Thursday, September 30, 2010

Hay Fever or Pollen allergy


Each spring, summer, and fall, trees, weeds and grasses release tiny pollen grains into the air. Some of the pollen ends up in your nose and throat. This can trigger a type of allergy called hay fever.

Symptoms can include

* Sneezing, often with a runny or clogged nose
* Coughing and postnasal drip
* Itching eyes, nose and throat
* Dark circles under the eyes

Taking medicines, using nasal sprays and rinsing out your nose can relieve symptoms. Allergy shots can help make you less sensitive to pollen and provide long-term relief.

Sunday, September 26, 2010

Food allergy

A food allergy is an exaggerated immune response triggered by eggs, peanuts, milk, or some other specific food.

Causes

Normally, your body's immune systemimmune system defends against potentially harmful substances, such as bacteria, viruses, and toxins. In some people, an immune response is triggered by a substance that is generally harmless, such as a specific food.

The cause of food allergies is related to your body making a type of allergy-producing substance called immunoglobulin E (IgE) antibodiesantibodies to a particular food.

Although many people have a food intolerance, food allergies are less common. In a true food allergy, the immune system produces antibodies and histamine in response to the specific food.

Any food can cause an allergic reaction, but a few foods are the main culprits. In children, the most common food allergies are to:

* Eggs
* Milk
* Peanuts
* Shellfish (shrimp, crab, lobster, snails, clams)
* Soy
* Tree nuts
* Wheat

A food allergy frequently starts in childhood, but it can begin at any age. Fortunately, many children will outgrow their allergy to milk, egg, wheat, and soy by the time they are 5 years old if they avoid the offending foods when they are young. Allergies to peanuts, tree nuts, and shellfish tend to be lifelong.

In older children and adults, the most common food allergies are:

* Fish
* Peanuts
* Shellfish
* Tree nuts

Food additives -- such as dyes, thickeners, and preservatives – may rarely cause an allergic or intolerance reaction.

An oral allergy syndrome may occur after eating certain fresh fruits and vegetables. The allergens in these foods are similar to certain pollens. Examples are melon/ragweed pollen and apple/tree pollen.

Many Americans believe they have food allergies, while in reality fewer than 1% have true allergies. Most people's symptoms are caused by intolerances to foods such as:

* Corn products
* Cow's milk and dairy products (See: Lactose intoleranceLactose intolerance)
* Wheat and other gluten-containing grains (See: Celiac diseaseCeliac disease)

Symptoms

Symptoms usually begin immediately, within 2 hours after eating. Rarely, the symptoms may begin hours after eating the offending food.

If you develop symptoms shortly after eating a specific food, you may have a food allergy. Key symptoms include hiveshives, hoarse voice, and wheezingwheezing.

Other symptoms that may occur include:

* Abdominal painAbdominal pain
* DiarrheaDiarrhea
* Difficulty swallowingDifficulty swallowing
* ItchingItching of the mouth, throat, eyes, skin, or any area
* Lightheadedness or faintingfainting
* Nasal congestionNasal congestion
* NauseaNausea
* Runny noseRunny nose
* Swelling (angioedemaangioedema), especially of the eyelids, face, lips, and tongue
* Shortness of breathShortness of breath
* Stomach crampsStomach cramps
* VomitingVomiting

Symptoms of oral allergy syndrome:

* Itchy lips, tongue, and throat
* Swollen lips (sometimes)

Exams and Tests

In severe reactions, you may have low blood pressurelow blood pressure and blocked airways.

A blood or skin test can be done to identify elevated antibody levels (particularly IgE) and confirm that you have an allergy.

With elimination diets, you avoid the suspected food until your symptoms disappear. Then the foods are reintroduced to see if you develop an allergic reaction.

In provocation (challenge) testing, you are exposed to a suspected allergen under controlled circumstances. This may be done in the diet or by breathing in the suspected allergen. This type of test may provoke severe allergic reactions. Challenge testing should only be done by a doctor.

Never try to deliberately cause a reaction or reintroduce a food on your own. These tests should only be performed under the guidance of a health care provider -- especially if your first reaction was severe.

Treatment

The only proven treatment for a food allergy is to avoid the food. If you suspect you or your child has a food allergy, consult an allergy specialist.

If you have symptoms on only one area of the body (for example, a hive on the chin after eating the specific food), you may not need any treatment. The symptoms will likely go away in a brief time. Antihistamines may relieve the discomfort. Soothing skin creams may provide some relief.

Consult your doctor if you think you have had an allergic reaction to food, even if it is only a local reaction.

Anyone diagnosed with a food allergy should carry (and know how to use) injectable epinephrine at all times. If you develop any type of serious or whole-body reaction (even hives) after eating the offending food, inject the epinephrine. Then go to the nearest hospital or emergency facility, preferably by ambulance. Seek immediate medical attention after injecting epinephrine for a food reaction.

When to Contact a Medical Professional

* Call your local emergency number, such as 911, if you have any serious or whole-body reactions (particularly wheezing or difficulty breathing) after eating a food.
* If your doctor prescribed epinephrine for severe reactions, inject it as soon as possible, even before calling 911. The sooner you inject the epinephrine, the better.
* Anyone who has had an allergic reaction to a food should be evaluated by an allergy specialist.

Prevention

BreastfeedingBreastfeeding may help prevent allergies. Otherwise, there is no known way to prevent food allergies except to delay introducing allergy-causing foods to infants until their gastrointestinal tract has had a chance to mature. The timing for this varies from food to food and from baby to baby.

Once an allergy has developed, carefully avoiding the offending food usually prevents further problems.

Thursday, September 23, 2010

Face pain

Face pain may be dull and throbbing or an intense, stabbing discomfort in one or both sides of the face or forehead.
Considerations
Considerations

Pain that starts in the face may be caused by a nerve disorder, an injury, or an infection in a structure of the face. Face pain may also begin elsewhere in the body.

Sometimes face pain occurs for no known reason.
Causes
Causes

* Abscessed toothAbscessed tooth (continuous throbbing pain on one side of the lower face aggravated by eating or touching)
* Cluster headacheCluster headache
* Herpes zosterHerpes zoster (shingles) or herpes simplexherpes simplex (cold sores) infection
* Injury to the face
* MigraineMigraine
* Myofascial pain syndrome
* SinusitisSinusitis or sinus infection (dull pain and tenderness around the eyes and cheekbones that worsens when bending forward)
* Tic douloureuxTic douloureux
* Temporomandibular joint dysfunction syndrome

Home Care
Home Care

Follow the treatment prescribed for the cause of the pain.

Painkillers may provide temporary relief. If the pain is severe or persistent, call your primary health care provider or dentist.
When to Contact a Medical Professional
When to Contact a Medical Professional

* Face pain is accompanied by chest, shoulder, neck, or arm pain. This could mean a heart attackheart attack. Call your local emergency number (such as 911).
* Pain is throbbing, worse on one side of the face, and aggravated by eating. Call a dentist.
* Pain is persistent, unexplained, or accompanied by other unexplained symptoms. Call your primary health care provider.

What to Expect at Your Office Visit
What to Expect at Your Office Visit

In emergency situations (such as a possible heart attack), you will first be stabilized. Then, the health care provider will take a medical history and perform a physical examination. For tooth problems, expect a referral to a dentist or orthodontist.

You may be asked the following questions:

* What part of your face is in pain?
* Is the pain on both sides?
* If the pain is only on one side, which side is it on?
* Is the pain over a sinus (forehead, cheekbones)?
* Did the pain begin suddenly?
* Is face pain occurring repeatedly (is it recurrent)?
* How long have the episodes of face pain lasted (for how many months)?
* How long does each episode of pain last (how many seconds)?
* Is the pain worse when speaking, chewing, or swallowing?
* Does the pain develop when touching a specific part of the face (trigger point)?
* Did face pain occur before the start of a brain or nervous system problem (weaknessweakness, speech loss)?
* What other symptoms do you have?

Diagnostic tests that may be performed include:

* Dental x-raysDental x-rays (if a tooth problem is suspected)
* ECGECG (if heart problems are suspected)
* TonometryTonometry (if glaucomaglaucoma is suspected)
* X-rays of the sinusesX-rays of the sinuses

Neurological tests will be performed if nerve damage is suspected.

Tuesday, September 21, 2010

Hyperthermia in Cancer Treatment

· What is hyperthermia?

Hyperthermia (also called thermal therapy or thermotherapy) is a type of cancer treatment in which body tissue is exposed to high temperatures (up to 113°F). Research has shown that high temperatures can damage and kill cancer cells, usually with minimal injury to normal tissues. By killing cancer cells and damaging proteins and structures within cells, hyperthermia may shrink tumors.

Hyperthermia is under study in clinical trials (research studies with people) and is not widely available.

· How is hyperthermia used to treat cancer?

Hyperthermia is almost always used with other forms of cancer therapy, such as radiation therapy and chemotherapy. Hyperthermia may make some cancer cells more sensitive to radiation or harm other cancer cells that radiation cannot damage. When hyperthermia and radiation therapy are combined, they are often given within an hour of each other. Hyperthermia can also enhance the effects of certain anticancer drugs.

Numerous clinical trials have studied hyperthermia in combination with radiation therapy and/or chemotherapy. These studies have focused on the treatment of many types of cancer, including sarcoma, melanoma, and cancers of the head and neck, brain, lung, esophagus, breast, bladder, rectum, liver, appendix, cervix, and peritoneal lining. Many of these studies, but not all, have shown a significant reduction in tumor size when hyperthermia is combined with other treatments. However, not all of these studies have shown increased survival in patients receiving the combined treatments.

What are the different methods of hyperthermia?

Several methods of hyperthermia are currently under study, including local, regional, and whole-body hyperthermia.

* In local hyperthermia, heat is applied to a small area, such as a tumor, using various techniques that deliver energy to heat the tumor. Different types of energy may be used to apply heat, including microwave, radiofrequency, and ultrasound. Depending on the tumor location, there are several approaches to local hyperthermia:
o External approaches are used to treat tumors that are in or just below the skin. External applicators are positioned around or near the appropriate region, and energy is focused on the tumor to raise its temperature.
o Intraluminal or endocavitary methods may be used to treat tumors within or near body cavities, such as the esophagus or rectum. Probes are placed inside the cavity and inserted into the tumor to deliver energy and heat the area directly.
o Interstitial techniques are used to treat tumors deep within the body, such as brain tumors. This technique allows the tumor to be heated to higher temperatures than external techniques. Under anesthesia, probes or needles are inserted into the tumor. Imaging techniques, such as ultrasound, may be used to make sure the probe is properly positioned within the tumor. The heat source is then inserted into the probe. Radiofrequency ablation (RFA) is a type of interstitial hyperthermia that uses radio waves to heat and kill cancer cells.
* In regional hyperthermia, various approaches may be used to heat large areas of tissue, such as a body cavity, organ, or limb.
o Deep tissue approaches may be used to treat cancers within the body, such as cervical or bladder cancer. External applicators are positioned around the body cavity or organ to be treated, and microwave or radiofrequency energy is focused on the area to raise its temperature.
o Regional perfusion techniques can be used to treat cancers in the arms and legs, such as melanoma, or cancer in some organs, such as the liver or lung. In this procedure, some of the patient’s blood is removed, heated, and then pumped (perfused) back into the limb or organ. Anticancer drugs are commonly given during this treatment.
o Continuous hyperthermic peritoneal perfusion (CHPP) is a technique used to treat cancers within the peritoneal cavity (the space within the abdomen that contains the intestines, stomach, and liver), including primary peritoneal mesothelioma and stomach cancer. During surgery, heated anticancer drugs flow from a warming device through the peritoneal cavity. The peritoneal cavity temperature reaches 106–108°F.
* Whole-body hyperthermia is used to treat metastatic cancer that has spread throughout the body. This can be accomplished by several techniques that raise the body temperature to 107–108°F, including the use of thermal chambers (similar to large incubators) or hot water blankets.

The effectiveness of hyperthermia treatment is related to the temperature achieved during the treatment, as well as the length of treatment and cell and tissue characteristics. To ensure that the desired temperature is reached, but not exceeded, the temperature of the tumor and surrounding tissue is monitored throughout hyperthermia treatment. Using local anesthesia, the doctor inserts small needles or tubes with tiny thermometers into the treatment area to monitor the temperature. Imaging techniques, such as CT (computed tomography), may be used to make sure the probes are properly positioned.

Does hyperthermia have any complications or side effects?

Most normal tissues are not damaged during hyperthermia if the temperature remains under 111°F. However, due to regional differences in tissue characteristics, higher temperatures may occur in various spots. This can result in burns, blisters, discomfort, or pain. Perfusion techniques can cause tissue swelling, blood clots, bleeding, and other damage to the normal tissues in the perfused area; however, most of these side effects are temporary. Whole-body hyperthermia can cause more serious side effects, including cardiac and vascular disorders, but these effects are uncommon. Diarrhea, nausea, and vomiting are commonly observed after whole-body hyperthermia.

What does the future hold for hyperthermia?

A number of challenges must be overcome before hyperthermia can be considered a standard treatment for cancer. Many clinical trials are being conducted to evaluate the effectiveness of hyperthermia. Some trials continue to research hyperthermia in combination with other therapies for the treatment of different cancers. Other studies focus on improving hyperthermia techniques.

Thursday, September 16, 2010

Tonsillitis

Tonsillitis is inflammation (swelling) of the tonsils.

Causes

The tonsils are lymph nodes in the back of the mouth and top of the throat. They normally help to filter out bacteria and other microorganisms to prevent infection in the body.

They may become so overwhelmed by bacterial or viral infection that they swell and become inflamed, causing tonsillitis. The infection may also be present in the throat and surrounding areas, causing inflammation of the pharynx. The pharynx is in the back of the throat, between the tonsils and the voicebox (larynx). See: PharyngitisPharyngitis

Tonsillitis is extremely common, particularly in children.

Symptoms

* Difficulty swallowingDifficulty swallowing
* Ear pain
* FeverFever, chills
* HeadacheHeadache
* Sore throat - lasts longer than 48 hours and may be severe
* Tenderness of the jaw and throat
* Voice changes, loss of voiceloss of voice


Exams and Tests

The health care provider will look in the mouth and throat for swollen tonsils. The tonsils are usually reddened and may have white spots on them. The lymph nodes in the jaw and neck may be swollen and tender to the touch.

Tests that may be done include:

* Rapid strep testRapid strep test
* Throat swab cultureThroat swab culture


Treatment

If the cause of the tonsillitis is bacteria such as strep, antibiotics are given to cure the infection. The antibiotics may be given once as a shot, or taken for 10 days by mouth.

If antibiotic pills are used, they must be taken for the entire amount of time prescribed by the doctor. DO NOT stop taking them just because the discomfort stops, or the infection may not be cured.

Rest to allow the body to heal. Fluids, especially warm (not hot), bland fluids or very cold fluids may soothe the throat. Gargle with warm salt water or suck on lozenges (containing benzocaine or similar ingredients) to reduce pain.

Over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen may be used to reduce pain and fever. Do NOT give a child aspirin. Aspirin has been linked to Reye syndromeReye syndrome.

Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomytonsillectomy).

Outlook (Prognosis)

Tonsillitis symptoms usually improve 2 or 3 days after treatment starts. The infection usually is cured after treatment is completed, but some people may need more than one course of antibiotics.

Complications of untreated strep tonsillitis may be severe. Children with tonsillitis related to strep throat or pharyngitis should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.
Possible Complications
Possible Complications

* Blocked airway from swollen tonsils
* Dehydration from difficulty swallowing fluids
* Kidney failure
* Peritonsillar abscessPeritonsillar abscess or abscess in other parts of the throat
* Pharyngitis - bacterial
* Post-streptococcal glomerulonephritisPost-streptococcal glomerulonephritis
* Rheumatic feverRheumatic fever and related cardiovascular disorders


When to Contact a Medical Professional

Call your health care provider if:

* A sore throat lasts longer than 48 hours
* New symptoms develop
* Symptoms get worse
* You have other symptoms with the sore throat

Sunday, September 12, 2010

Sore throat

A sore throat is discomfort, pain, or scratchiness in the throat. A sore throat often makes it painful to swallow.

Sore throats are common. Most of the time the soreness is worse in the morning and improves as the day progresses.

Like colds, the vast majority of sore throats are caused by viral infections. This means most sore throats will NOT respond to antibiotics. Many people have a mild sore throat at the beginning of every cold. When the nose or sinuses become infected, drainage can run down the back of the throat and irritate it, especially at night. Or, the throat itself can be infected.

Some viruses can cause specific types of sore throat. For example, Coxsackievirus sometimes causes blisters in the throat, especially in the late summer and early fall. Mononucleosis and the flu can also cause specific viral throat infections.

Strep throatStrep throat is the most common bacterial cause of sore throat. Because strep throat can occasionally lead to rheumatic feverrheumatic fever, antibiotics are given. Strep throat often includes a feverfever (greater than 101°F), white, draining patches on the throat, and swollen or tender lymph glandslymph glands in the neck. Children may have a headacheheadache and stomach painstomach pain.

A sore throat is less likely to be strep throat if it is a minor part of a typical cold (with runny noserunny nose, stuffy ears, coughcough, and similar symptoms). Strep can NOT be accurately diagnosed by looking at the throat alone. It requires a laboratory test.

Sometimes breathing through the mouth will cause a sore throat in the absence of any infection. During the months of dry winter air, some people will wake up with a sore throat most mornings. This usually disappears after having something to drink.

In addition, allergies (allergic rhinitisallergic rhinitis) can cause a sore throat.

With a sore throat, sometimes the tonsils or surrounding parts of the throat are inflamed. Either way, removing the tonsils to try to prevent future sore throats is not recommended for most children.

Causes
Causes

* Breathing through the mouth (can cause drying and irritation of the throat)
* Common coldCommon cold
* Endotracheal intubationEndotracheal intubation (tube insertion)
* FluFlu
* Infectious mononucleosisInfectious mononucleosis
* Something stuck in the throat (See: Choking child or adultChoking child or adult and CPRCPR)
* Strep throatStrep throat
* Surgery such as tonsillectomytonsillectomy and adenoidectomyadenoidectomy
* Viral pharyngitispharyngitis

Home Care
Home Care

Most sore throats are soon over. In the meantime, the following remedies may help:

* Drink warm liquids. Honey or lemon tea is a time-tested remedy.
* Gargle several times a day with warm salt water (1/2 tsp of salt in 1 cup water).
* Cold liquids or popsicles help some sore throats.
* Sucking on hard candies or throat lozenges can be very soothing, because it increases saliva production. This is often as effective as more expensive remedies, but should not be used in young children because of the choking risk.
* Use a cool-mist vaporizer or humidifier to moisten and soothe a dry and painful throat.
* Try over-the-counter pain medications, such as acetaminophen. Do NOT give aspirin to children.

When to Contact a Medical Professional
When to Contact a Medical Professional

Call your health care provider if there is:

* Excessive drooling in a young child
* Fever, especially 101°F or greater
* Pus in the back of the throat
* Red rash that feels rough, and increased redness in the skin folds
* Severe difficulty swallowing or breathing
* Tender or swollen lymph glandsswollen lymph glands in the neck

Prevention
Prevention

Clean your hands frequently, especially before eating. This is a powerful way to help prevent many sore throat infections. You might avoid some sore throats by reducing contact with people with sore throats, but often these people are contagious even before they have symptoms, so this approach is less effective.

Not too long ago, tonsils were commonly removed in an attempt to prevent sore throats. This is no longer recommended in most circumstances.

A cool mist vaporizer or humidifier can prevent some sore throats caused by breathing dry air with an open mouth.

Friday, September 10, 2010

Tourette Syndrome

What is Tourette syndrome?

Tourette syndrome (TS) is a neurological disorder characterized by repetitive, stereotyped, involuntary movements and vocalizations called tics. The disorder is named for Dr. Georges Gilles de la Tourette, the pioneering French neurologist who in 1885 first described the condition in an 86-year-old French noblewoman.

The early symptoms of TS are almost always noticed first in childhood, with the average onset between the ages of 7 and 10 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. It is estimated that 200,000 Americans have the most severe form of TS, and as many as one in 100 exhibit milder and less complex symptoms such as chronic motor or vocal tics or transient tics of childhood. Although TS can be a chronic condition with symptoms lasting a lifetime, most people with the condition experience their worst symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

What are the symptoms?

Tics are classified as either simple or complex. Simple motor tics are sudden, brief, repetitive movements that involve a limited number of muscle groups. Some of the more common simple tics include eye blinking and other vision irregularities, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, coordinated patterns of movements involving several muscle groups. Complex motor tics might include facial grimacing combined with a head twist and a shoulder shrug. Other complex motor tics may actually appear purposeful, including sniffing or touching objects, hopping, jumping, bending, or twisting. Simple vocal tics may include throat-clearing, sniffing/snorting, grunting, or barking. More complex vocal tics include words or phrases. Perhaps the most dramatic and disabling tics include motor movements that result in self-harm such as punching oneself in the face or vocal tics including coprolalia (uttering swear words) or echolalia (repeating the words or phrases of others). Some tics are preceded by an urge or sensation in the affected muscle group, commonly called a premonitory urge. Some with TS will describe a need to complete a tic in a certain way or a certain number of times in order to relieve the urge or decrease the sensation.

Tics are often worse with excitement or anxiety and better during calm, focused activities. Certain physical experiences can trigger or worsen tics, for example tight collars may trigger neck tics, or hearing another person sniff or throat-clear may trigger similar sounds. Tics do not go away during sleep but are often significantly diminished.

What is the course of TS?

Tics come and go over time, varying in type, frequency, location, and severity. The first symptoms usually occur in the head and neck area and may progress to include muscles of the trunk and extremities. Motor tics generally precede the development of vocal tics and simple tics often precede complex tics. Most patients experience peak tic severity before the mid-teen years with improvement for the majority of patients in the late teen years and early adulthood. Approximately 10 percent of those affected have a progressive or disabling course that lasts into adulthood.

Can people with TS control their tics?

Although the symptoms of TS are involuntary, some people can sometimes suppress, camouflage, or otherwise manage their tics in an effort to minimize their impact on functioning. However, people with TS often report a substantial buildup in tension when suppressing their tics to the point where they feel that the tic must be expressed. Tics in response to an environmental trigger can appear to be voluntary or purposeful but are not.

What causes TS?

Although the cause of TS is unknown, current research points to abnormalities in certain brain regions (including the basal ganglia, frontal lobes, and cortex), the circuits that interconnect these regions, and the neurotransmitters (dopamine, serotonin, and norepinephrine) responsible for communication among nerve cells. Given the often complex presentation of TS, the cause of the disorder is likely to be equally complex.

What disorders are associated with TS?

Many with TS experience additional neurobehavioral problems including inattention; hyperactivity and impulsivity (attention deficit hyperactivity disorder—ADHD) and related problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors. For example, worries about dirt and germs may be associated with repetitive hand-washing, and concerns about bad things happening may be associated with ritualistic behaviors such as counting, repeating, or ordering and arranging. People with TS have also reported problems with depression or anxiety disorders, as well as other difficulties with living, that may or may not be directly related to TS. Given the range of potential complications, people with TS are best served by receiving medical care that provides a comprehensive treatment plan.

How is TS diagnosed?

TS is a diagnosis that doctors make after verifying that the patient has had both motor and vocal tics for at least 1 year. The existence of other neurological or psychiatric conditions[1] can also help doctors arrive at a diagnosis. Common tics are not often misdiagnosed by knowledgeable clinicians. But atypical symptoms or atypical presentation (for example, onset of symptoms in adulthood) may require specific specialty expertise for diagnosis. There are no blood or laboratory tests needed for diagnosis, but neuroimaging studies, such as magnetic resonance imaging (MRI), computerized tomography (CT), and electroencephalogram (EEG) scans, or certain blood tests may be used to rule out other conditions that might be confused with TS.

It is not uncommon for patients to obtain a formal diagnosis of TS only after symptoms have been present for some time. The reasons for this are many. For families and physicians unfamiliar with TS, mild and even moderate tic symptoms may be considered inconsequential, part of a developmental phase, or the result of another condition. For example, parents may think that eye blinking is related to vision problems or that sniffing is related to seasonal allergies. Many patients are self-diagnosed after they, their parents, other relatives, or friends read or hear about TS from others.

How is TS treated?

Because tic symptoms do not often cause impairment, the majority of people with TS require no medication for tic suppression. However, effective medications are available for those whose symptoms interfere with functioning. Neuroleptics are the most consistently useful medications for tic suppression; a number are available but some are more effective than others (for example, haloperidol and pimozide). Unfortunately, there is no one medication that is helpful to all people with TS, nor does any medication completely eliminate symptoms. In addition, all medications have side effects. Most neuroleptic side effects can be managed by initiating treatment slowly and reducing the dose when side effects occur. The most common side effects of neuroleptics include sedation, weight gain, and cognitive dulling. Neurological side effects such as tremor, dystonic reactions (twisting movements or postures), parkinsonian-like symptoms, and other dyskinetic (involuntary) movements are less common and are readily managed with dose reduction. Discontinuing neuroleptics after long-term use must be done slowly to avoid rebound increases in tics and withdrawal dyskinesias. One form of withdrawal dyskinesia called tardive dyskinesia is a movement disorder distinct from TS that may result from the chronic use of neuroleptics. The risk of this side effect can be reduced by using lower doses of neuroleptics for shorter periods of time.

Other medications may also be useful for reducing tic severity, but most have not been as extensively studied or shown to be as consistently useful as neuroleptics. Additional medications with demonstrated efficacy include alpha-adrenergic agonists such as clonidine and guanfacine. These medications are used primarily for hypertension but are also used in the treatment of tics. The most common side effect from these medications that precludes their use is sedation.

Effective medications are also available to treat some of the associated neurobehavioral disorders that can occur in patients with TS. Recent research shows that stimulant medications such as methylphenidate and dextroamphetamine can lessen ADHD symptoms in people with TS without causing tics to become more severe. However, the product labeling for stimulants currently contraindicates the use of these drugs in children with tics/TS and those with a family history of tics. Scientists hope that future studies will include a thorough discussion of the risks and benefits of stimulants in those with TS or a family history of TS and will clarify this issue. For obsessive-compulsive symptoms that significantly disrupt daily functioning, the serotonin reuptake inhibitors (clomipramine, fluoxetine, fluvoxamine, paroxetine, and sertraline) have been proven effective in some patients.

Psychotherapy may also be helpful. Although psychological problems do not cause TS, such problems may result from TS. Psychotherapy can help the person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur. More recently, specific behavioral treatments that include awareness training and competing response training, such as voluntarily moving in response to a premonitory urge, have shown effectiveness in small controlled trials. Larger and more definitive NIH-funded studies are underway.

Is TS inherited?

Evidence from twin and family studies suggests that TS is an inherited disorder. Although early family studies suggested an autosomal dominant mode of inheritance (an autosomal dominant disorder is one in which only one copy of the defective gene, inherited from one parent, is necessary to produce the disorder), more recent studies suggest that the pattern of inheritance is much more complex. Although there may be a few genes with substantial effects, it is also possible that many genes with smaller effects and environmental factors may play a role in the development of TS. Genetic studies also suggest that some forms of ADHD and OCD are genetically related to TS, but there is less evidence for a genetic relationship between TS and other neurobehavioral problems that commonly co-occur with TS. It is important for families to understand that genetic predisposition may not necessarily result in full-blown TS; instead, it may express itself as a milder tic disorder or as obsessive-compulsive behaviors. It is also possible that the gene-carrying offspring will not develop any TS symptoms.

The sex of the person also plays an important role in TS gene expression. At-risk males are more likely to have tics and at-risk females are more likely to have obsessive-compulsive symptoms.

People with TS may have genetic risks for other neurobehavioral disorders such as depression or substance abuse. Genetic counseling of individuals with TS should include a full review of all potentially hereditary conditions in the family.

What is the prognosis?

Although there is no cure for TS, the condition in many individuals improves in the late teens and early 20s. As a result, some may actually become symptom-free or no longer need medication for tic suppression. Although the disorder is generally lifelong and chronic, it is not a degenerative condition. Individuals with TS have a normal life expectancy. TS does not impair intelligence. Although tic symptoms tend to decrease with age, it is possible that neurobehavioral disorders such as depression, panic attacks, mood swings, and antisocial behaviors can persist and cause impairment in adult life.

What is the best educational setting for children with TS?

Although students with TS often function well in the regular classroom, ADHD, learning disabilities, obsessive-compulsive symptoms, and frequent tics can greatly interfere with academic performance or social adjustment. After a comprehensive assessment, students should be placed in an educational setting that meets their individual needs. Students may require tutoring, smaller or special classes, and in some cases special schools.

All students with TS need a tolerant and compassionate setting that both encourages them to work to their full potential and is flexible enough to accommodate their special needs. This setting may include a private study area, exams outside the regular classroom, or even oral exams when the child's symptoms interfere with his or her ability to write. Untimed testing reduces stress for students with TS.

What research is being done?

Within the Federal government, the leading supporter of research on TS and other neurological disorders is the National Institute of Neurological Disorders and Stroke (NINDS). The NINDS, a part of the National Institutes of Health (NIH), is responsible for supporting and conducting research on the brain and central nervous system.

NINDS sponsors research on TS both in its laboratories at the NIH and through grants to major medical institutions across the country. The National Institute of Mental Health, the National Center for Research Resources, the National Institute of Child Health and Human Development, the National Institute on Drug Abuse, and the National Institute on Deafness and Other Communication Disorders also support research of relevance to TS. And another component of the Department of Health and Human Services, the Centers for Disease Control and Prevention, funds professional education programs as well as TS research.

Knowledge about TS comes from studies across a number of medical and scientific disciplines, including genetics, neuroimaging, neuropathology, clinical trials (medication and non-medication), epidemiology, neurophysiology, neuroimmunology, and descriptive/diagnostic clinical science.

Genetic studies. Currently, NIH-funded investigators are conducting a variety of large-scale genetic studies. Rapid advances in the technology of gene finding will allow for genome-wide screening approaches in TS, and finding a gene or genes for TS would be a major step toward understanding genetic risk factors. In addition, understanding the genetics of TS genes will strengthen clinical diagnosis, improve genetic counseling, lead to the clarification of pathophysiology, and provide clues for more effective therapies.

Neuroimaging studies. Within the past 5 years, advances in imaging technology and an increase in trained investigators have led to an increasing use of novel and powerful techniques to identify brain regions, circuitry, and neurochemical factors important in TS and related conditions.

Neuropathology. Within the past 5 years, there has been an increase in the number and quality of donated postmortem brains from TS patients available for research purposes. This increase, coupled with advances in neuropathological techniques, has led to initial findings with implications for neuroimaging studies and animal models of TS.

Clinical trials. A number of clinical trials in TS have recently been completed or are currently underway. These include studies of stimulant treatment of ADHD in TS and behavioral treatments for reducing tic severity in children and adults. Smaller trials of novel approaches to treatment such as dopamine agonist and GABAergic medications also show promise.

Epidemiology and clinical science. Careful epidemiological studies now estimate the prevalence of TS to be substantially higher than previously thought with a wider range of clinical severity. Furthermore, clinical studies are providing new findings regarding TS and co-existing conditions. These include subtyping studies of TS and OCD, an examination of the link between ADHD and learning problems in children with TS, a new appreciation of sensory tics, and the role of co-existing disorders in rage attacks. One of the most important and controversial areas of TS science involves the relationship between TS and autoimmune brain injury associated with group A beta-hemolytic streptococcal infections or other infectious processes. There are a number of epidemiological and clinical investigations currently underway in this intriguing area.

Tuesday, September 7, 2010

Bedwetting

Is your child ready to use a potty? The more important question may be, are you? Children are usually ready around ages 18-24 months. They often signal that they are ready by letting you know when their diapers need changing. You should be prepared to commit to three months of daily encouragement. Successful trips to the potty should be rewarded. Missteps shouldn't get as much attention. Training requires patience. If it is not successful, it may mean your child is not ready.

Many children wet the bed until they are 5 or even older. A child's bladder might be too small. Or the amount of urine produced overnight can be more than the bladder can hold. Some children sleep too deeply or take longer to learn bladder control. Children should not be punished for wetting the bed. They don't do it on purpose, and most outgrow it. Until then, bed-wetting alarms, bladder training and medicines might help.


The pad and bell method
One way to help your child become aware of urinating during sleep is to use a pad and bell. With this simple system, a bell rings and wakes the child once the pad is wet. Over a period of a few weeks, the child gains greater bladder control until they are consistently waking up to go to the toilet. It is best to use this under the guidance and supervision of a doctor.

Things to remember

* Bedwetting is common in young children and is part of their physical and emotional development.
* The child isn’t deliberately wetting the bed, so don’t punish them.
* Most children stop bedwetting as they grow older.
* A relapse of bedwetting can be a sign of stress in children.

Thursday, September 2, 2010

Common Cold and Cough Medicines

Sneezing, sore throat, a stuffy nose, coughing - everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

You can get a cold by touching your eyes or nose after you touch surfaces with cold germs on them. You can also inhale the germs. Symptoms usually begin 2 or 3 days after infection and last 2 to 14 days. Washing your hands and staying away from people with colds will help you avoid colds.

There is no cure for the common cold. For relief, try

* Getting plenty of rest
* Drinking fluids
* Gargling with warm salt water
* Using cough drops or throat sprays - but not cough medicine for children under four
* Taking over-the-counter pain or cold medicines

However, do not give aspirin to children. And do not give cough medicine to children under four.

Sneezing, sore throat, a stuffy nose, coughing -- everyone knows the symptoms of the common cold. It is probably the most common illness. In the course of a year, people in the United States suffer 1 billion colds.

What can you do for your cold or cough symptoms? Besides drinking plenty of fluids and getting plenty of rest, you may want to take medicines. There are lots of different cold and cough medicines, and they do different things.

* Nasal decongestants - unclog a stuffy nose
* Cough suppressants - quiet a cough
* Expectorants - loosen mucus so you can cough it up
* Antihistamines - stop runny noses and sneezing
* Pain relievers - ease fever, headaches, and minor aches and pains

Here are some other things to keep in mind about cold and cough medicines. Read labels, because many cold and cough medicines contain the same active ingredients. Taking too much of certain pain relievers can lead to serious injury. Do not give cough medicines to children under four, and don't give aspirin to children. Finally, antibiotics won’t help a cold.