http://www.msnbc.msn.com/id/20429230/site/newsweek/ Taking On Tourette's A new approach to stopping tics before they happen offers hope to thousands who live with the disorder. By Catharine Skipp and Arian Campo-Flores Newsweek Sept. 3, 2007 issue - Marg Mackrell was just 3 when her parents noticed the first signs of what turned out to be Tourette syndrome. The blond toddler began sniffing her fingers repeatedly, and over the next six years, her uncontrolled tics came to include clicking, whirring and scrunching her nose. Her condition was manageable (she attends school with other kids) until last year, when, at the age of 9, she began to suffer about 60 episodes a day of repeated head jerks that left her sore and spent by nighttime. So when MacKrell's parents learned about an old but little-used therapy called habit-reversal training (HRT), they decided to try it. Last November, Marg started learning new ways to pre-empt her most severe tics at the Child and Family Study Center at Duke University Medical Center in Durham, N.C. When she felt a head jerk coming on, she was taught to drop her head and stare at the second hand on her watch for a minute. "Soon [the head jerking] was down by 90 percent," says Marg's mother, Diane MacKrell. "I couldn't believe it." An estimated 200,000 Americans have the most severe form of Tourette syndrome, a neurological disorder sometimes marked by outbursts of jerking or swearing. In addition, as many as 1 in 100 exhibits milder symptoms of the disorder. Tourette's Syndrome is usually treated with drugs, including antipsychotics and antidepressants. While they can be effective in controlling symptoms, they are often accompanied by bothersome side effects, including lethargy and weight gain. Now, with the help of a $5.4 million grant from the National Institute of Mental Health, researchers at six universities, including UCLA and the University of Texas at San Antonio, are taking a fresh look at HRT, which was originally developed in 1973 as a treatment for problems like chronic nail biting. The results so far have been encouraging. HRT has "the potential to bring significant relief to Tourette's Syndrome sufferers without the serious side effects characterizing most Tourette's Syndrome medications," says Dr. John Piacentini of UCLA. In theory, HRT substitutes a competing actionlooking at a watch, for examplefor a disabling or socially embarrassing tic. Patients undergoing HRT learn to recognize the so-called premonitory urges that precede their tics. They are then taught how to counteract the approaching tic with an opposing response. Before a tic, Marg says, she feels "energy in my body that feels like it needs to get out. It's like a balloon." Rick Shocket, 9, also undergoing HRT therapy at Duke, has had a tic that involves squatting after every step. To divert it, he's been taught to lock his knees and count to 60 when he feels it coming on. After just three therapy sessions, he has managed to get a handle on the squatting and many of his other tics, which include neck jerking and eye movements. HRT is "another tool in my tool belt," he says. Yet the treatment remains controversial. Many doctors believe tics can't be suppressed, or that suppressing them only aggravates them, though more than two dozen studies suggest that isn't so. "We don't see a particularly important role for the behavioral therapy," says Dr. Roger Kurlan, a neurologist at the University of Rochester, who usually uses medication when his Tourette's Syndrome patients need treatment. "I'm not sure it has any effect on the underlying condition." Critics also complain that depicting tics as "habits" that can be reversed ignores the underlying biology of Tourette's. (Imaging studies suggest that tics involve a disruption of normal brain processes.) "We in the Tourette community have fought hard to get insurance companies to understand that this is a genetic neurological disorder," says Leonard Misner, 39, who has Tourette's and opposes HRT. Dr. Alan Peterson, an HRT researcher at UT San Antonio, says Tourette's Syndrome, like other disorders, can be behavioral and biological. "There are all kinds of medications and genetic work being done to help people with type 2 diabetes. But the largest study that's been done proved lifestyle modification can cure it." David Retano, 34, welcomes the new approach. He tried HRT after years of severe tics, including swearing and punching himself. He's managed to control nearly all the tics involving his face and head. A troubling one remains, though: his tendency to thump his wife when they embrace. "I just don't hug her much," he says. Perhaps with continued HRT, they'll finally be able to snuggle in peace. © 2007 Newsweek, Inc.