Neuroanatomy of coprolalia in Tourette syndrome using functional magnetic resonance imaging

OBJECTIVE: To determine the neural substrates of phonic tics in Tourette syndrome (TS) using functional magnetic resonance imaging (fMRI) and compare with a proposed tic-generating network (TGN). PATIENTS: One with TS and one normal control. METHODS: fMRI scans were obtained on the TS patient during which numerous unsuppressed phonic tics occurred and, along with the scanner noise, were recorded on audiotape. The control underwent the same functional MRI sequence but mimicked the tics within predetermined, on-off time blocks. Fuzzy clustering (FC) methods were used to generate the activation maps. RESULTS: The TS patient and control showed fMRI activation in the left middle frontal gyrus and right precentral gyrus. The TS patient also had activity in the caudate nucleus, cingulate gyrus, cuneus, left angular gyrus, left inferior parietal gyrus, and occipital gyri. CONCLUSIONS: fMRI, using an FC analysis, is a viable technique for studying TS patients with phonic tics. These results give further support to the hypothesis of a tic-generating circuit model. Further studies are required to confirm our data.     

Hearing in the elderly--the Framingham cohort, 1983-1985: Part II. Prevalence of central auditory processing disorders.

The relation between central auditory processing disorders (CAPD) and age has been described in selected subjects. However, the prevalence of CAPD in the general population has not been established. We tested 1026, 64- to 93-yr-old members of the Framingham Heart Study cohort with Central Institute for the Deaf W-22 lists (CID W-22) in quiet, the Synthetic Sentence Identification test with ipsilateral competing message (SSI-ICM), and the Staggered Spondaic Word test. The presence or absence of CAPD could be established with at least one of three indices in 1018 subjects. The CID W-22 performance-intensity function rollover index was greater than 0.20 in 1.4% of 1009 subjects. The difference between maximum CID W-22 and SSI-ICM (0 dB message-to-competition ratio) scores was greater than 20% in 18.2% of 816 subjects. The Staggered Spondaic Word category was moderately, severely, over-corrected moderately, or over-corrected severely abnormal in 10.7% of 941 subjects (using 12-59-yr-olds' norms and adjusting scores when appropriate). Abnormal results on any one index occurred in 22.6% of the subjects. Thus, we conclude that the prevalence of CAPD in the elderly is less common than previous studies would suggest. Furthermore, although the rate of CAPD increased with age, age accounted for no more than 15% of the variability of any of the three indices. Therefore, its presence is dominated by factors other than chronological age.     

Incidence of hearing decline in the elderly

Pure-tone audiometry was done on 1475 persons on two occasions 6 years apart by the same audiologist in the same facility. The age of the subjects ranged from 58 to 88 years at the initial testing and 63 to 95 at the second. The average 6-year threshold change ranged from 1 to 8 dB at 250-6 kHz and 10-15 dB at 8 kHz. The differences in thresholds fell into two patterns, one for low frequencies (250-1 kHz) and the other for high frequencies (4-8 kHz). For the lows, thresholds worsened at an increasing rate with increasing age independent of the initial hearing level, and women's thresholds worsened more than men's. For the highs, the rate of threshold change decreased with age and with the initial threshold at rates that did not differ between genders. Using a change in PTA (0.5, 1, 2 kHz) of greater than 10 dB as a criterion, significant worsening occurred in the right ear in 8.5%, in the left ear in 13.5%, and in both ears of 4.1% of the subjects over the 6 year period. The rate of significant worsening increased with age. Although hearing loss increased with age, age alone accounted for less than 10% of the variance. Therefore, factors that co-vary with age may be responsible. The difference in phenomena between the low frequencies and the highs suggests that two different processes are occurring. Hair-cell degeneration is the most likely cause for the change in the high frequencies. Strial atrophy or other intracochlear processes may be the cause of the low frequency changes.     

Hearing in the elderly: the Framingham cohort, 1983-1985. Part I. Basic audiometric test results

Many studies have documented the decline in auditory function with age. We broaden that data base in this the first of a series of reports emanating from the auditory testing of the Framingham cohort during biennial exam 18. The results of the auditory questionnaire, hearing sensitivity, acoustic compliance measures, and word recognition tests obtained from 1662 men and women in their 60th through 90th decades are presented. Pure-tone thresholds increased with age but the rate of change with age did not differ by gender even though men had poorer threshold sensitivity. Maximum word recognition ability declined with age more rapidly in men than in women and was poorer in men than in women at all ages. Acoustic compliance and middle ear pressure did not vary with gender or age. Acoustic reflex thresholds to a contralateral stimulus at 1 kHz increased slightly with age, more in women than in men; ipsilateral acoustic reflex thresholds did not vary with age or gender. Hearing aids were being used in only 10% of subjects likely to benefit from amplification.     

Effect of adenoidectomy upon children with chronic otitis media with effusion

To investigate the mechanism whereby adenoidectomy influences the subsequent course of patients with chronic otitis media with effusion, we analyzed, on the basis of adenoid size, the outcomes of 476 children randomly assigned to receive, after paracentesis and aspiration of the middle ear, either no treatment, tympanostomy tubes, adenoidectomy, or both. The two groups receiving adenoidectomy did significantly better than those who did not, and the effect was independent of adenoid size. This suggests that reduction of the adenoidal bacterial reservoir may be the mechanism whereby adenoidectomy is effective.     

Intracranial EEG versus flumazenil and glucose PET in children with extratemporal lobe epilepsy

OBJECTIVE: To compare abnormalities determined in 2-deoxy-2-[18F]fluoro-D-glucose (FDG) and [11C]flumazenil (FMZ) PET images with intracranial EEG data in patients with extratemporal lobe epilepsy. BACKGROUND: Although PET studies with FDG and FMZ are being used clinically to localize epileptogenic regions in patients with refractory epilepsy, the electrophysiologic significance of the identified PET abnormalities remains poorly understood. METHODS: We studied 10 patients, mostly children (4 boys, 6 girls, aged 2 to 19 years; mean age, 11 years), who underwent FDG and FMZ PET scans, intracranial EEG monitoring, and cortical resection for intractable epilepsy. EEG electrode positions relative to the brain surface were determined from MRI image volumes. Cortical areas of abnormal glucose metabolism or FMZ binding were determined objectively based on asymmetry measures derived from homotopic cortical areas at three asymmetry thresholds. PET data were then coregistered with the MRI and overlaid on the MRI surface. A receiver operating characteristics (ROC) analysis was performed to determine the specificity and sensitivity of PET-defined abnormalities against the gold standard of intracranial EEG data. RESULTS: FMZ PET detected at least part of the seizure onset zone in all subjects, whereas FDG PET failed to detect the seizure onset region in two of 10 patients. The area under the ROC curves was higher for FMZ than FDG PET for both seizure onset (p = 0.01) and frequent interictal spiking (p = 0.04). Both FMZ and FDG PET showed poor performance for detection of rapid seizure spread (area under the ROC curve not significantly different from 0.5). CONCLUSIONS: [11C]flumazenil (FMZ) PET is significantly more sensitive than 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET for the detection of cortical regions of seizure onset and frequent spiking in patients with extratemporal lobe epilepsy, whereas both FDG and FMZ PET show low sensitivity in the detection of cortical areas of rapid seizure spread. The application of PET, in particular FMZ PET, in guiding subdural electrode placement in refractory extratemporal lobe epilepsy will enhance coverage of the epileptogenic zone.     

Toward a healthy democracy

Because it represents a revival of citizen responsibility, the Healthy Communities movement is not only a health and quality-of-life movement but a civic and democratic movement as well. Healthy Communities efforts need to seek meaningful partnerships with local governments and work their collaborative and citizen-based efforts into formal local political structures. As the foundation of the Healthy Communities movement, civic renewal should be elevated as a major theme and goal for its future.