Hypothesized treatment for migraines using low doses of tryptophan, niacin, calcium, caffeine, and acetylsalicylic acid.

The author hypothesized that existing agents known to influence serotonin blood level, vascular tone, and inflammatory reactions might terminate migraines. The author presented the rationale for using five different agents therapeutically and avoiding two other agents during a migraine. The proposed treatment is to use low doses of tryptophan, niacin, calcium, caffeine, and acetylsalicylic acid (ASA) soon after migraine symptoms are noticed and to avoid during a migraine high-potassium food and magnesium supplements. Preliminary results from 12 migraine patients indicated that 9 of 12 (75%) had significant benefit from this approach. Using these five agents together is a novel combination and a new idea for treating migraines.

Neuroleptic-induced dementia documented in four adults with mental retardation.

This is the first report to my knowledge of neuroleptic-induced dementia in adults with mental retardation. Four adults showed full recovery after having significant cognitive deterioration that persisted until the offending medication was withdrawn. The ages at onset of dementia were 37, 37, 39, and 55 years; the duration of dementia ranged from .5 to 2.5 years. Three adults had Down syndrome and one had mental retardation due to an unknown cause. The neuroleptic-induced dementia occurred while the individuals were on a low dose of either loxapine, thioridazine, haloperidol, or pimozide.

Issues Involved in Recognizing Obsessive-Compulsive Disorder in Developmentally Disable Clients.

Certain unusual behaviors in people with developmental disabilities might be unrecognized obsessive-compulsive disorder (OCD). Compulsions, in persons unable to think abstractly or count, can appear differently from compulsions in persons able to comprehend concepts like contamination and counting sequences. The content of obsessive speech also varies depending on the comprehension and vocabulary of the person with OCD. People not showing classic symptoms of OCD have been at risk for this disorder not being recognized. Researchers report that certain medications are ineffective or worsen OCD, and that developmentally disabled people with undiagnosed OCD are at risk for being put on such medications. This article provides information to facilitate the recognition of OCD in developmentally disabled clients.

Anatomy of self-injurious, stereotypic, and aggressive movements: evidence for involuntary explanation.

Self-injurious movements, common in persons diagnosed with Tourette syndrome, or mental retardation, are typically difficult to eliminate. The author considers the possibility that certain self-injurious movements are involuntary phenomena. An anatomical analysis of high-frequency movements in a patient with severe head slapping is presented by tracing the muscles and nerves involved. The median nerve innervates muscles that bring the hand/arm to the head and also muscles that control this patient's other frequent movements, viz., pill-rolling, thumb-gouging, wrist-flapping, and pinching the neck or cheek. Other patients underwent similar investigation: one who headbangs, one who hits out repetitively, and one with non-injurious stereotypic movements. An anatomical explanation suggests that certain self-injurious, aggressive, and stereotypic movements are involuntary muscle contractions that reflect abnormal innervation along specific nerves.

Serotonin-GABA treatment is hypothesized for self-injury in Lesch-Nyhan syndrome.

The self-injurious movements of Lesch-Nyhan patients are considered extremely severe and currently intractable. Lesch-Nyhan syndrome is a genetic disorder of purine metabolism resulting in several abnormalities, one of which is elevated levels of xanthine. The author reasons that elevated plasma xanthine sets off a chain of events that produce excessive endogenous convulsants and diminished endogenous anticonvulsants. Treatment is proposed for self-injury in Lesch-Nyhan that entails reducing production of two endogenous convulsants (kynurenine and quinolinic acid) and enhancing two endogenous anticonvulsants (serotonin and gamma aminobutyric acid).

The self-injury hypothesis: addressing a neurologist's concerns.

Coulter (1991) concluded that a "poor study design" (p. 81) was used and my hypothesis was unproven. My article was not an experimental study in the sense of presenting experimental data intended to confirm or deny my hypothesis. Rather, it: 1. Described remarkable similarity between movements in patients with mental retardation during self-injury episodes and reports in the literature of involuntary movements during confirmed frontal lobe seizures; 2. Pointed out that the movements by some patients with mental retardation were so frequent and/or forceful that self-injury resulted; 3. Presented the hypothesis that the movements by patients with mental retardation may, in some cases, be involuntary and due to undiagnosed frontal lobe seizures; and 4. Suggested that if this hypothesis were correct, then one ought to consider what sort of treatment approaches might reduce the incidence/severity of frontal lobe seizure episodes. I agree that a well-designed experimental study to test my hypothesis would be very desirable. The preceding literature review has shown how difficult it would be using present methods to do a definitive study that rigorously confirms or rejects my hypothesis. Other approaches might be considered for testing my hypothesis with persons who are unable to give informed consent. One approach using rigorous observable criteria was suggested. In the interim, it seemed worthwhile to present my hypothesis to mental retardation professionals with the hope that others would consider this possibility and its implications for diagnosis and treatment, and the hope that some patients might benefit sooner rather than later. I appreciate Coulter's (1991) comments because they provided an opportunity to clarify potential misunderstandings. It is possible that other readers have had similar concerns, and I trust that this is the appropriate forum for addressing such matters.

Serotonergic treatment for aggression in a Down's syndrome adult showing signs of Alzheimer's disease.

Sudden-onset, unprovoked aggression has typically been difficult to reduce or eliminate in persons with mental handicaps or dementia. Several medications have been reported in the literature with varying success, though some risk serious side effects. This study tested the effectiveness of a low dose antidepressant (trazodone) with a serotonin-enhancing diet to reduce aggression while not risking serious side effects. Aggression decreased by 96% in a mentally handicapped adult with Down's syndrome showing signs of Alzheimer-type dementia. The benefit was robustly demonstrated using an on-off-on-again design with detailed recording for nearly 4 months.

Tourette syndrome attributed to frontal lobe dysfunction: numerous etiologies involved.

The etiology of Tourette Syndrome (TS) according to prevailing views is unknown; there is evidence for both familial and sporadic cases. The author theorizes that abnormal discharges in the frontal lobes comprise the "final common dysfunction" that results in numerous phenomena labelled Tourette syndrome. Facial, vocal, and other motor symptoms of TS are catalogued in parallel with facial, vocal, and body movements that occur during frontal lobe seizures. The variety of etiologies that cause frontal lobe seizures--when applied to TS--can account more readily for heterogeneity of clinical presentations, the numerous "dual diagnosis" cases, and differential response to medication than can a single-gene theory.

Frontal lobe seizures in autism.

The set of features that constitute 'autism' has been traced to numerous etiologies. Certain autistic features have been localized to dysfunction in certain neural areas, most notably frontal and temporal regions. The author hypothesizes that many of the symptoms characteristic of autism fit the clinical picture of frontal lobe seizures. Facial, vocal, and other body movements in autism are catalogued in parallel with facial, vocal and body movements that occur during frontal lobe seizures. The variety of etiologies that cause frontal lobe seizures also accounts for the variety of etiologies traced to autism.

Dietary increase in serotonin reduces self-injurious behaviour in a Down's syndrome adult.

A 26-year-old profoundly mentally handicapped woman with Down's syndrome and severe self-injurious behaviour was treated by dietary means. Treatment consisted of regular institutional entrees, supplemented with serotonin-containing foods, and modified to ensure dietary sources of potassium each intake and low protein relative to carbohydrate. Dramatic benefit was evident the first day and, after 6 months self-hitting was still close to 90% lower than baseline rates. Relevant literature was discussed regarding why a serotonergic approach was chosen for reducing self-injury.

Severe head injury hastens age of onset of Alzheimer's disease.

Head trauma has been found with greater frequency in the histories of Alzheimer patients than age-matched controls in some studies, but not in others. We hypothesized that events that accelerate neuron loss, such as significant head trauma, hasten the onset of symptoms of Alzheimer's disease in persons vulnerable to the disorder. Retrospective data on 148 probable Alzheimer patients and 33 demented controls were examined. Alzheimer patients with severe head injury before the age of 65 showed onset of symptoms at an earlier age than Alzheimer patients without head trauma.

Episodic rage and aggression attributed to frontal lobe seizures.

Episodic rage and aggression in mentally handicapped people have typically been very difficult to eliminate or even reduce. Behaviour modification programmes designed to reduce extremely aggressive outbursts are based on various theories which presume these behaviours are volitional. This paper considers the possibility that these behaviours are involuntary and probably due to frontal lobe dysfunction. Twenty extremely aggressive cases are reported which present the clinical picture of frontal lobe seizures. Specific eye, face, trunk and limb movements plus vocalizations are extracted from the neurologic literature on frontal lobe seizures. A similarity with Tourette syndrome is noted.

Extreme self-injury attributed to frontal lobe seizures.

Extreme self-injury (e.g., head-banging, skin-gouging, and self-biting) among mentally retarded people has typically been very difficult to reduce or eliminate. Clinicians design behavior programs to reduce these behaviors based on various theories that presume this is volitional behavior. In this study specific limb and eye movements plus other ictal phenomena were catalogued from the neurologic literature on frontal lobe seizures. Ten patients were described who presented the clinical picture of frontal lobe seizures. Extreme self-injury in some brain-damaged persons was therefore regarded as involuntary, and need for recognition of this behavior as frontal lobe dysfunction, not a "behavior problem" under voluntary control, was noted.