ALTERNATIVE THERAPIES
Diet/Allergy
INTRODUCTION
Since its inception, the Tourette Syndrome Association has received letters
from individuals, families, doctors, and other researchers regarding the
successful control of TS symptoms through the use of treatments other than
the medications referred to in previous chapters. These reports may frequently
be quite dramatic and convincing. All of us interested in TS eagerly look
forward to the development of alternative treatments, pharmacological or
otherwise, which are free of the many side effects and disadvantages associated
with the medications presently available. However, the TSA Medical Committee
feels an obligation to lend its expertise in evaluating these reports and
to put them in their proper perspective.
It must be emphasized that none of the "alternative therapies"
mentioned herein have been proven effective by scientific study. It should
also be pointed out that there is approximately a 25% rate of spontaneous,
transient decrease in symptoms inherent in the waxing and waning which are
characteristic of TS. Related tic disorders may have considerably higher
rates of remission or transient amelioration. Therefore, in order to provide
scientific validation of any treatment modality, the improvement in symptoms
subsequent to its use must be significantly higher than the rate of spontaneous
improvement of the disorder. Scientific studies have been conducted which
demonstrate a significantly high rate of improvement with such drugs as
haloperidol (Haldol), Clonidine (Catapres), and some others. No such statistics
are available for the "alternative therapies."
On the other hand, it has generally been acknowledged that TS and tics may
actually encompass a variety of different disorders with different causes.
Therefore, certain treatments may be valid only for some individuals. Other
treatments may be only mildly effective in most individuals, may be effective
enough in a individual with mild symptoms, or may be effective as an adjunct
to one of the standard medications.
Five physicians responded to the call for information on alternative therapies.
All had had some degree of success with allergy control, either through
the elimination of certain allergenic foods from the diet or by desensitization
to known allergens (via inoculation). One doctor reported on three different
dietary approaches which he found to be effective for different subgroups
of patients: 1. B vitamins with reduced milk intake; 2. B vitamins with
increased dietary choline; 3. Reduced dietary gluten. This doctor also observed
that the harmful effect of allergens may be compounded by the use of certain
decongestant preparations which may be prescribed or bought over-the-counter.
Another physician wrote that "A minority of patients...have total relief
of their tics on a dietary basis, but that dietary management does seem
to cause some symptomatic relief in up to a third of the patients."
His experience was with children only. This physician emphasized that his
experience has convinced him "that Tourette's is not a single entity,
but a multiplicity of different conditions" and that "tics, hyperactivity
and/or behavioral problems are three separate and, at times, interrelated
problems." Dietary restrictions were varied to meet the needs of individual
patients, but usually consisted of the Feingold diet or a modification thereof,
eliminating additives, preservatives, artificial coloring and flavoring.
SUMMARY
The popular concern with nutrition as an influence on behavior reflects,
and has also stimulated, a growing general concern among the scientific
community. It will take time, however, for science to separate truth from
rumor or exaggeration. The Medical Committee has available to it various
reports sent in on "alternative therapies." These will be kept
on file and, when appropriate, may be shared with interested physicians,
other qualified researchers, and interested families. Rather than encouraging
families and patients with what are, as yet, claims unsubstantiated by scientific
studies, the Medical Committee sees its role as encouraging interested parties
in pursuing carefully designed clinical studies of new treatment approaches.
Please be advised that some of these treatments may have harmful side effects
and that there are also anecdotal reports of cases which have worsened by
some of these treatments. Therefore, before trying any of these therapies,
we urge you to consult with a physician.
Diet and Allergy is taken from "Commentary on Alternative Therapies
for Tourette Syndrome" from the TSA Newsletter, Fall/Winter
1983-84.
Behavioral Therapy
Relaxation Training
Relaxation training has been used in a number of studies as a behavioral
therapy for TS. This training involves the conscious relaxation of the muscles.
In each study the number of tics and the frequency of tics were greatly
reduced. In some cases the tics were completely eliminated while in the
relaxed state. This decrease in symptoms, however, was usually temporary
with the tics returning to baseline levels after a few hours or days. Another
limitation of these studies was the small number of subjects studied. Additionally,
no published study to date has evaluated the independent effectiveness of
relaxation training in treating TS.
Self-monitoring
There have been four studies where self-monitoring has been used with TS
subjects as the major source of symptom management. Self-monitoring involves
the identification of certain tics and the use of a hand-held counter to
count the tics. All showed a significant decrease in tics. Again, the study
results were limited by the short time and small number of subjects.
Habit Reversal
There have been several studies where habit reversal has been evaluated.
The primary feature of habit reversal is the use of competing responses
to prevent the occurrence of tics. The competing response for each tic was
developed by practicing a competing or opposite movement. Results showed
an approximate decrease in tics by 64%. Again, the study results were limited
by time and number of subjects.
Peterson and Azarin evaluated the effectiveness of self-monitoring, relaxation
training, and habit reversal in six TS patients. Their results showed that
habit reversal led to the largest overall average percent reduction in tics.
Self-monitoring yielded less of a reduction in the number of tics than habit
reversal. It was noted, however, to be more effective than relaxation training.
They also found that self-monitoring had an unexpected iatrogenic effect
in two patients. These patients increased their total number of tics by
52%.
The limitations of this study, again, include small number of subjects and
the short amount of time involved in this trial.
Hypnobehavioral Treatment
There have been a couple of studies done on the effectiveness of hypno-therapy.
In the first study the subject was taught to discriminate tic behaviors
from other motor behaviors. Simultaneously, self-hypnosis training was initiated.
This involved relaxation techniques and visual imagery for deepening of
the trance. Skill application and problem resolution was followed by aiding
the subject to concentrate and focus on the urge that preceded the need
to tic. They then determined the competing muscle and practiced habit-reversal
techniques.
This resulted in a significant decrease in tics. Limitations of this study
obviously would include the limited time and number of subjects, as well
as the limited time involved in follow-up.
The second study involved four subjects who were receiving medication together
with the hypno-therapy. The approach used in the hypno techniques were very
similar to those of the above study. The findings were also similar and
lasting in their group of subjects. The additional benefit of a decrease
in medication required to control symptoms was significant.
References
An Evaluation of Behavioral Treatments for TS, Alan L. Peterson and Nathan
H. Azrin, Behavioral Res. Therapies. Vol 30, No.2, 1992;167-174.
Great Britain.
Relaxation-Imagery (Self-Hypnosis) in Tourette Syndrome: Experience with
Four Children, Daniel P. Kohen, Minneapolis Children's Med. Cntr., Pamela
Botts, The Bert Nash Community Mental Health Center, Inc., American J
of Clinical Hypnosis, Vol.29, No. 4, April 1987.
Young MH, Montano RJ: A New Hypnobehavioral Method for the Treatment of
Children with Tourette's Disorder, American J of Clinical Hypnosis. Vol.
31, No. 2, October 1988.
REPRINTED WITH PERMISSION FROM:
Wang, C., & Curry, L. (Eds.) Tourette Syndrome A Continuing Education
Course for Registered Nurses, Tourette Syndrome Association - Southern California
Chapter. TSA-SC Reseda, CA 1993.
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