Ronnas

Hi there, We also had a very similar experience with our son worsening once off the antibiotics. It is hard to believe but we have been dealing with all of this for 5 years and let me tell you with time all of it is just so much easier to deal with. We do still have our ups and downs but nothing compared to a few years ago. A turning point for our son was switching to clindamycin three years ago. He has been on the clindamycin approximately 5 times since then with good results. Having said that we have also treated for yeast, removed milk from his diet and corn, eggs and chocolate to a certain extent (milk is the biggest trigger though), we use essential fatty acids which help ALOT and do use Bonnie's vitamins (though he does not like to take these so we don't fight with him over it). If your doctor is willing I would give the clindamycin a try. It was once we did a trial of clindamycin that we finally did not notice a set back once off the antibiotics. For some reason November to February is always a difficult time for my son. This year we kept him on clindamycin throughout this time and he is doing very well right now...no tics, and MELLOW.........so nice!!! Take Care. Ronna

I recently added more omega 3 to my son's supplements and he also ticced more. I stopped about a week ago and yesterday they were less but still there. A few years ago I supplemented with Bonnie's fish oil and I thought that he reacted badly to them but I guess now I know for sure that he does not do well with too much omega 3. Knowing my son I suspect that within about a week the tics will be better.

Hi Kim, this is a long article but I think it is very good... Omega-3 Fatty Acids: Theory, Clinical Trials and Safety Issues by James Lake, M.D. Psychiatric Times October 2002 Vol. XIX Issue 10 -------------------------------------------------------------------------------- Since the 1930s, research evidence has indicated that certain essential fatty acids (EFAs) are required for normal human fetal and neonatal development (Uauy et al., 1996). An inadequate supply of these fatty acids during critical developmental periods can result in pathological changes in immune function; degenerative changes in the lungs, liver and kidneys; and abnormalities in central nervous system maturation. Other researchers have hypothesized that chronic deficiencies in dietary EFAs can result in an increased incidence of several diseases, including multiple sclerosis, arthritis, enteritis, immune system dysfunction, heart disease, cancer, diabetes, schizophrenia and bipolar disorder (Peet et al., 1999; Rudin, 1982, 1981; Stoll, 2001). This article briefly discusses EFAs, and then reviews the uses of omega-3 fatty acids for treating psychiatric disorders, with attention to efficacy and safety issues. Linoleic acid (LA; 18:2n-6) and α-linolenic acid (ALA; 18:3n-3) are true EFAs. They must be consumed in the diet because humans lack the ability to synthesize them. Food sources of LA include seeds, nuts, grains and legumes; ALA is abundant in cold-water fish (e.g., mackerel, herring, tuna); green leaves of plants; and some seeds, nuts and legumes (flax, canola, walnuts and soy). Linoleic acid and ALA are metabolically transformed into long-chain polyunsaturated fatty acids (LC-PUFAs) in the liver with the aid of many cofactors, including insulin, zinc and several vitamins. Long-chain fatty acids include the omega-6 fatty acids of dihomo-y-linolenic acid (DGLA; 20:3n-6) and arachidonic acid (AA; 20:4n-6) and the omega-3 fatty acids of eicosapentaenoic acid (EPA; 20:5n-3) and docosahexaenoic acid (DHA; 22:6n-3). However, various dietary, lifestyle and disease factors (e.g., oxidative damage, viral infection and hormonal changes) can interfere with the synthesis process. Thus, many individuals may be deficient in long-chain fatty acids, despite an availability of the EFA precursors in their diet. After conversion from LA and ALA in the liver, the LC-PUFAs enter the blood and are incorporated into cell membranes. The fatty acids of cell membrane phospholipids are essential for normal membrane structures, for the functioning of membrane-bound and membrane-associated proteins, and for normal cell-signaling responses. Phospholipid Deficiency Rudin (1982, 1981) and others have suggested that present-day refining and food selection patterns have led to widespread deficiencies of omega-3 fatty acids in some industrialized countries, with a consequent increase in the incidence and prevalence of many medical and psychiatric disorders. According to the phospholipid deficiency hypothesis, there has been an increase in the consumption of plant-derived products high in omega-6 fatty acids concurrent with dietary deficiencies in sources of the omega-3 fatty acids. The resulting increased ratio of omega-6 to omega-3 fatty acids available for metabolism has important consequences for the balance of opposing processes in normal human physiology, as fatty acids are precursors of prostaglandins, the body's principal regulatory molecules. The omega-6 fatty acids are crucial to synthesis of many cytokines that mediate inflammation, including several interleukins, tumor necrosis factor α (TNF-α) and interferon-y (Maes et al., 1997a, 1997b). In contrast, diets high in the omega-3 fatty acids are correlated with reduced overall production of these inflammatory cytokines (Caughey et al., 1996). Some researchers suggest that the shift in the omega-6/omega-3 ratio has led to increases in medical and psychiatric disorders mediated by chronic inflammatory changes. LC-PUFAs and the Brain Phospholipids comprise approximately 25% of the dry weight of the human brain. Together, arachidonic acid and docosahexaenoic acid account for roughly half of total brain phospholipids. Brain phospholipids are essential for fluidity of nerve cell membranes and provide the physicochemical environment in which cell-membrane-associated proteins are embedded, influencing their tertiary structure and their capacity to function as neurotransmitter receptors. The fatty acid components of neuron membrane phospholipids also are central to the integrity of cell-signaling systems involving protein kinases and other second messenger systems believed to play an important role in the pathogenesis of many psychiatric disorders. Additionally, the synthesis and breakdown of phospholipids in the brain is integral to normal growth of axons and dendrites, as well as the formation of new synapses and the pruning of old ones. Phospholipids in Schizophrenia Horrobin (1998, 1996) has proposed a "membrane phospholipid" model of schizophrenia. He stated that abnormal metabolism of phospholipids resulting from genetic and environmental factors manifests as a range of symptoms that are classified as schizophrenia. Several case reports (Puri et al., 2000) and double-blind studies (Laugharne et al., 1996; Mellor et al., 1995; Peet et al., 2001; Peet et al., 1996) have consistently demonstrated sustained improvement of both positive and negative symptoms in patients with chronic schizophrenia consuming certain fatty acids who were not being treated concurrently with conventional antipsychotic medications. However, a double-blind, placebo-controlled study revealed no differences in response between eicosapentaenoic acid (E-EPA) (3 g/day) and placebo in a group of 87 patients with schizophrenia or schizoaffective disorder who were concurrently receiving antipsychotic medications (Fenton et al., 2001). In contrast to earlier studies, patients in this study were older, had a longer duration of illness and had residual psychotic symptoms. The membrane phospholipid hypothesis, according to Horrobin, may provide a unifying conceptual framework for not only understanding schizophrenia but also bipolar disorder, dyslexia, schizotypal personality disorder, other schizophrenia-like syndromes and possibly other psychiatric disorders (Horrobin, 1998; Horrobin and Bennett, 1999). Additionally, his hypothesis may be compatible with the paradigm ascribing the etiology of psychiatric disorders to dysfunction at the level of neurotransmitters and their receptors. According to Horrobin's theory, an inadequate dietary supply of EFAs or metabolic factors interfering with the normal conversion of parent EFAs into DHA or EPA would ultimately restrict the supply of omega-3 fatty acids to the brain for incorporation into nerve cell membranes. This deficiency results in abnormal phospholipid composition and suboptimal functioning of a range of membrane-based neurotransmitter systems. The membrane phospholipid hypothesis suggests that a spectrum of psychiatric disorders is associated with abnormalities at the level of the neuronal membranes, and that the nature and severity of symptoms are related to the magnitude and type of metabolic errors leading to abnormal phospholipid metabolism. In schizophrenia, for example, there is evidence for an increased rate of docosahexaenoic and arachidonic acid loss from membranes because of enhanced phospholipase A2 activity (Horrobin et al., 1995), whereas in dyslexia, dyspraxia and attention-deficit/hyperactivity disorder (ADHD), there may be a problem in the conversion of linoleic acid and α-linolenic acid into their long-chain derivatives (Richardson, 2001). (I am beginning to think that this may be the case for my son...) Horrobin cites the following findings in support of the membrane phospholipid hypothesis: Increased blood levels of an enzyme (phospholipase A2) that is known to remove polyunsaturated fatty acids from phospholipids in nerve cell membranes of patients with schizophrenia (Horrobin, 1996); Reduced levels of AA and DHA in red cell membranes of patients with schizophrenia (Horrobin et al., 1994); Magnetic resonance imaging data showing relatively increased rates of phospholipid breakdown in the brains of never-medicated patients with schizophrenia; Reduced electroretinogram (ERG) response in patients with schizophrenia (an indicator of reduced retinal DHA); Studies showing that clozapine (Clozaril) increases red blood cell phospholipid AA and DHA levels; The gene for lipoprotein lipase, the enzyme that regulates supply of EFAs to the brain, is on chromosome 8, where evidence points to a gene predisposing to schizophrenia. This enzyme's activity typically diminishes during puberty, a time often associated with the full expression of schizophrenia; Children with ADHD have reduced blood concentrations of EFAs. Omega-3s and Depression Food preferences influencing EFA consumption may directly relate to observed cross-national differences in depression rates. Countries where fish is a mainstay of the average diet are characterized by significantly lower rates of major depression and postpartum depression (Hibbeln, 2002; 1998). For example, in Japan, where fish consumption is very high, only 0.12% of the population experienced depressed mood in a given year. In contrast, New Zealanders, who consume relatively little fish, reported a 6% annual rate of depression. Recently, Hibbeln (2002) found that higher concentrations of DHA in mothers' milk and greater seafood consumption both predicted lower prevalence rates of postpartum depression. The data suggest that a nearly 50-fold difference in prevalence rates of major postpartum depressive symptoms across countries is associated with omega-3 fatty acid nutritional status. Well-controlled studies looking at long-chain fatty acids and depression are needed. To date, only one small double-blind study of omega-3 fatty acid and depression has been completed (Nemets et al., 2002). This four-week study compared two groups of adults with relatively uncomplicated unipolar depressive disorder who received a placebo or ethyl ester of E-EPA (2 g/day) while continuing their antidepressant medications. None of the study participants met criteria for refractory depression, and all but one had been successfully treated with conventional antidepressants previously. The 24-item Hamilton Rating Scale for Depression (HAM-D) was administered at baseline and weekly thereafter. Average HAM-D baseline scores were ≥18. By the end of the study, E-EPA-treated patients showed a mean reduction of 12.4 points, compared to a mean reduction of 1.6 points in patients receiving a placebo. Overall, six of the 10 patients assigned to the E-EPA group showed a 50% reduction in HAM-D scores compared to only one of 10 patients in the placebo group. The researchers found that E-EPA had a significant effect on several core depressive symptoms, including feelings of guilt, worthlessness and insomnia. There were no reports of significant side effects in either group, and only one patient (from the placebo group) dropped out because of worsening depression. The authors noted that the results do not clarify whether E-EPA has an independent antidepressant effect or augments antidepressants via second messenger systems in the manner of lithium. Confirmation of the significance of an antidepressant effect and clarification of the mechanism of action of E-EPA will require a long-term prospective design. A recent case report (Puri et al., 2002) claimed rapid dramatic improvement in a 21-year-old student with a seven-year history of unremitting depressive symptoms. The patient was actively suicidal and had a Montgomery-Asberg Depression Rating Scale (MADRS) score of 32. He had been refractory to multiple antidepressant trials, including lithium augmentation. Administration of E-EPA (4 g/day) led to rapid improvement and sustained improvement over nine months. The patient's symptoms eventually disappeared. No adverse effects were reported. Accumulating laboratory evidence suggests a plausible link between the dietary ratio of omega-6 to omega-3 fatty acids and the incidence of depression. Adams et al. (1996) demonstrated a positive correlation between the severity of depression and the ratio of AA (an omega-6) to EPA (an omega-3) in erythrocyte phospholipids. Additionally, researchers have found evidence that major depression is accompanied by activation of the inflammatory response system as indicated by an increased production of pro-inflammatory cytokines (Kubera et al., 2001; Maes et al., 1996; Mikova et al., 2001). Further, direct administration of the same cytokines into the brain causes dysregulation in serotonin metabolism that is consistent with changes observed in depressed individuals. Tricyclic antidepressants and selective serotonin reuptake inhibitors are known to suppress release of many pro-inflammatory cytokines by immune cells in the blood, consistent with the view that these drugs may perform a similar therapeutic role in the brain, resulting in improved mood (Kubera et al., 2001). Bipolar Disorder Considerable indirect evidence and one preliminary double-blind, placebo-controlled trial (Stoll et al., 1999) suggest that omega-3 fatty acids improve both depressive and manic symptoms in patients with bipolar disorder (BD). Omega-3 fatty acids may inhibit the activity of CNS phospholipases, thereby limiting the production of specific prostaglandins (e.g., PGE1) that are known to be associated with mania or depression. It has been postulated that lithium, dopamine antagonists and serotonin-blocking agents are effective in the treatment of mania through a similar mechanism of correcting such "overactivity" in cell membrane signal transduction processes. In a four-month study, Stoll and colleagues (1999) compared a combination of EPA and DHA (9.6 g/day) versus placebo (olive oil) in 30 patients with BD. While most of the patients received omega-3 fatty acids or placebo along with their usual mood-stabilizing medications (e.g., lithium, divalproex [Depakote], carbamazepine [Tegretol]), eight patients entered the study while receiving no other mood-stabilizing drugs. Significantly, a post-hoc analysis determined that four out of eight patients who took only omega-3 fatty acids remained in remission significantly longer than three patients who received only placebo. Further, among the remaining 22 patients taking mood-stabilizing drugs, those treated with omega-3 fatty acids performed significantly better on all outcome measures than patients in the placebo arm. Stoll and colleagues received a grant from the National Center for Complementary and Alternative Medicine (2000) to repeat the study on a much larger scale and a more rigorous design in 120 patients (Perry, 2001). The study examined the efficacy of omega-3 fatty acids as a maintenance therapy in patients with bipolar I disorder (BDI) over 12 months. All patients had to be euthymic or have only subsyndromal mood symptoms. Patients were randomized to receive omega-3 fatty acids or placebo in combination with their ongoing mood-stabilizing medication (e.g., lithium, divalproex). The study design also included one group of stable patients who will remain off mood stabilizers while taking omega-3s. Results of this study will help to clarify the role of omega-3 fatty acids in maintenance treatment of BDI and may also provide useful insights about safe and appropriate ways to combine mood-stabilizing agents with omega-3 fatty acids for different patient populations with BD. A multicenter study (National Institute of Mental Health, 1999) is underway on the effects of omega-3 fatty acids in the treatment of major depression and BD. The patients recruited for this study were randomly assigned to receive E-EPA (6 g/day) or placebo during a 16-week period, followed by an optional eighth-month open trial on the omega-3 fatty acid. All patients continued on their current antidepressant or mood-stabilizing medications. The hypothesis of the study is that EPA acting on some of the same signal transduction mechanisms as mood stabilizers will be beneficial in breakthrough depression, mania and cycling of BD. Other Indications Cognitive decline. Emerging evidence suggests that regular intake of omega-3 fatty acids is inversely related to cognitive impairment or rate of cognitive decline in nondemented older males. Kalmijn et al. (1997) compared cognitive impairment scores over a three-year period in two groups of men (69 years to 89 years of age) with different dietary preferences. High intake of foods rich in linoleic acid (omega-6) was associated with higher rates of cognitive decline (Kalmijn, 2000). In contrast, high fish consumption (containing large amounts of omega-3 fatty acids) was inversely correlated with cognitive impairment. The authors inferred that high dietary intake of omega-6 polyunsaturated fatty acids likely contributes to increased oxidative stress in the brain, indirectly promoting atherosclerosis and thrombosis that eventually manifest as declines in cognitive functioning. Conversely, high intake of omega-3-rich foods, especially fish, may reduce oxidative stress and associated atherosclerotic changes in the brain, mitigating factors known to be associated with cognitive decline. Violent and impulsive behavior. Observational studies (Hibbeln et al., 2000, 1998a, 1998b) suggest that low plasma DHA levels and, therefore, presumably low CNS levels may increase the predisposition of some individuals to violent or impulsive behavior. This effect appears to be larger in certain groups, especially males who develop alcohol dependence before 20 years of age. One proposed explanation is that genetic abnormalities in EFA metabolism result in a higher turnover rate of serotonin in the CNS, associated with higher levels of cerebrospinal fluid hydroxyindolacetic acid (CSF 5-HIAA). A placebo-controlled, double-blind study (Hamazaki et al., 1996) compared DHA (1.5 g/day to 1.8 g/day) with placebo (soybean oil plus 3% fish oil) in matched cohorts of Japanese students. A significant rate of "aggression against others" was reported in the placebo group at times of peak academic stress whereas students taking DHA did not exhibit increased aggressive behavior. A recent report of a double-blind, placebo-controlled, randomized trial in 231 adult prisoners showed that prisoners given a vitamin/mineral supplement and an EFA supplement committed an average of 26.3% fewer disciplinary offenses than those receiving placebos (Gesch et al., 2002). Dyslexia, ADHD and other learning disabilities. Anecdotal reports of improvements in dyslexia with DHA supplementation have long suggested that abnormal phospholipid metabolism is associated with this disorder. Using MRIs, Richardson et al. (1997) found results suggestive of a problem in the synthesis of membrane phospholipids in dyslexia. Double-blind trials (Richardson, 2002; Richardson et al., 2000, 1999) are providing promising evidence that dietary supplementation with fatty acid supplements may be of benefit in managing dyslexia and other disorders. In a descriptive study, a greater number of behavioral, sleep, learning and health problems were reported in boys with lower plasma phospholipid omega-3 fatty acid levels compared with those with higher levels (Stevens et al., 1996). Burgess et al. (2000) reported that omega-3 supplementation trials are being conducted in subjects with ADHD who show symptoms of EFA deficiency and lower proportions of EFAs than control subjects. Well-controlled prospective studies -- including those with age-matched girls -- are needed. Safety Considerations A review article suggested that no significant safety issues are associated with consumption of unsaturated fatty acids, including EFAs, as long as these substances do not account for more than 10% of total caloric intake (Eritsland, 2000). Above this level, there is evidence linking high intake of certain EFAs with reduced glycemic control in type 2 diabetics (Friday et al., 1989; Glauber et al., 1988) and also with a tendency for increased bleeding (Goodnight et al., 1982). There is also evidence of a slight overall increase in liver enzyme activity with large amounts of omega-3 fatty acids, which could affect metabolic clearance of certain medications. Anecdotal reports of a possible correlation between high doses of omega-3 fatty acids and hypomania or mania have been reported (Stoll et al., 2000; Su et al., 2000). Stoll et al. (2000) reported fewer than 10 cases of apparent omega-3-induced hypomania or mania in a series of more than 300 patients treated with various open-label preparations of flaxseed oil or fish oil. Almost all cases of apparent hypomania induction were associated with flaxseed oil. This effect was first noticed more than 20 years ago (Rudin, 1981) and was also associated with high doses of flaxseed oil, but not fish oil products. This effect is still under investigation. There has been a case report that prolonged use of a fish oil supplement resulted in hypervitaminosis A (Grubb, 1990). Other reports have suggested an increased incidence of hypertension and stroke (Kenny, 1990) in individuals who consume large amounts of omega-3-containing supplements. Controlled studies have not confirmed the presence or magnitude of these risks. Some patients complain of gastrointestinal (GI) distress when taking flaxseed oil or fish oil products. Eight of 13 (62%) patients taking omega-3 fatty acids in the Stoll study (Stoll et al., 1999) reported mild GI side effects compared to eight of 15 (53%) placebo-treated subjects. The difference between the groups was not statistically significant, and no other side effects were reported frequently. Serum and RBC Lipid Analysis In view of the growing evidence for fatty acid abnormalities in several psychiatric disorders, it is likely that more clinicians will consider treating patients with omega-3 fatty acid preparations. Lipid analysis will have an increasingly important role in differential diagnosis and treatment decisions regarding EFA supplementation for a range of medical and psychiatric disorders. Plasma fatty acid analysis reflects dietary intake, while red cell fatty acid analysis can reveal disturbances in metabolism. In the future, errors of metabolism may be approached through genetic engineering and corrective metabolic nutritional therapies. Conversely, disorders resulting from dietary fatty acid imbalances may be treated with targeted ratios of specific fatty acids. Research into making accurate laboratory determinations of the specific biochemical type and magnitude of dysfunction in the metabolic or dietary pathways of EFAs is underway.

My son responded best to Keflex in the beginning and he has done well with clindamycin. He had no response to penicillin VK. Ronna

I came across this information today and I am in shock as it describes Kurt perfectly...I thought others may be interested. I can't believe that after all of my years "on-line" I had not heard of this! Ronna Dyspraxia: Developmental Co-ordination Disorder; Clumsy child syndrome; Perceptuo-Motor Dysfunction; Motor Learning Difficulty Dyspraxia is a developmental disorder of organisation and planning of physical movement. The essential feature is the impairment of motor function that significantly interferes with academic achievement or activities of daily living, and is not due to a general medical condition, such as cerebral palsy or muscular dystrophy. Performance in daily activities that require motor co-ordination is substantially below that expected given the person's chronological age and general intelligence. This may be manifested in marked delays in achieving the main motor milestones of sitting, crawling and walking, or such problems as difficulty in self help skills, knocking over or dropping things, poor performance in sport or poor handwriting. Dyspraxia is a disorder with great variation between one child and another. In severe cases there is global dysfunction affecting gross, fine and oro-motor skills. These children are likely to present early in the pre-school period with gross and fine motor delay, hypotonia and clumsiness with poor speech articulation. At the other end of the spectrum, problems become apparent at school age, with more subtle impairments in fine motor skills affecting buttoning, tying laces and poor handwriting. Neuro-developmental examination may reveal signs such as left/right confusion, poor balance and postural maintenance, as well as hypotonia and weakness, poor rhythm and timing, and unusual patterns of sensory processing. Psychological assessment may show considerable discrepancies, typically with satisfactory verbal skills and relatively poor visual skills. Besides the problems of motor control, there is usually significant impairment in skills relating to sequencing, organisation and planning as well as difficulties in attention control. These problems also contribute to the practical difficulties with skills such as dressing, and can have a major impact on written output and recording abilities at school. The overall result is discrepant academic performance. The child shows ability by having good oral skills but is unable to achieve literacy or recording skills at the same level. Poor concentration and attention control and physical restlessness or over activity may be an additional problem. It is not uncommon for such children to be described by teachers as lazy or poorly motivated. In older children and adolescents, there may be progressive educational underachievement for expected ability, avoidance of difficult tasks and disengagement from school life. Secondary emotional problems with low self esteem are more likely and this may be apparent from a young age. In the past, dyspraxia was sometimes held to be a delay in maturation with motor problems resolving in the teen years. Recent longitudinal studies suggest that rather than resolving, dyspraxia may have important long term sequelae that persist into adult life. Motor problems may become ameliorated with therapy in childhood and practice, as well as with increasing neurological maturity. The organisational problems may continue to be a major impairment into adult life. The risk of mental health problems, substance abuse and disruptive behaviour disorders are all increased. Neuro-developmental disorders as a group do tend to show a great deal of overlap and therefore tend to have features in common. So problems seen in Dyspraxia may be also seen in other disorders. Common to many of these disorders are such problems of concentration, short term (especially auditory) memory, organisation and planning, specific learning difficulties, sensory processing abnormalities, language and communication, socialisation difficulties, motor tics and emotional disorders. Sometimes these associated problems are severe enough to fulfil the criteria for a separate clinical diagnosis for example, Attention Deficit Hyperactivity Disorder, Autistic Spectrum Disorders, Dyslexia or Tourette syndrome. Because of these common associations, some practitioners have adopted the term 'DAMP', used in the Nordic countries, to describe those children with Deficits in Attention, Motor control and Perception. The complexity of presentation, use of different terms and the possibility of multiple diagnostic labels can lead to difficulties or delays in families getting a satisfactory diagnosis. For these reasons, a child presenting with features suggestive of Dyspraxia ideally should have access to a comprehensive multidisciplinary assessment. A very good website re: DCD/dyspraxia...the website is just full of good information. Ronna

I have known for years that efa's help Kurt significantly especially with behavior and interestingly when I tried fish oil alone Kurt did not respond positively...he does very well with a combo efa of omega 3's and 6's. PEDIATRICS Vol. 115 No. 5 May 2005, pp. 1360-1366 (doi:10.1542/peds.2004-2164) The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder Background. Developmental coordination disorder (DCD) affects 5% of school-aged children. In addition to the core deficits in motor function, this condition is associated commonly with difficulties in learning, behavior, and psychosocial adjustment that persist into adulthood. Mounting evidence suggests that a relative lack of certain polyunsaturated fatty acids may contribute to related neurodevelopmental and psychiatric disorders such as dyslexia and attention-deficit/hyperactivity disorder. Given the current lack of effective, evidence-based treatment options for DCD, the use of fatty acid supplements merits investigation. Methods. A randomized, controlled trial of dietary supplementation with -3 and -6 fatty acids, compared with placebo, was conducted with 117 children with DCD (5–12 years of age). Treatment for 3 months in parallel groups was followed by a 1-way crossover from placebo to active treatment for an additional 3 months. Results. No effect of treatment on motor skills was apparent, but significant improvements for active treatment versus placebo were found in reading, spelling, and behavior over 3 months of treatment in parallel groups. After the crossover, similar changes were seen in the placebo-active group, whereas children continuing with active treatment maintained or improved their progress. Conclusions. Fatty acid supplementation may offer a safe efficacious treatment option for educational and behavioral problems among children with DCD. Additional work is needed to investigate whether our inability to detect any improvement in motor skills reflects the measures used and to assess the durability of treatment effects on behavior and academic progress.

Hi there! From a $$$ standpoint I think one of the easiest things to try is changing your diet before buying supplements. The only time my son has vocal tics is with any dairy. He is also sensitive to corn (corn syrup, corn flour etc.), eggs and chocolate. Others have problems with gluten, food additives etc...everyone is different. It would be worthwhile to read up on doing a food elimination diet. Good luck! I would also highly recommend Sheila Rogers new book on tics and tourettes...it is very good and may give you some insights into triggers for your vocal tics. Ronna

Brett, we did a food elimination test as Andy has described and it was VERY helpful. Milk (casein) was obvious and easy to figure out as was chocolate...a surprise to me was eggs and corn...I liked the book "Is this Your Child" by Doris Rapp and she described food elimination diet in a very easy to understand way. Ronna

Mommy11...I know I have read lots of your posts but I can't remember the "specifics" of your son...I just wanted to let you know that I really have probably done the least testing of anyone on the forum...we have done very minimal testing and I have relied alot more on my own observation skills. Rather than testing I would suggest trying a food elimination diet. I had to experiment with several essential fatty acids until I found the right combo and as for supplements I added them slowly one at a time to see what was helping and which were not. If I had not seen such improvment with the diet and supplements I would have done more testing like for heavy metals and we did test for yeast but sometimes it is good to go back to the basics of looking at diet and supplements. I can not say enough about Shiela's book...it is fabulous and if you have not read it yet I would highly recommend it as even though I have been at this for a long time with each page I find useful information... Anyways, please ignore me if you have done a food elimination diet etc...I really hope you will see an improvement soon...it has been my own personal decision to not do alot of testing on Kurt. It has worked for us but I know it is necessary for some kids. Again, Sheila's book is well worth the $ and time to read it...take care! Ronna

I received the threelac today. Allison, I will try to answer your questions. I have thought about yeast for a long time. I bought the book "The Yeast Connection" 3 years ago. Over the years I did use grape seed extract etc. Mostly they seemed to cause some stomach irritation for Kurt. Years ago when we first discovered that PANDAS was an issue we saw an immediate and stunning improvement with Keflex. Over the next six months the Keflex did not seem to be as effective. Our doctor switched Kurt to clindamycin...again we saw great improvement. Since that time it seems that we have cycled off and on clindamycin about every 4-6 months. I have long wondered "why" the clindamycin gave us such great results...a reduction in tics and most importantly a huge improvement in behavior. The reason that I started aggressivley treating yeast this fall is because Kurt has been on antibiotics for a long time and it is just my guess that the clindamycin IS treating a yeast problem as it does have an anti fungal effect (our doctor seemed to think this was a reasonable thought). I feel that with the initial use of keflex we traded a strep problem for a yeast problem. As well given Kurt's food sensitivities I feel that the yeast has contributed to this. I do not have my yeast connection book...I lent it to a friend but I really identified with alot of the symptoms and Kurt has the "fog" and overall had a very bloated look...anyways, so now I am going down the "yeast road". We are still using nystatin. The reason I am trying threelac is because I have read many good things about it and I have a friend who is using threelac with her daughter who has autism. I am not convinced that once we stop using the nystatin that we won't be in the same boat in a few months. I am hoping that adding the threelac will help balance things as it is a very good probiotic. As well the claim that the yeast diet is not necessary with the use of threelac is appealing as with Kurt's restricted diet doing the yeast diet would be difficult. The improvements I have seen with the nystatin has been in behvior...more focus and for sure he has lost the bloated look. Kurt is actually ticcing more yesterday and today...some brand new ones even. It is the most he has ticced in probably 2 years but I am not worried as I think it is related to the holidays and his behavior has been just awesome. Tics don't bother me...it's the behavior (impulsiveness, separation anxiety, and just absolute grumpiness) that we find difficult. I am thankful that Kurt's behavior is so stable right now...makes the whole house so happy and calm! By focusing on the yeast I feel that this is the tail end of what has been a long journey. We have had stool testing done for yeast and there was lots of it along with some other imbalances that I hope the threelac will address and help. We have done so much over the years and I just feel that overall Kurt will benefit from it...as a matter a fact I plan to give the threelac to my other kids as well. We have also (myself included) used colloidal silver for the last couple of months which also treats yeast and I can tell you I have never felt better and it has for sure helped with PMS so we will see what happens with the threelac. I hope this answers some of your questions. I will post as things progress and let you know how it goes. Take Care. Ronna

We have been using nystatin. I ordered threelac last Friday and I am waiting for it to be delivered. I will keep you posted as to how we do with it. ronna

Hi Allison! Happy Holidays! I am glad to hear you came to a compromise. Holidays can be a hard time for our kids. I let Kurt have a whole bunch of soy egg nog thinking it would be "ok"...yeesh his tics were not too troublesome but let me tell you...his behavior was awful. He nearly drove me NUTS! A big note to self...soy IS a problem in large amounts! I might as well as given him a carton of milk! Anyways I am happy to say he has had really good days yesterday and today. I am continuing with nystatin for him...I think it is helping and I ordered Threelac on Friday. A friend of mine is giving it to her kids with good results so we are going to try it. Take Care. Ronna

Hi Brett, I can understand your distress. I know all of this is very hard. I do not know if your son has PANDAS. Certainly from your posts there is some signs that point to it but in others ways not. You said that you had bloodwork done...was it an antiDNase B titer, ASO titer? If you are concerned about PANDAS then zithromax is a appropriate antibiotic to try. I think it is appropriate to give it a try in order to reassure yourself one way or the other if it will make a difference. Overall you should know within a few days if it will help. Certainly in our situation and in most cases I have read the antibiotics make a DRAMATIC difference and for us it was unmistakeable that the antibiotics were helping. If the zithromax does not help alleviate your son's symptoms considerably I think you can rule out PANDAS as the cause of your son's tics. Given that your son did worse on the amoxicillin would lead me to consider if yeast is a problem as Chemar has suggested. As well if your son does have yeast problems summer camp could aggravate the problem in terms of exposure to molds at camp in the bunk house etc. If yeast is a problem then antibiotics will not help with this and could make your son's symptoms worse. As well the stress could also be a trigger. You may find this information interesting about yeast and tics... http://www.nutritioninstitute.com/Tourettes_Syndrome.html It does sound like your son had tics as a younger child as well as some anxiety and often the age of 9/10 is a time when tics etc seem to become more intense. There are many things you can do to help your son but you need to do the changes slowly and one at a time so that you can determine what is helping and what is not and what may be making things worse. You can start with changing your son's diet. I would consider looking at doing a food elimination diet or looking at a yeast elimination diet. I would consider doing a test of no "screens" (eliminating TV, PS2 etc) for a week to see if this makes a difference and then you can look at vitamins and supplements. Working with a knowledgeable doctor is important. As well it may be helpful to reduce any stress your son is feeling by as much as possible such as reducing after school activities, lots of sleep and relaxation, time spent doing things he finds relaxing and fun and really take care of yourself and try to limit your time spent on the computer looking for answers (and from personal experience I know how hard this is). Well I have to go b/c my wiggly baby loves to bang the keys while I am typing! Ronna Take care, R

I will tell you a quick story...baby is feeling a bit better...but I am exhausted! When I first started looking at food as a trigger for my son's tics...my husband was "sort of" on board...mostly I think he thought I was crazy because I insisted that milk (casein) was a trigger...this includes ALL dairy including cheese. He became a true believer one night when we were at a bowling fundraiser with the kids. It was a pizza night. Prior to supper we were having a great time and Kurt was doing very well. We had the pizza and then resumed bowling...Kurt changed right before our eyes...tics, impulsive, budging in front of his brother...a real handful...my husband was a believer after that night. We eliminated milk (casein) completely along with corn, eggs and chocolate and my son improved alot. At this point he tolerates corn, chocolate and eggs but milk is still a problem...in the sense that I would NEVER give him a glass of milk...however he does now seem to tolerate cheese if we don't give it more than once or twice a week (we had pizza for supper tonight). Interestingly last week he seemed "off" and I even said to a friend..."I swear someone is giving him milk...do you think he is getting some at school"...well jeepers a few days later I was tucking the kids into bed and Kurt came into his room drinking a BIG glass of chocolate milk (My husband had bought a carton and the carton was a different color and more similar to the soy milk that Kurt drinks) and Kurt thought it was "his" soy chocolate milk...mystery solved and no more chocolate milk for Kurt...he had been drinking it for a few days before I noticed! Anyways...a book that I highly recommend and started me off thinking about diet was... http://www.amazon.com/gp/product/076790798...=books&v=glance It is about autism but I think just about anyone can relate to this book and it is the story of a mother who made an incredible difference for her child and shows that as a parent we can make a very big difference! Ronna

Hi Brett, Although I don't have much time to post tonight I just wanted to let you know I saw your post and will try to give more information as soon as I have a moment. My 5 month old baby has been sick so it has been a bit crazy the last few days. I sooo remember my own desperate search for information when my son was 5-6 years old. We have done many things. I do use bonnie's vitamins, essential fatty acids, removal of milk (casein), corn, eggs and chocolate from Kurt's diet and more recently treating him for yeast. As well for a time we limitied TV etc and this really helped. I would HIGHLY recommend Sheila's new book...I have not read it yet but I know it will be good! How I wish I had a book like it 4 years ago! "Is this your child" by Doris Rapp is also very good and food elimination diets are discussed. We used a single food elimination diet...it takes longer but is easier. Hang in there. Make sure to take care of yourself! Keep reading and post with any questions...it is a great bunch here! With time this all gets much easier. I will sit down and post more when I have a more quiet moment...Ronna

Hi Allison, I only have a few seconds...I REALLY want to get the kids to bed and I need to go to bed! I have hesitated to say too much about treating Kurt for yeast until I could assess over a longer period if it was making a difference. I started treating Kurt aggressively for yeast about the middle of September. In the past I have used grape seed extract etc. but decided this fall to use nystatin, more strict diet, and we are using colloidal silver. It has for sure helped. We are no longer having the big up and down days and he has been absolutely tic free for awhile now (knock on wood). I will post more when I have more time. When looking at PANDAS kids it is really important to look at yeast due to the antibiotics. Take Care. Ronna

A great post to read. Hang in there and take care. Ronna

My son was on ORAP which is like Haldol. He had many of the same side effects from the Orap as chemar described as related to Haldol. My son became very lethargic, almost no personality, and one of the worst side effects was hyperphagia (overeating)...seriously...it was UNBELIEVABLE...he was eating an enormous amount of food and crying and sobbing for more...he gained weight and looked soooo unhealthy. On the Orap my son's tics did improve alot but over time he needed a higher dose to get the same effect. In the end it was absolutely no answer for us. Within a month of discontinuing the Orap my son lost about 10-15 pounds and grew. While on the Orap he did not grow. Changing my son's diet and eliminating milk (casein) specifically and adding vitamins and supplements really helped my son. Knowing what I know now...I would NEVER have put my son on Orap. ronna

Hi Brett, I never seem to have time to post anymore but I wanted to reply really quick as our experience was very similar to yours (4years ago)...my son is now 9 and doing very well. We also had many eeg's and tests done and did go the med route initially. If you are seeing improvement with the Tenex then I would continue with this and as far as I know it may take up to a month to see improvment...a week is not long enough to determine whether it will help or not. ORAP...yikes everyone knows we had a terrible experience with this med...I am sure it must help someone or else why would it ever be prescribed but personally I thought this med was horrible (my son was on it for about 8 months). Once we started looking at underlying causes such as food sensitivities and vitamin deficiences etc. was when my son started to make significant progress. My son is also a PANDAS kid...he has never responded to amoxicillin. It is a long story but his initial antibiotic was Keflex which was like a miracle to us. Within 2 days my son was a completely different kid...no tics, behavior stabalized etc. We have also used climdamycin. As a side...my son did tic during his sleep...obviously not as much as during the day but it was for sure there and we video taped him and his sleep was very restless with some tics and restless legs. I do have to go but let me know if you have any questions. Do a search here at lattitudes and at braintalk on the TS board or the PANDAS board and you will see some of the information I have posted. Ronna

Hi there, I am glad to hear things are a bit better. My son is 9 years old and is in the 3rd grade also. He had a sudden onset of tics at the age of 5. He is a PANDAS kid and he also had a dx of rheumatic fever and sydenham's chorea...anyways...that was 4 years ago and a long story. In the end lattitudes was a life line for me and changed our lives and I am happy to say my son is doing very well. Ronna

Hi there! This is the first chance I have had to read this thread. When I saw Orap I just had to reply! How I wish 4 years ago I had the information available on Lattitudes for my son. I am a nurse and listened to our neurologists and did put my son on Orap (he was on it for about 8 months in total)...believe me at the time we were desperate and it certainly did stop the tics and it was AMAZING at the time to see his body still...however Orap was no answer for us...my sweet little boy disappeared...and it was like he was a zombie at times...he gained tons of weight...and in the end had some terrible side effects. We stopped it and tried clonidine briefly. At the time I was VERY uneasy about starting medications but I listened to our doctors. In the end I found answers on-line as I always felt that the tics, etc. were "symptoms" and that all the meds did was mask the symptoms. Once we got to the route causes things improved. A book that I read early on really made a huge difference in my life as it showed me that as a parent there were things I could do to help my son. It is a book about autism but is highly worth reading. http://www.amazon.com/gp/product/076790798...=books&v=glance I understand the need to do "something" but be very careful when introducing supplements. Each child is very different and what helps one will not necessarily help another. Introduce things slowly and one at a time so you can really asess whether something is helping, making no difference or causing an adverse reaction. I also tried amino acids and my son reacted to them...as well he reacted to fish oil which does seem to be beneficial to some kids. In the end we found a very supportive pediatrician who along with a naturopath doctor helped guide us. Without a doubt one of the absolute best things we did for our son was a food elimination diet and once we removed milk (casein), corn. eggs and chocolate my son did much better. A one time my son's tics were debilitating and now he is doing so well and is tic free. It has been a LONG road but worth every second. My best advice is to take a deep breath, go slowly, make changes one at a time, keep a diary, and overall before adding supplements I would recommend looking at food sensitivities first. Take Care, Ronna

I just ordered my copy and I REALLY am looking forward to reading it! Congratulations! Ronna

Hi there. I do understand how you feel as my son had a sudden onset of tics at the age of 5. He is now 9 years old. The NIMH has good information about PANDAS and I have highlighted below some parts I think you may want to review. What are the diagnostic criteria for PANDAS? A. They are: Presence of Obsessive-compulsive disorder and/or a tic disorder Pediatric onset of symptoms (age 3 years to puberty) Episodic course of symptom severity Association with group A Beta-hemolytic streptococcal infection (a positive throat culture for strep. or history of Scarlet Fever.) Association with neurological abnormalities (motoric hyperactivity, or adventitious movements, such as choreiform movements) (My son had all of these including the motoric hyperactivity, or adventitios movements and choreiform movements) Q. What is an episodic course of symptoms? A. Children with PANDAS seem to have dramatic ups and downs in their OCD and/or tic severity. Tics or OCD which are almost always present at a relatively consistent level do not represent an episodic course. Many kids with OCD or tics have good days and bad days, or even good weeks and bad weeks. However, patients with PANDAS have a very sudden onset or worsening of their symptoms, followed by a slow, gradual improvement. If they get another strep. infection, their symptoms suddenly worsen again. The increased symptom severity usually persists for at least several weeks, but may last for several months or longer. The tics or OCD then seem to gradually fade away, and the children often enjoy a few weeks or several months without problems. When they have another strep. throat infection the tics or OCD return just as suddenly and dramatically as they did previously. Q. Are there any other symptoms associated with PANDAS episodes? A. Yes. Children with PANDAS often experience one or more of the following symptoms in conjunction with their OCD and/or tics: ADHD symptoms (hyperactivity, inattention, fidgety) Separation anxiety (Child is “clingy” and has difficulty separating from his/her caregivers. For example, the child may not want to be in a different room in the house from his/her parents.) (This absolutely describes my son and is one of the first symptoms I notice when he has a flare-up)Mood changes (irritability, sadness, emotional lability) Again the emotional lability is another sign even before the tics that my son is having a flare-up)Sleep disturbance Night- time bed wetting and/or day- time urinary frequency Fine/gross motor changes (e.g. changes in handwriting) Joint pains My son has all of the above symptoms during a flare-up It does sound like your son does have tics and that the recent strep infection caused them to intensify. The fact that it improved with the antibiotic could mean that he will be prone to symptom fare-ups with strep. You do not say if anyone in your family ticced. Once you start reading about tics you may see some of the same tics in other family members and were just unaware of them. PANDAS is a tricky subject and you are lucky to have found the support of a good doctor and just the fact that he was aware of PANDAS is good news. The excellent thing is that from now on you can be watchful of him for any symptoms of strep and if you are at all concerned re: an increase in tics it sounds like your doctor will be open to having him tested for strep and treated if necessary. You asked... does PANDAS ever go away? Certainly my own experience has been that even though it has not "gone away" for my son as he has gotten older it has become much, much easier to deal with. I would expect that as he gets older this tread will continue. It really is ok for kids to tic...tons of kids do if you look around. I have found not focusing on the tics to be of great benefit to my son. What can I do today to help stop the blinking and neck tics? I would begin by looking at his diet. There is a ton of information here regarding dietary causes of tics. My son tics with all dairy, others see benefits from the fiengold diet etc. Eliminating dairy, eggs, chocolate and corn (ie. cornstarch, corn flour etc) was all an important part of helping my son....as of now milk is really only his only big trigger. For now you could begin giving him a good multi-vitamin and seek out a doctor knowledgeable in natural therapies for children especially tics if you can. We had the guidance of a wonderful pediatrician and naturopath docotr which supplemented what I learned on-line. There is a link at the top of the page to get you started in finding a doctor. Finally, welcome to Lattitudes...it's a great site...tons of information and keep reading and asking questions...as far as guilt goes...believe me it is a waste of time...you do the best you can and hindsight is just that...you move forward and do the best you can. Take care...I have to run and get my kids from school now! Ronna

Allison, Hi there! I am back in the city for a short bit as we have been at our cottage for the summer...we leave tomorrow for a family wedding this weekend which is a 6 hour drive...anyways as always I HAD TO check up and see how everyone is doing. Your post about having a waxing of tics while at your cottage caught my eye. I have noticed this with Kurt and overall my conclusion is that it may be a problem with mold as our cottage is older. Kurt has always reacted to mold...he developed asthma as a baby...just a thought ...my baby boy is waking up...oh yeah I should mention he is an absolute delight and he is adored by everyone. He is a easy baby and the love of my life right now...BUT...let me tell ya...I'm feeling a bit busy this summer! Today I felt like this ...best wishes! Ronna

Thanks for posting this! It is nice to see some studies confirming what many of us as parents already know!