European clinical guidelines for Tourette syndrome and other tic disorders. Part II: pharmacological treatment

To develop a European guideline on pharmacologic treatment of Tourette syndrome (TS) the available literature was thoroughly screened and extensively discussed by a working group of the European Society for the Study of Tourette syndrome (ESSTS). Although there are many more studies on pharmacotherapy of TS than on behavioral treatment options, only a limited number of studies meets rigorous quality criteria. Therefore, we have devised a two-stage approach. First, we present the highest level of evidence by reporting the findings of existing Cochrane reviews in this field. Subsequently, we provide the first comprehensive overview of all reports on pharmacological treatment options for TS through a MEDLINE, PubMed, and EMBASE search for all studies that document the effect of pharmacological treatment of TS and other tic disorders between 1970 and November 2010. We present a summary of the current consensus on pharmacological treatment options for TS in Europe to guide the clinician in daily practice. This summary is, however, rather a status quo of a clinically helpful but merely low evidence guideline, mainly driven by expert experience and opinion, since rigorous experimental studies are scarce

An endogenous nanomineral chaperones luminal antigen and peptidoglycan to intestinal immune cells.

In humans and other mammals it is known that calcium and phosphate ions are secreted from the distal small intestine into the lumen. However, why this secretion occurs is unclear. Here, we show that the process leads to the formation of amorphous magnesium-substituted calcium phosphate nanoparticles that trap soluble macromolecules, such as bacterial peptidoglycan and orally fed protein antigens, in the lumen and transport them to immune cells of the intestinal tissue. The macromolecule-containing nanoparticles utilize epithelial M cells to enter Peyer's patches, small areas of the intestine concentrated with particle-scavenging immune cells. In wild-type mice, intestinal immune cells containing these naturally formed nanoparticles expressed the immune tolerance-associated molecule 'programmed death-ligand 1', whereas in NOD1/2 double knockout mice, which cannot recognize peptidoglycan, programmed death-ligand 1 was undetected. Our results explain a role for constitutively formed calcium phosphate nanoparticles in the gut lumen and show how this helps to shape intestinal immune homeostasis

Phytochemical studies and effect on urine volume of <i>Glossostemon bruguieri </i>Desf. constituents

186-189Two new flavonoids, takakin 7-O-glucoside (1) and bucegin 7-O-glucoside (2), and six other known compounds (3-8), takakin, isosctullarien, its 7-O-glucoside, takakin 8-O-glucoside, xanthotoxin and esculetin, were separated and identified from Glossostemon bruguieri. The new compounds were characterized using modern spectroscopic techniques, including UV spectroscopy, proton nuclear resonance (1HNMR), carbon thirteen nuclear resonance (13C NMR), homomolecular quantum coherance (HMQC), heteromolecular bonding connectivity (HMBC) and chemical ionization mass spectra (CI). The effect on rats urine volume of the plant powder, its ethanolic extract, (500 mg kg-1) along with four of the purified compounds (1,4-6), ( 100 mg kg-1) are described. Eight groups of albino rats (200-300 g body weight) (n=5 for each group) were used in the tests for a one-time treatment , and other seven groups (150-180 g body weight) (n=5 for each group) were tested using the same dose with repeated administration for 15 days. The rat sera were collected and used to determine liver and kidney functions based on alanine amino transferase (ALT) and aspartate amino transferase (AST) for both single and repeated administration. Levels of urea, creatinine and uric acid were determined for both sets of experiments. The toxic effects of both the powder and its alcoholic extract were also studied on mice to determine their LD50, both materials proved to be non-toxic up to 2500 mg kg-1 body weight

The use of botulinum toxin A in children with cerebral palsy, with a focus on the lower limb

Purpose The purpose of this review is to clarify the role of botulinum toxin serotype A (BTX-A) in the treatment of children with cerebral palsy (CP), with a special focus on the lower limb. Background The treatment of spasticity is central in the clinical management of children with CP. BTX-A blocks the release of acetylcholine at the motor end plate, causing a temporary muscular denervation and, in an indirect way, a reduced spasticity. Children with increased tone develop secondary problems over time, such as muscle contractures and bony deformities, which impair their function and which need orthopaedic surgery. However in these younger children, delaying surgery is crucial because the results of early surgical interventions are less predictable and have a higher risk of failure and relapse. As BTX-A treatment reduces tone in a selective way, it allows a better motor control and muscle balance across joints, resulting in an improved range of motion and potential to strengthen antagonist muscles, when started at a young age. The effects are even more obvious when the correct BTX-A application is combined with other conservative therapies, such as physiotherapy, orthotic management and casts. There is now clear evidence that the consequences of persistent increased muscle tone can be limited by applying an integrated multi-level BTX-A treatment approach. Nevertheless, important challenges such as patient selection, defining appropriate individual goals, timing, dosing and dilution, accuracy of injection technique and how to measure outcomes will be questioned. Therefore, ‘‘reflection is more important than injection’’ remains an actual statement.status: publishe