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Tourette syndrome: general information and a case study in support of the nutritional approach.

The following general information has been supplied by the National Institute of Neurological Disorders and Stroke. For more information contact the Institute's Brain Resources and Information Network.

The mother of Lukas B. received all of this information and more, and kept searching. She was not willing to accept the Tourette diagnosis, and doubted the ADI-IS label. Her personal description of the events reflects the situation (see below). Her critical assessment seemed right.

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.

Early symptoms of TS are typically first noticed in childhood, with the average onset between the ages of 3 and 9 years. TS occurs in people from all ethnic groups; males are affected about three to four times more often than females. (ADHD is also more prevalent in males.)

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. Although TS can be a chronic condition with symptoms lasting a lifetime, most of the afflicted experience their worst tic symptoms in their early teens, with improvement occurring in the late teens and continuing into adulthood.

Typical 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 eye movements, facial grimacing, shoulder shrugging, and head or shoulder jerking. Simple vocalizations might include repetitive throat-clearing, sniffing, or grunting sounds. Complex tics are distinct, 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 the repetitive use of words or phrases.

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 (against their will). Tics in response to an environmental trigger can appear to be voluntary or purposeful, but are not.

Tics come and go over time, varying in type, frequency, location, and severity. 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.

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 10-15 percent of those affected have a progressive or disabling course that lasts into adulthood.

Causes and associated disorders

The cause of TS is unknown, but 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 complex.

Many individuals with TS experience additional neurobehavioral problems that often cause more impairment than the tics themselves. These include inattention, hyperactivity and impulsivity (attention deficit hyperactivity disorder--ADHD); problems with reading, writing, and arithmetic; and obsessive-compulsive symptoms such as intrusive thoughts/worries and repetitive behaviors.

TS diagnosis

The diagnosis of TS is based on symptoms and observation, and usually the diagnosis is made after the patient has experienced both motor and vocal tics for at least 1 year. Conventional medicine offers no specific blood, laboratory, or imaging tests for diagnosing TS. In rare cases, neuroimaging studies, such as magnetic resonance imaging (MRI) or computerized tomography (CT), electroencephalogram (EEG) studies, or certain blood tests may be used to rule out other conditions that might be confused with TS when the history or clinical examination is atypical. Alternative therapies such as hair mineral analysis for the evaluation of chronic under-supplementation of nutrient elements or the diagnosis of toxic metal exposure are rarely considered, even though heavy metals such as lead or mercury are neurotoxins, known to cause ADHD. Magnesium has been linked to the development of TS and ADHD. While conventional blood magnesium analysis rarely confirms the increased magnesium need of these patients, magnesi urn supplementation generally is effective in TS and ADHD patients. In fact, most children with nervous systems disorders benefit from magnesium therapy. One publication specifies that the evaluation of Magnesium levels in children with neurological problems through blood serum, red blood cell and in hair analysis found that 95% of those examined showed a magnesium deficiency, most frequently in hair (77.6 per cent).

Conventional Treatment

Conventional research rarely acknowledges nutritional therapy, and thus magnesium supplementation of ADHD or IS patients is not common medical treatment. Stimulant medication such as Ritalin is far more preferred, but the controversies and side effects surrounding the use of stimulants has caused parents to be more critical and careful.

Behavioral treatments such as awareness training and competing response training are frequently used to reduce tics. A recent NIH-funded, multi-center randomized control trial called Cognitive Behavioral Intervention for Tics, or CBIT, showed that training to voluntarily move in response to a premonitory urge can reduce tic symptoms. Other behavioral therapies, such as biofeedback or supportive therapy, have not been shown to reduce tic symptoms. However, supportive therapy such as ergotherapy can help a person with TS better cope with the disorder and deal with the secondary social and emotional problems that sometimes occur.

Genetics

Evidence from twin and family studies suggests that TS is an inherited disorder. 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 also possible that the gene-carrying offspring will not develop any TS symptoms.

The gender 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.

General 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 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 ADHD, OCD, depression, generalized anxiety, panic attacks, and mood swings can persist and cause impairment in adult life.

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 Rill 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.

The Case of Lukas B.

Clinicians working in orthomolecular medicine will not be surprised by the outcome of this simple approach that would not have been applied had the mother not been insistent. As is often the case, the mother of Lukas went the general medical route, involving neurological evaluations and ergotherapy. The suggestion to place her son on Ritalin caused her to evaluate alternative options. This is her personal description of events:

Lukas B DOB 9.6.2006

September 2011: for the first time we noticed tics such as repeated blinking and throat-clearing. Ergotherapy was started at the recommendation of the preschool teachers and the Family physician January 10, 2012: IQ Test recommended through Preschool. Result = IQ 115

March 6, 2012: Visited neurologist. Diagnosis: Tourette & AHDH. Recommendation: Omega 3 fatty acids and Ergotherapy. If problems continue, Ritalin will be prescribed. Omega3 given for several months, without improvement.

May/June 2012: severe tics in form of throat-clearing and eye rolling (until we only saw the white), occasional flapping of arms. Visited naturopath who prescribed homeopathy and Bachblueten. No real change in symptoms and behavior.

August 24, 2012: visit to child psychologist. Diagnosis: Asperger Syndrom & temporary Ties. ADHD, Tourette excluded! Recommendation: continue Ergo therapy once weekly (as had been followed since Sept. 2011)

December 14, 2012: visited child neurologist. Diagnosis, Asperger Syndrome & temporary Tics. IQ above normal average. ADHD & Tourette excluded. Recommendation: Ergotherapy and behavioral therapy, no medication!

January 29, 2013: hair analysis through friend's recommendation. (see Table 1). Nutritional program: Calcium, taken in the morning and at lunch, Magnesium taken in the evening after dinner, Amino Power, 3x daily (which is a multivitamin/mineral/amino acid complex in powder form) and B-Vitamins (such as HypoB50).

Table 1: Hair analysis results

TMI Trace Minerals International Laboratory

MINERAL ANALYSIS                   Childs' Hair

Patient Name     Lukas B.          Lab     2KH131286  Page  2/2
                                   Number

Clinical Information

               Acceptable    Test
                    Range   Value

Potentially Toxic Elements (ppm = mg/kg = mcg/g)

Arsenic-total      < 0.20    0.02

Barium             < 2.65    0.17

Beryllium          < 0.03  < 0.01

Bismuth            < 0.18  < 0.01

Cadmium            < 0.20    0.01

Lend               < 3.00    0.41

Mercury            < 0.30    0.12

Nickel             < 0.85    0.14

Palladium          < 0.10  < 0.05

Platinum           < 0.07     n.n

Silver             < 1.00    0.64

Thallium           < 0.01    0.00

Tin                < 0.93    0.13

Titanium           < 0.65  < 0.16

Uranium            < 0.10    0.01

Zirconium          < 1.47  < 0.05

Essential Trace Elements (ppm = mg/kg = mcg/g)

Chromium         0.02-0.15    0.04

Cobalt              < 0.15  < 0.01

Copper          6.70-37.00   30.47

Iodine           0.15-3.50    0.12  *

Iron            7.70-15.00    5.30  *

Manganese        0.07-0.50  < 0.05

Molybdenum       0.02-1.00    0.02

Selenium         0.40-1.40    0.54

Vanadium         0.01-0.15    0.01  *

Zinc         110.00-227.00  185.70

Essential Macroelements (ppm = mg/kg = mcg/g)

Calcium      200.00-850.00  233.40

Magnesium     20.00-115.00   21.85

Nonessential Trace Elements (ppm = mg/kg = mcg/g)

Boron               < 2.00  < 0.25

Gormanium           < 0.50    0.00

Lithium             < 0.20    0.00

Stronlium        0.11-4.28    0.81

Tungsten            < 0.02  < 0.00

Potentially Toxic Elements (ppm = mg/kg = mcg/g)

Aluminum            < 8.00    1.99

Antimony            < 0.20    0.01

n.n = not detected

Accreditation DIN EN ISO 17025; Quality contract Dipl. Ing.
Friedle, Ing J Merz, Dr, Rautand; Validation; Dr. E
Blaurock-Busch PhD, Laboratory physician Dr. med A Schonberger.


March 2013: Tics (almost) gone!

Summary:

The hair analysis report showed no toxic burden but marked deficiencies of nutrient elements including magnesium. The nutritional program implemented alleviated symptoms within two months. The boy remains active, parents (and teachers) are grateful. School progress is good.

For more information, contact the author at ebb.blaurock@gmx.de or service@tracemin.com.

USA Address:

4323 Apple Way

Boulder, Colorado 80301

1) http://www.ninds.nih.gov

2) http://www.ninds.nih.gov/disorders/tourette/detail_tourette.htm

3) Nigg JT et al Confirmation and Extension of Association of Blood Lead with Attention-Deficit/Hyperactivity Disorder (ADHD) and ADHD Symptom Domains at Population-Typical Exposure Levels. J Child Psychol Psychiatry. 2010 January; 51 (1): 58-65.

4) Grimaldi BL. The central role of magnesium deficiency in Tourette's syndrome: causal relationships between magnesium deficiency, altered biochemical pathways and symptoms relating to Tourette's syndrome and several reported comorbid conditions. Med Hypotheses. 2002 Jan: 58 (1): 47-60.

5) Starobrat-Hermelin B., Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. http://europepmc.org/abstract/MED/9368236

6) Starobrat-Hermelin B., Kozielec T. Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). http:// www.seekinghealth.com/media/mg_b6_reduces_nervous_system_hyperexcitability.pdf

by: E. Blaurock-Busch, PhD

About the author:

E. Blaurock-Busch PhD is research director of Micro Trace Minerals Analytical Laboratory Germany and Trace Mineral International of Boulder. Her specialty is metal toxicology and human nutrition.

She is a founding member and co-chairman of the International Association of Trace Element Research and Cancer, and organizer of the first East-West World Congress on Trace Element and Cancer, held in Beijing, China in 1996. As scientific advisor to the International Board of Clinical Metal Toxicology (IBMT) she lectured worldwide at medical meetings and universities. As scientific advisor to the German Medical Association for Clinical Metal Toxicology (Deutsche Arztegesellschalt fur Klinische Metalltoxilogie--KMT) and IBCMT (International Board of Clinical Metal Toxicology).

She is instrumental in environmental and laboratory research projects in metal toxicology, including epidemiological studies that evaluated the toxic burden of people of various countries, including India. In 2005, she received the IBCMT Award for Outstanding Service. She was a guest speaker at radio and TV shows in the US, Germany and elsewhere. She published several books in German and English at Prentice Hall (later Simon and Schuster), Hugendubel, Germany and other publishers. Her many articles were published in various languages in medical and lay journals around the world. She is a member of the European Academy for Environmental Medicine and the British Society for Ecological Medicine. She
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Author:Blaurock-Busch, E.
Publication:Original Internist
Article Type:Clinical report
Geographic Code:1USA
Date:Jun 1, 2013
Words:2350
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