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10 June 2005 Back to Medical Updates

   Tourette's Syndrome:

  A Novel, But Effective, Treatment

INTRODUCTION

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

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

  

HISTORY

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

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

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

2. Ritalin LA (methylphenidate hydrochloride) (Novartis), 30 mg daily since age 6 1/2, and

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

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

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

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

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

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

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

  Do you ever have itching of the skin?

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

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

 

FAMILY HISTORY

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

   FATHER: has sinus problems but was never allergy tested.

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

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

 

PHYSICAL EXAMINATION

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

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

 

LABORATORY ANALYSIS

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

 

  

THERAPY:

I will not detail the therapy here on the website because each patient will have to be individualized depending upon his particular circumstances and the medications he is taking. I will, however, describe his response in the following PROGRESS reports.

PROGRESS

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

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

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

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

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

Fifth Visit (three weeks later): At the time of this writing, the fifth visit had not occurred.

 

DISCUSSION

This is a story of a young man who suffered from Tourette's Disease for almost ten years from age 2 ½ till the time I examined him at age 12 years His problem got so bad that it required his removal from school 2 ½ months previously.

Being in early adolescence, he was beginning to feel the usual anxieties resulting from being isolated from his friends. On his second visit, one week after he came to the office for the first time, he told me: “Doctor, I want to thank you for what you have done for me.” This is quite a comment coming from a 12 year old child.

As he continued to improve, he appeared happier and he smiled more. His mother who was a nurse was well versed in the form of therapy we were giving the boy for she sought me out because of our approach.

The mother was very concerned about the fact that the boy was not improving and that he was on three medications, namely, Celexa, Ritalin, and Focalin (a quicker acting Ritalin-related drug). Most amazing is the fact that even though the child was getting worse on these drugs, little thought was being given to considering stopping such medications.

I know well that an objective scientific paper of this kind should be free of recriminations of others who insist upon staying the conventional course by giving such drugs even though they do little good and in fact can do more harm. The fact that this boy was worsening while on the drugs appeared not to awaken those who prescribed such drugs.

The theory we are considering can best be described in the answer to a question: Did the Good Lord Creator intend for some who apparently appear normal in most other respects to have impaired brain chemistry or why are some individuals abnormal in these manifestations while others are normal? I fully well realize that invoking the word Lord Creator brings in a non-scientific Theological Approach, but in essence the reader should know what we mean.

What is impaired in an individual's brain chemistry which makes him prone to Tourette's Disease, or ADHD, or Autism, or such other abnormal manifestations of the brain and mind? Is it dietary? Is it a reaction to toxic elements in our environment? It is difficult for us to believe that it is the outward manifestation of impaired genetics. Genetics could explain why some are affected while others are not in so far as some may resist the aberrational effect of an impaired diet or toxins. Looked at in another way, everything that happens in our human body is related to genetics. But to explain the cause to genetics begs the question: given a normal clean environment including a proper diet and the lack of toxins, would we express such abnormal diseases.

Although we have the enzymes to rid our bodies of some toxins, such as limited amounts of arsenic and mercury, do we have the enzymes capable of eliminating those man-made chemicals which over the many years of evolution, adaptation, and mutation did not exist within the environment for us to develop those enzymes necessary for their detoxification?

Our theory begins with DIET. We believe that given the proper nutrients which may or may not include vitamins, minerals, trace minerals, and other supplements, the body should be equipped to act and react normally to the environment. This theory would have little merit were it not for the fact that approaching treatment in this manner achieves results.

Placing an individual on a very strict elimination diet is the first step. It allows the body to eliminate what it has already taken in, and it begins a process by which no additional dietary insults are introduced. We consume too much of the same foods every day. Have you ever considered how many foods contain corn or a corn product, such as corn sweetener, corn starch, etc.? How about milk and milk products, such as whey and milk solids? These are in very many processed foods.

Years ago, there were some clinics both in the United States and Europe who advocated placing individuals on a water (distilled) only diet for two plus weeks before doing anything else. People responded. Some rare private clinics still do. These clinics still have their advocates and followers.

In our opinion, allergy testing, especially for foods, has little merit. It is in the process of elimination followed by food rotation and observing the response in the patient himself where the true and correct solution exists.

We fully realize that our young man with Tourette's Disease is a single patient. But the undeniable fact that his symptoms COMPLETELY disappeared on an elimination diet and complete cessation of his medications must prove something. It will take some persons other than we to convince this boy that his response did not really happen!

CONCEPT OF THE TOTAL LOAD

Environmental physicians have for some time proposed the Concept Of The Total Load . At the outset of this discussion, it would be prudent to define two terms: the allergic and sensitivity reactions. The allergic reaction would refer to a more specific set of circumstances where the body's reaction results from a series of biologic events initiated by a specific antigen/antibody reaction. A sensitivity reaction would result from a series of events not necessarily the result of an antibody reacting to a specific antigen. It could be a reaction to any number of toxic substances, such as irritants like cigarette smoke, perfumes and colognes, etc. As an overall term, sensitivity could encompass the allergic reaction, but not necessarily vice versa. An allergic reaction could be a sensitivity, but a sensitivity would not always be an allergic reaction. For the sake of our argument here, I will refer to the more general and less specific term “sensitivity.”

A person could be sub-minimally sensitive to one substance so that no clinical symptoms occur. A person can be sub-minimally sensitive to a second substance again to the point that no symptoms are experienced. But the combination of exposure to both substances are additive to the point where symptoms now occur. Therefore, the total load resulting from both exposures increased the insult above the body's capacity to control symptoms. It is in this situation that skin testing may not truly represent what is happening within the body.

In a form of allergy testing, an antigen is introduced and the patient's reactions to the antigen are observed. Rarely are two antigens tested simultaneously. If what we wish to determine is the total load concept, this form of allergy testing falls short of the mark. A more prudent approach is to eliminate the suspected culprit foods or antigens, watch for the symptoms to disappear, then introduce the foods one by one. It may well be that, if rotation of foods were on the agenda, one may never know which combination of foods is causing which symptoms. But then, is this really important if what we wish to achieve is the curing of the patient?

In the concept of food rotation, it is generally accepted that a person can eat a food to which he is sensitive if he were to eat it no more than once every three or four days. It is important to note that this may hold true with most foods, but not to chance it with allergies to the legume peanuts, regular nuts or shellfish. With these complete elimination from the diet is essential.

The Concept Of The Total Load would hold true to combinations of sensitivity reactions, such as foods, pollens, other inhalants, and other exposures. Interesting may be the response of addicted individuals to an elimination. We had a patient who we wished to cure of her serious addiction to Paxil. During the course of a diet elimination program, she was able to slowly tapir Paxil where she was unable to do so before.

 

SUMMARY

We are reporting the cessation of severe vocal and motor symptoms in a 12 year old boy suffering from Tourette's Disease for ten years on an elimination diet. During the treatment period of four weeks, we were able to completely discontinue the three medications he was taking for his condition. It would appear that others should try this rather harmless, but effective, approach to the therapy of Tourette's Disease.

nicola michael c. Tauraso, M.D.

7051 Poole Jones Road

Frederick , Maryland 21702

www.drtauraso.com