections of the entry. For example, the sentence about tic severity and adolescence does not belong in symptoms.

I agree, why don't you move or delete the sentence?

DIAGNOSIS

Has no treatment at all of differential diagnosis, or how the diagnosis is made, typical presentation and age of onset, etc. “Highly functioning” is a term more often found in autism discussions. Tourette’s does not typically impact upon functioning, so this term is confusing.

Why don't you add something about differential diagnosis, age of onset, etc.? I believe Tourette's can affect functioning, that is all that is claimed by the article.

TREATMENT

The most commonly used medications in Tourette’s are never even mentioned (clonidine, tenex). Much more of the article is dedicated to controversial topics and alarming information, while commonplace treatment modalities are overlooked or never mentioned. A dramatic tone is employed in the description of some other medications. Example: “have caused severe permanent brain damage to some people taking them, sometimes as severe as Tardive dyskinesia.” These medications are typically safe when used at correct dosages. The mention of Parkinson’s is spurious.

Perhaps this means the treatment section should be expanded. Why don't you write something about clonodine or other beta-blockers that you say are overlooked?

The discussion of atypicals includes quotes which aren’t referenced, and discusses only potential negatives, out of context.

The reference to the quote on atypicals is in the wikipedia article on atypicals

The two paragraphs on tic severity and living with TS do not belong in the treatment section. A prognosis or outcome section is needed. Why are drummers in particular even mentioned? That seems like a vanity entry.

I don't know who mentioned drummers. However, the person was probably referring to Witty Ticcy Ray, decribed by Oliver Sacks.

The issues with the marijuana and marinol entries have already been discussed here (see above). Expert input is needed to bring the treatment section up to the quality needed for a medical entry, along with copy editing.

GENETICS

Includes outdated information and does not present the entire story. It was once accepted that the mode of transmission was autosomal dominant, but this has been called into question, and is now held to be an overly simplistic view of the genetics involved in Tourette's. This section also needs a major overhaul by a qualified expert. There are too many vague statements like “it is known that.”

You could be right. I personally do not know enough about genetics and I have never edited the genetics section at all. Do not assume that I wrote everything you object to.

FAMOUS PEOPLE

Is one section that looks improved over the past. Relevance needs to be taken into account when adding “famous” people. In the past, this section included vanity entries about people who were not known outside of Tourette’s, or people who had conditions which may co-occur with tics, rather than actual Tourette’s. The idea that Mozart had TS is discredited by experts and it is unfortunate to see that entry here, but that rumor needs to be addressed.

I also did not add the entry of Mozart under famous people. However, the person who did cited both experts who believe that Mozart had TS and experts who do not. But it is more that just a "rumor." I did add the link to the documentry on Mozart and Tourette's.

Toluca, James McConel is a musician and composer, not an expert on Tourette's. I do not concur with the edit you just made to the Mozart entry. Experts who have opined concur that there is no basis for speculating that Mozart had Tourette's. A musician/composer is not an expert on Tourette's. You are making changes without consensus, even as these items have been brought to your attention on the talk page. Sandy 01:03, 4 February 2006 (UTC)

Toluca, you earlier argued vehemently that Leslie Packer's TS Plus website should be included as an authoritative link. Now you are deleting her professional opinion that there is no evidence that Mozart had Tourette's. You can't have it both ways. Is she an authority on TS or not? Either leave in the link to her opinion about Mozart, or take her link out of the External Links section. I'm fine with either option that you choose. I will accept your entry about Simkin, although I don't think anyone would qualify him as a "TS expert." Even you have acknowledged that he is an endocrinologist. Not a psychiatrist or a neurologist? But I will accept that compromise. Sandy 01:45, 4 February 2006 (UTC)

Yes Sandy, I know that James McConel is not an expert on TS. But Dr. Benjamin Simkin is a medical expert who wrote a book argueing that Mozart had Tourette's! You belief that there is a consensus amongst experts is flat out wrong!

ENTERTAINMENT INDUSTRY

Why is every possible mention of Tourette’s in the industry worthy of mention here? Why should every show which uses Tourette’s as a cheap plot twist be included as an entry? And why are realistic, important and/or controversial productions, such as 7th Heaven, Ally McBeal, or The Practice overlooked in favor of cheap plot twist mentions of Tourette’s? Some criteria for what should be included here might be helpful. Why is mention of a possible upcoming film, not even in production, warranted? There are too many vanity entries. Again, the entire tone and content of this entry is just not Wikipedic or encyclopedic.

EXTERNAL LINKS

What do all of these add? Multiple sources of the same or similar information. At least this is better than in the past, when this section included many vanity entries or outdated sites, some of which included copyright issues.

Using this logic, why do we need four different links to the TSA around the world? Why not just one link to the TSA, since have similar information. Have a link to organizations that are not the TSA makes this article more neutral!

I hope this list is a starting place for improving this entry. Sandy 19:16, 3 February 2006 (UTC)

Thanks for the suggestions. Those are all sections I could work on, but I hesitate to make edits given the current contention that exists, and would prefer to see more consensus before tackling major rewrites. For example, I don't really know how the external links should be handled, and I agree that multiple links to advocacy organizations may not be necessary, but I'm not sure what kind of consensus could be reached about which to include. Certainly, the TSA should not be the only side of the story told. I also don't understand why Witty Ticcy Ray deserves special mention in the symptoms and diagnosis of the condition, but don't want to offend by deleting that. I could clean up the genetics, but this is a recognized area of controversy, so will have to be written carefully, presenting all views, and with consensus. The environment right now seems a bit touchy to tackle that. I could also rewrite treatment, symptoms, etcetera, but again, I hesitate to do so without consensus. I also don't want to just delete rage attacks, as I know that could develop into an issue. Sandy 20:16, 3 February 2006 (UTC)

If others agree, perhaps we could at least create a Prognosis or Outcome section of the entry, and move some of the statements about tic severity and adolescence and others out of the symptoms and diagnosis sections and into that section, which could later be expanded ? What should that section be named? Sandy 22:33, 3 February 2006 (UTC)

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