Talk:Tourette syndrome/Archive 1

Remission after adolescence
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)

Aphasia and Tourette syndrome
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)


 * Brain injury (such as caused by stroke or trauma) is a known cause of non-genetic tics, which is referred to as tourettism, to distinguish it from inherited Tourette syndrome.   Sandy 18:01, 8 February 2006 (UTC)

Descriptions of premonitory urge
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 Wikipedia invaluable. Welcome to Wikipedia. -- 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 respectfully disagree with the yawn analogy. If you suppress or stifle a yawn, the urge to yawn usually goes away.  If you suppress a tic, the urge usually grows, and an explosion of tics afterwards can result.  Yawning doesn't behave that way -- if you suppress a yawn, you don't then later have an explosion of yawns.  So, it's more like an itch -- you've got to scatch it, or it gets worse.   Sandy 00:06, 6 February 2006 (UTC)

Tourette syndrome does exist, but...
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 Wikipedia and general public understanding. Without verifiable etiology, there can't be any consensus on how to define TS. It doesn't look like the etiology is ever confirmed, only the symptoms. In that case, just by changing the threshold of how bad the tics have to be, claiming a prevalence of 10% is as fair as claiming a prevalence of .1%. Any statement about prevalence should warn that it depends on the threshold used to define the disease.

On that note let me try to restate my previous objection. The paragraph in question goes on at length about popular misconceptions about Tourette syndrome. It has a "blame the media" tone which misses an important point: If there are popular misconceptions, they will also interfere with diagnosis. If bystanders believe that Tourette syndrome is defined as excessive swearing, then certainly there are parents who want this diagnosis in their children, and probably there are doctors who accede to these parents. The way that a condition is diagnosed does ultimately affect its definition. It is fair to say that bad movies have been irresponsible about TS. But the article should not imply that these movies stray from objective expertise, when the latter does not exist. --Greg Kuperberg 15:26, 3 Dec 2004 (UTC)


 * 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 Wikipedia is all about, after all. - Vaelor 16:06, 4 Dec 2004 (UTC)

I understand completely that Tourette syndrome exists. I have never doubted it. I believe in scientific explanations of the world and I have seen obvious cases of people with uncontrollable tics. It is only reasonable to call this Tourette syndrome. I also believe in basic human sympathy and I would be very glad if the medical community found an effective treatment for involuntary tics in general, or for specific classes of them. If you have Tourette syndrome, then really, you have my sympathy.

However, that does not mean that Tourette syndrome has a fixed, objective definition. Art, pornography, justice, and democracy also exist, but they have no fixed definition either. What would your reaction be if someone said that 1.13% of television programs are pornographic? I would hope that you would be skeptical. I would hope that you would be equally skeptical of claims that TV pornography is "underdiagnosed" or "overdiagnosed". Would that mean that you excuse pornography?

You say that, while you don't approve of overzealous parents who bend the definition of Tourette syndrome, you would prefer that to discrediting the disease entirely. How would you like both together? It is very unfortunate for sufferers of Tourette syndrome that its definition is malleable. People who try to bend the definition, often people who also deny that it can be bent, have unwittingly done the most to discredit diagnosis. Skeptics are not the problem, because there is no organized campaign against diagnosis.

For these reasons I would want the definition in Wikipedia to reflect common sense and limitations of knowledge, rather than to be officious or defensive.

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


 * 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 Wikipedia 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)

I know this is an old discussion, but I just wanted to add these comments for new readers. Greg, there is one problem with your argument, which is that coprolalia is such a rare symptom, that it's not really the norm to find moms seeking diagnoses of children for swearing. (Although I also agree with you that there are far too many moms willing to attribute bad behavior to tics.) What is likely is to encounter families who have been to endless doctors, trying to understand if their child has asthma or allergies (due to coughing and sniffing), eye or vision problems (due to blinking), or epilepsy (blocking tics), as just a few examples. But, you do raise a concern shared by many about the diagnostic boundaries of the condition. Roger Freeman's blog, referenced in the article, contains a very good discussion of how "arbitrary" the definition of Tourette's is. A person can have two motor tics, plus coprolalia, and be considered to have "severe" TS, because of the coprolalia. But, a person with twenty minor, less noticeable motor tics (abdominal tensing, leg tensing, slight eye blinking, small shoulder shrugs, etc.) -- but no vocal tic -- doesn't meet the diagnostic criteria. Makes no sense !! Sandy 23:08, 8 February 2006 (UTC)

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)


 * Done - revised tic and tic disorders entry, some content about tics moved to there, only basic and items specifically relevant to Tourette syndrome left here.. Sandy 20:32, 8 February 2006 (UTC)

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.

Howard Hughes
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.

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. Sandy 02:42, 4 February 2006 (UTC)
 * I don't think we should mention Dr. Lowe's name either or make it a personal thing. But I think that my statement about how Dr. Comings reported higher success rates with clonadine patches is not that controversial.  Comings may be controversial, but I don't think that means his name should be excluded in the Clonidine example.
 * I disagree. This is an encyclopedia.  It describes the way thing are.  What success rates Comings may or may not have reported, before controlled research was done on any given medication, has no place in an encyclopedia, and much less in a medical entry, where current contolled research is more reflective of the usefulness of the medication.  Sandy 03:42, 4 February 2006 (UTC)


 * 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?  Wikipedia 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 Wikipedia offical verifiability policy may be helpful. On that basis, the TSDA website seems to comply. Although Babajobu accurately pointed out that the term "Tourette Syndrome Plus" is not widely accepted or recognized, the website itself is written by a reputable and practicing professional, and it does contain verifiably accurate medical information. The objection (with respect to Wikipedia verifiablility) is to websites not written by professionals or maintained by verifiable professional organizations or containing verifiably accurate medical information. With respect to your statements about persons and organizations (such as the TSA or individuals within the TSA), I urge you to review the Wikipedia policy on NPOV- Neutral Point of View, and the five pillars of Wikipedia. We can make better progress towards correcting this article with those policies in mind. 64.12.116.13 04:10, 3 February 2006 (UTC)

"tics"
The Wikipedia entry for tics needs work, and has some information which is confusing and misleading relative to Tourette's and tic disorders. Perhaps this article can unlink from it until it improves?


 * This suggestion has been out here for many days now. I unlinked from the Wiki entry for tics, because it contains information that is just not descriptive of Tourette's tics, and I don't want to undertake repairing that article.  I hope someone bolder than I will fix the tic article and link us back in.  I included definitions and descriptions of tics as they apply to Tourette's in this article.  Sandy 20:11, 4 February 2006 (UTC)


 * I've done all I can. But the tic entry really needs a complete rewrite.  Most of what I wrote at the top of the Symptom section really belongs in the tic entry, and even more, the tic entry should probably be redefined and redirected to tic disorders in general, so that transient and chronic tics could be discussed there.  I hesitate to operate on the tic entry, because I just don't understand why most of what is there is even there, or what conditions most of it applies to, but it sure doesn't reflect an accurate description of Tourette's.  Sandy 00:41, 5 February 2006 (UTC)


 * No one else commented, so I did this work. I rewrote the tic entry, moved a lot of the content from Tourette's to there, and linked back in to the tic entry.  Sandy 18:04, 8 February 2006 (UTC)

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 Wikipedia 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 Wikipedia, 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 Wikipedia 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 Wikipedia 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)


 * Here are the ad hominem entries. 28 Jan Sandy 13:19, 12 February 2006 (UTC)
 * And, the initial entry: 26 Jan Sandy 00:40, 16 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.


 * I know that virtually all of the deletions made to the Marinol section after it was disputed, around 12 hours ago, were deleted by myself!


 * Edits to clean up adhominem attacks have been occurring since Jan 26, not just in the last 12 hours. And the only IP addresses making these additions about marijuana/marinol are all in Oakwood Toluca. That is neither here nor there.  The entry is improving.  Let's get the article fixed, so the dispute can be removed. Sandy 04:06, 4 February 2006 (UTC)


 * I do agree with you that the research on marijuana is just anecdotal, and doesn't prove anything. I believe the article makes that clear, however.  I do believe that preliminary investigations into Marinol treatment, frankly, showed a lot of promise for Marinol.  And of course, I am not claiming that Marinol is an effective treatment.  The preliminary findings with Marinol were quite positive, and as scientists usually do, when a smaller study like these shows promise, larger research should be done!  Unfortunately, no research is being done.  All I want is to point out that so far, all the controlled research on Marinol has shown Marinol to be very safe and effective.  I don't mind saying that since the research is only preliminary,  Marinol's value as a treatment for TS cannot be completely assessed without doing larger and longer studies.  And I think it should be noted that no studies are being done.  (I don't have to mention anything about the TSA stopping the funding.)


 * So, can you summarize what the point is you want to make, so that it can be made concisely? It seems that it boils down to you saying more research is warranted based on the preliminary research?  There has been no good controlled research on marinol -- you need to stop insisting there has, and just come to the point, without all the extraneous info. Do you see why it has been stated that this topic warrants one or two sentences?  Can you get it down to a manageable, concise, accurate argument, which doesn't overextend the results of the studies, or the claims about safety, and without ad hominem issues involving people or the TSA?  I'm sure, if you focus on what you want to say, it can be said concisely.  Sandy 04:06, 4 February 2006 (UTC)


 * Yes, I probably can say it more concisely. But not in two or three sentences.  Right now, I am going to rest for a while.


 * One last thing, however is that yes, most of the studies, like the 6-week study on Marinol were ] well controlled studies.  Look up the article on randomized controlled trials, I'm not sure you understand what it is!


 * I took a crack at it. I hope we're almost there, now that I think I know what you wanted to say.  OK, two or three sentences was an exaggeration, but I got it down to a manageable paragraph, which I hope is concise and I hope says what you wanted to convey.  I am still concerned that the issue of dependence, as raised by RxList, is completely missing.  This is not an entirely safe medication.  BTW, you really should check your tone, when you question whether people know what blinded or controlled studies are :-))   Sandy 04:40, 4 February 2006 (UTC)


 * What I want to avoid is some misleading disclaimer that makes it look like all the research on Marinol is crap. The preliminary research is incouraging.  That cannot be denied.


 * The research is what it is, and it is not up to us to characterize it. It is largely uncontrolled, unblinded, on small samples, and not using validated measurements.  That doesn't mean it's worthless.  It just means it is what it is, and more controlled, long-term research is needed.  That can be said, really, it can, without the emotion, in encyclopedic format.  You can't characterize the preliminary research as encouraging:  you can characterize it as preliminary.  Remember how the inversine stuff didn't pan out once controlled studies were done.  An encyclopedia reports as it is, not as we would like it to be.  Sandy 04:06, 4 February 2006 (UTC)


 * 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 Wikipedia 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 Wikipedia 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.


 * It may be clear to you. An unitiated reader needs to know which chemical is which.  To some readers, it's all marijuana, until/unless you define each better.  The studies refer to names you haven't defined.  Sandy 04:06, 4 February 2006 (UTC)


 * The paragraph on Marinol starts out by explaining that Marinol is synthetic THC in pill for in the first sentence of the paragraph! It is referred to as Marinol in the rest of the paragraph.  If someone is still confused about the concept of THC in a pill, they can click on the Marinol article and read more about it, and even look at a picture of Marinol pills in the Marinol article!  The only way to make it more clear in this article is to post the picture of Marinol in this article, but I don't think the picture is necessary in this article.


 * I just cut out the paragraph mentioning Dr. Komopoliti, because I agree this should not be about personality. I also change the last couple of lines to make it clear that the findings, while incouragings, are preliminary, etc. ...read it for yourself.


 * I think the section is quite NPOV now.


 * That's a good start !! It still needs more work to be encyclopedic.   Now that I think I know what you wanted to accomplish, I took a crack at editing it.  If you concur with my changes, I think the dispute could now be removed.  There are no longer any claims about the TSA, about the safety of Marinol, ad hominem attacks, and I think it now says what you want to say -- which is that more study is warranted.  I hope we're almost there now. Sandy 04:34, 4 February 2006 (UTC)

Move Pot Elsewhere
The Marinol/marijuana sections are a wild tangent of alternative medicine and the politics of illegal drugs. The material should be moved to the Marinol page and a medical marijuana page. The section should be reduced to a short statement that this is a proposed treatment of Tourette's syndrome, with links to the other pages.

I suppose that the whole treatment section simply dwells too much on on-going research and speculation. It would be a better article if the discussion started with the proven treatments, and then separately and briefly listed the unproven treatments.

Greg Kuperberg 18:34, 4 February 2006 (UTC)


 * I fully concur. MOST of what has added to treatment seems to have started as vanity entries, by people perhaps wanting to publicize certain controversial or unproven treatments. There is far too much focus on the controversial and unproven.  I have been attempting to clean it up, and am still working on beefing upu accepted treatment sections, but if there is more concurrence, I agree with bolder editing and deleting of large portions of the treatment section.  ON THE OTHER HAND, some of the more controversial topics do generate a lot of media hype, so maybe it is good to include realistic appraisals of these modalities ???   Sandy 18:52, 4 February 2006 (UTC)


 * You know, you should not assume that my motive is to publicize certain controversial or unproven treatments. I have contriputed to this article in other ways as well.  You are NOT ASSUMING GOOD FAITH!
 * The experimental treatment section now includes Deep Brain Stimulation and Nicotine. My comments were not directed at you.  With respect to marijuana and Marinol, my comments have been with respect to the research, not you.  Sandy 01:55, 8 February 2006 (UTC)
 * Just look a couple of paragraphs up. You said that what has been added to treatment on Marinol was started by "people perhaps wanting to publicize certain controversial or unproven treatments."  I was the person who started the posting on Marinol, so you are obviously referring to me!  It is an insult to my intelligence when you claim your comments were not directed at me!  And even if you comments are not directed at me, they were directed at other people who posted to this article, and you therefore are NOT ASSUMING GOOD FAITH! (For myself or for others!)
 * I shortened all of the entires for modalities which are experimental or for which there is not good empirical evidence, and combined them into one section, so that these items are now more brief. I don't want to move the discussions elsewhere without the concurrence of others.  Sandy 20:02, 4 February 2006 (UTC)

Consensus
Okay, I think a consensus has been reached. But for now, I won't delete the stuff on the talk page on Marinol.


 * It is noted that you have changed your original statements here after you received responses. To preserve context, I include your original statement, and note that you have made several other changes.  You originally wrote "Okay, I think a consensus has been reached, so would Sandy or anyone else object if I delete all this stuff on Marinol? "  Sandy 19:23, 8 February 2006 (UTC)
 * I changed my original statement because I wanted to say that I was not going to delete the stuff on Marinol on the talk pages, and I didn't want people to panic.
 * But the statement I'm referring to now is: "The paragraph on Marinol should stay roughly as it is and where it is in this article, and not be moved to the Marinol article now or in the future because it belongs in this article."  Do you have a good reason to disagree?206.59.60.140 19:27, 8 February 2006 (UTC)


 * The essence of Wikipedia is that any editor could come along tomorrow and decide to change the entire entry. Leaving the talk page here helps people understand the history and what consensus exists, and what the issues are.  But no one can assure that anything you write on Wikipedia will stand.  I really suggest you relax on this for a few days, as I've tried to reassure you I have no plans to operate on the Experimental Section.  Sandy 19:30, 8 February 2006 (UTC)
 * If some editor just removed the entire paragraph on Marinol or changed it for no good reason, it would be vandalism.  That's not the essence of wikipedia!206.59.60.140 19:45, 8 February 2006 (UTC)


 * This is my final response on this topic. You misunderstand the essence of Wikipedia, which is editors working together to achieve a better article.  If we follow the example you give above, then I vandalized myself when I re-wrote the entire tic article, using the words I had originally included in the Tourette syndrome article, then deleted some of the repetition from the Tourette syndrome article, and linked instead to the tic article.  Now it's a more efficient and concise encyclopedia entry.  I won't be responding anymore on this topic. Sandy 20:03, 8 February 2006 (UTC)
 * I understand the concept of people working together to achieve a better article! That is why I think right now the paragraph on Marinol is nearly perfect as it is, where it is and that it should not be moved to the Marinol article in part because that is not precidented on this page or in wikipedia.  However, I know I could be wrong!  I am always looking for a way to improve this paragraph!  That is why I want to see if somebody had a good reason to disagree with me about that statement!  If they do, it would be a way to improve the article even more!  But I realize now I have asked the wrong question, and I will clairify it.206.59.60.140 20:15, 8 February 2006 (UTC)
 * Also, are you saying that you had no good reason to rewrite the article on tics? I am saying that deleting the entire paragraph on Marinol or drastically changing it FOR NO GOOD REASON is vandalism!206.59.60.140 20:29, 8 February 2006 (UTC)


 * I want to clarify something. Yes, I know that the paragraph on Marinol may change, that is why I used the word "ROUGHLY" in that statement.  But drastic changes to the paragraph or deleting it altoghether for no good reason would be vandalism.206.59.60.140 19:54, 8 February 2006 (UTC)
 * So since you still have not provided a good reason to disagree with the statement: "The paragraph on Marinol should stay roughly as it is and where it is in this article, and not be moved to the Marinol article now or in the future because it belongs in this article," after reading the four points I made in support of that statement, I think you do not have a good reason to disagree with it!  And if I'm wrong, please post the reason!206.59.60.140 19:49, 8 February 2006 (UTC)

Consensus again
Does anybody have a good reason to drastically change the paragraph on Marinol or move the paragraph to the Marinol article in the future?

(Please read my four points against drastic change and against moving the paragraph to the Marinol article before you answer the question!)
 * I changed the question to make it more clear. 206.59.60.140 20:19, 8 February 2006 (UTC)

I don't think drastic changes are needed, here's why?:


 * 1. There is just one paragraph on Marinol in this article. It is in the "experimental treatsments" section.  It is made clear that the research is only preliminary.


 * 2. In spite of the fact that Greg accused me (or at least somebody who posted to this article) of getting into the "politics of illegal drugs" and being pro "medical-marijuana" when it comes to Marinol (legal by Rx in all 50 states) Greg is wrong! In fact, this could actually be an arguement AGAINST medical marijuana, because it appears that the legal alternative (Marinol) is supperor to marijuana for treating TS!  Greg should assume good faith, and learn that marijuana and Marinol are not the same thing.

The information does not belong in the Marinol article because:


 * 3. The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article.  That sort of information belongs in the articles about specific conditions.


 * 4. Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!


 * Well, nobody has disagreed with me so far... so I decided to highlight a this subsection before I delete the stuff on Marinol. But I do think we have a consensus!


 * As I explained when you raised this earlier, it's not clear that there is consensus, and the discussion should stand, in case some future editor wants to review the issue. Deleting a discussion after only a week or ten days seems premature, and is rarely if ever done on discussion pages.  I'm not sure, but deleting talk discussions may be considered vandalism on Wikipedia.


 * If you are concerned that I may edit the items and move them to the appropriate sections as discussed, I won't do that until/unless there is more concurrence, so I respectfully suggest that relaxing about this issue for now may help.


 * It would also help if you would start attaching a signature to your entries, so we can follow the conversation easier. All you have to do is put four tildes in a row (~) after each entry, and the date will be included, along with your IP address, which is already included on your entries anyway. Sandy 18:26, 8 February 2006 (UTC)


 * Okay, if you don't believe there is a concensus that the paragraph on Marinol should remain as it is, where it is, can you at least provide a reason why you disagree? If you do not disagree personally, then I will wait for someone else to come up with a reason to disagree with keeping the Marinol paragraph as it is where it is and let them post their reason!206.59.60.140 18:43, 8 February 2006 (UTC)
 * But you can't just say "I disagree" without providing a good reason to disagree. If nobody provides a reason to actually disagree, then removing the stuff on Marinol is the right thing to do.  Why?  Because if nobody has a reason to disagree then a concensous has been reached!  Some people may not like the fact that a concensous has been reached, but if they can't come up with a reason to disagree, then there is a concensus!206.59.60.140 18:43, 8 February 2006 (UTC)


 * Thanks for signing the entry -- that will really help make the conversation easier to follow. As I see you are also concerned about the length of some of these discussions, maybe you will feel encouraged to take some of the more personal discussions to personal talk pages?  You can do that by clicking on the person's user name, and from there, click on "Discussion" to go to their talk page.  Even better, you can register and set up your own talk page :-))  I hope that's an idea that may help.  I've already addressed the issue of consensus, both Greg and I have explained our reasons, and I've mentioned that I have no plans to change the entries for now.  How about we just relax?   :-))   Sandy 18:46, 8 February 2006 (UTC)
 * It is usually wiki policy (or at leat it is a precident in other articles) to remove long discussion on the talk page after a concensous has been reached.
 * I want an agreement not to move the Marinol paragraph because that is where it belongs. I certainly have compromised and worked with you guys, but you are not at all justified in moving the paragraph to the Marinol article now or in the future!  Here's my reasoning again:


 * The Marinol article just has information on what Marinol is and what it has been approved for. It has been used experimentally in treating all sorts of things, and therefore there is no laundry list of all Marinol research for all conditions in the Marinol article.  That sort of information belongs in the articles about specific conditions.


 * Many medications' names have been posted to this article, and many of these medications have their own articles in wikipedia that don't mention Tourette's Syndrome at all! So the standard precident, in this very article and on wikipedia, is: Information about off the label research on a drug for treating a specific condition belongs in the article about the specific condition, not the article about the drug!


 * So do you have any reason to disagree that the Marinol paragraph should stay in the article, now and in the future?


 * I am not following your logic -- it's possible I'm not understanding what you're asking? I think you want to delete large sections of this talk page?  Please check the Wikipedia guidelines for vandalism.  I'm fairly certain that deleting talk page entries is considered vandalism.  Further, it's not my call or your call to decide that Greg's comments, for example, can be deleted.  Also, the discussion is recent, other editors may come along and need to read the discussion.  That is the purpose of talk pages. Sandy 18:49, 8 February 2006 (UTC)


 * I'm asking if you have a reason to disagree with the two points I made above about the why the paragraph belongs in this article and not in the Marinol article.206.59.60.140 18:55, 8 February 2006 (UTC)
 * Also it is fine with me to keep these talk pages here, unless we get a concensus otherwise. But I mainly want to see if anybody can come up with a good reason to disagree with the statement at the beginning of this section. 206.59.60.140 19:08, 8 February 2006 (UTC)

Please do not continue altering the talk page. These changes significantly alter a conversation in which others have engaged, and changes the context. Sandy 20:56, 8 February 2006 (UTC)

Suggested wording to incorporate consensus
The current entry, which started on 26 Jan, and became an ad hominem issue about the TSA on 28 Jan, is now in better shape, consolidated under Experimental treatments. I continue to concur with Greg, however, with respect to the Marinol entry. Neither marijuana nor Marinol are currently useful in the treatment of Tourette's, nor are they likely to become useful treatments in the near future. Reference, What Wikipedia is not -- a soapbox. The considerable contributions of Unsigned User can be moved to Marinol and marijuana. Here is my suggested wording to incorporate both Greg's and my concerns over the length and relevance of the Experimental treatments section. Suggested wording Nicotine showed preliminary promise in case reports, but these effects were not reproduced in well-controlled trials several years later. Studies of nicotine derivatives (mecamylamine, inversine) also showed that they were not effective as monotherapy for the symptoms of Tourette's. Deep brain stimulation has been used in treating a few patients with severe Tourette's, but is regarded as an experimental and dangerous procedure that is unlikely to become widespread. Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome. Case reports found that marijuana helped reduce tics, but validation of these results requires longer, controlled studies on larger samples. Preliminary research on Dronabinol, synthetic THC in pill form (brand name Marinol®) as a treatment for Tourette's syndrome was promising, but there are concerns about the safety of Marinol, and longer, controlled studies on larger samples are needed. Sandy 01:10, 16 February 2006 (UTC)
 * "There are concerns about the safety of Marinol" is far to POV. Just because somebody is "concerned" that Marinol causes cognitative impairment, for example, is meaningless.  The research shows that Marinol is quite safe and no concerns were raised by the actual trials.  You have to have a REASON to be concerned.  It just so happens that the only controlled studies on Marinol and TS are very positive.  I'm sorry if you wise they were not.  But you are not going to cover up something!  At the very least, the concerns about cognative impairment were actually addressed by actual controlled scientific trials and it found that cognitive functioning improved!  They did a study on cognative impairment JUST TO ADDRESS THAT CONCERN!  The actual science does not give a reason to be concerned about Marinol's safety!206.59.61.72 22:54, 16 February 2006 (UTC)

Other - Links, Prevalance & Reliable Sources
I deleted the following sentence as I can't understand what it says or means. "No one has proposed using the qualified criteria "the disturbance causes, or has caused, marked distress or significant impairment in social, occupational, or other important areas of functioning at some time in their life" as a compromise."

Also, the recent edits have blurred the line between symptoms and diagnosis, introducing elements of each into the other section.

The article needs a complete rewrite, as very little of what remains is an accurate medical reflection of Tourette's. It would be helpful if proposed changes were brought to the talk page for discussion.


 * The article does not need a complete rewrite. I deleted some things from diagnosis section, and it is close to where it was a few days ago.  However, it would be nice to have a link to the website (which was the Tourette's Disorder website) that provided the "4 or 5 in 10,000" figure.  But I did not add the link, because I know some people would object.


 * There are multiple grounds to object to that website, including potential copyright, authenticity, and verifiability. According to the principle of Verifiability, the Tourette's disorder website you referenced should not be cited as a reference source here.  It is a source of dubious reliability and a self-published source, without mentioning the copyright issues and the allegation of a "PhD" title, from a non-accredited "institution".


 * Another argument against referencing the website, tourettes-disorder.com (and its numerous redirects and mirror sites), is that even if the "PhD" were from a legitimate accrediting agency, according to WP:RS, "Beware false authority. Try to use sources who have degrees in the field they are discussing. The more reputable ones are affiliated with academic institutions. The most reputable have written textbooks in their field for the undergraduate level or higher: these authors can be expected to have a broad, authoritative grasp of their subject." In other words, the most reputable sources in TS are Leckman, Cohen, Kurlan, (soon-to-be) Walkup, Goetz, Jankovic, as they have prolificly published in peer-reviewed journals, and are authors/editors of the current medical textbooks on Tourette's, and some (Leckman at least) affiliated with academic institutions.  On the same grounds, we should delete the external link to the Tourette Spectrum Disorder Association, as its advisory board fails to achieve the criteria established in WP:RS. On the same premise, Comings has some (very old) peer-reviewed, published research, but MOST of his work is self-published by his own vanity press, Hope Press, with no editorial oversight.  Sandy 14:32, 9 February 2006 (UTC)


 * I think we can probably find a valid reference source for that number, as I have seen several reputable sources which reference that range. (No, I cannot concur that the Tourette's Disorder website meets Wiki's Verifiability criterion, particularly because it was not authored by a professional and the problems with the dubious use of the "PhD" title.)  The most recent numbers I have seen state that the range may be between 1 and 10 per 10,000, so I don't imagine anyone will object to the 4 or 5 number being presented.  However, I do think the article now needs a complete rewrite, for a large number of reasons.  Perhaps we can discuss those reasons before any more major changes are made ??  64.12.116.13 04:21, 3 February 2006 (UTC)

The information above highlights the problem with unreliable sources.
 * Zinner, Pediatrics in Review Nov 2000 puts the prevalence at 5 to 10 per 10,000.
 * Scahill et al, Advances in Neurology 2001 puts it at 10 to 30 per 10,000.
 * Peterson et al, J. Amer Acad Child Adolesc Psychiatry 2001 puts it at 26 per 10,000.
 * Khalifa, Dev Med Child Neurol 2003, puts it at 60 per 10,000.
 * Hornsey et al, J Child Psychology Psychiatry 2001, puts it at 80 per 10,000.
 * Kurlan et al, Neurology 2001, puts it at 80 per 10,000 in regular education classes, with a much higher number in special ed classes.
 * Kadesjo et al, J Amer Acad Child Adolesc Psychiatry 2000, puts it at 115 per 10,000.

So, we find current estimates ranging from 5 per 10,000 to 115 per 10,000 if we actually review the current research. All of these studies reflect different issues of methodology, clinical ascertainment, differing diagnostic criteria, and method of observation. Presenting an absolute number can be misleading in the face of so much difference. All of these, but in particular the large, community-based samples (Kurlan 2001 and Khalifa 2003) suggest that the prevalance of Tourette's is much higher than previously reported. Both Kurlan and Khalifa used DSM-IV, which included the significant impairment criteria, which has since been dropped. None of these sources used DSM-IV-TR, so actual numbers using the current diagnostic criteria could be even higher. Some "official" sources still quote the older numbers, based on older research, and some layperson's websites have parroted those numbers without reading the research. A full discussion of the newer data is warranted, particularly since it appears that none of the standard "official" sources are reporting these numbers on their webpages. Nonetheless, all of the current literature includes wording to the effect that Touertte's syndrome is no longer considered to be a rare disorder. Sandy 22:14, 3 February 2006 (UTC)


 * It depends on what you define as rare. I think anything that affects 0.5% of the population is fairly rare.  Also, since the TSA (which you claim the the foremost authority on TS) said the number of people who have ANY tic disorders was 1 in 200, which equals 50 in 10,000.  Therefore, I think the numbers than claim that there are more than, or even too close to 50 in 10,000 people who have Tourette's Syndrome are suspect because all tic disorders combines are 50 in 10,000!


 * We aren't the ones doing the defining. An encyclopedia reports it as it is.  Multiple referenced medical journal articles clarify that it is no longer considered a rare disorder, based on numerous large community-based studies on prevalence.  Sandy 18:34, 8 February 2006 (UTC)


 * With respect to the other links added, please see What Wikipedia Is Not. Wikipedia is not a repository of links or a free webpage or a search engine.  I understand your concern that information not be restricted only to TSA websites, but there are other valid medical websites out there (such as the NIH, WEMove and others) which can be referenced, in order to comply with Wikipedia's policies.  For example, the TSDA seems to comply, while pages which are just links of links do not.  64.12.116.13 04:31, 3 February 2006 (UTC)

Andre Malraux
Malraux certainly had TS. Many books on Malraux say so... I put the link in to cite a biography that mentions his TS, but if the link is somehow offensive, feel free to delete it. But Malraux did have TS.


 * I found a reputable source. TS Foundation of Canada mentions Malraux.


 * Another source is the book "Malraux: A life."

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)