MEDICAL UPDATENew York City • JULY <strong>2002</strong>FOR PARENTS, EDUCATORS & STUDENTS• 12Talking with Pioneer Dr. Ira Black About Parkinson’s DiseaseBy JOAN BAUMIt’s hard to believe that this internationallyknown clinical neurologist and neuroscientist,at the cutting edge of research, wasn’t thinkingof medicine when he was in college. Althoughhe was graduated from the Bronx High Schoolof Science, he went on to Columbia Universitywhere he got a B.A. in philosophy. Somewherealong the way, however, and certainly by thetime he entered Harvard Medical School, hehad become “more interested in the organ thatphilosophizes than in philosophy.” And sobegan the career of one of the most distinguishedresearch scientists in the country. Forthe past 10 years Dr. Ira Black has been professorand chairman of the Department ofNeuroscience and Cell Biology at the UMDNJ-Robert Wood Johnson Medical School,Director of the Joint Graduate Program inPhysiology and Neurobiology there and atRutgers, and is past president of the Society forNeuroscience of North America. A descriptivelisting of agency, society, committee, and boardaffiliations; of publications, including majortexts; of patents granted and pending; of peerjournaleditorial positions; and of visiting professorshipsat major universities would consumethis entire newspaper. It’s said that hemay be the most significantresearcherworking on Parkinson’sDisease (P.D.)today. A modest man,with an engagingsense of humor, hestated, “Maybe at onetime a singleresearcher paved theway; our societydotes on heroes,” butthe truth of the matteris that “scientistswork in communities,”and medicaladvances “derivefrom the work of alarge number of people.”In fact, Dr.Ira Black, M.D.Black is even moreecumenical. He believes that all modes of treatingP.D. and all avenues of research should bepursued, regardless of what he, himself, isworking on. “We must proceed on all fronts, wemust customize for each patient.” He has greatrespect for Parkinson’s advocacy groups, suchas the Michael J. FoxFoundation.“ They haveplayed an immenselyimportant role in supportingresearch andrecruiting scientists,” hepoints out, adding thatthey are also reliablesources of informationfor the lay public. It isto those foundationsthat fearful, newly diagnosedpatients mightturn, rather than jumptoo quickly into clinicaltrials.Certainly Dr. Blackappreciates more thanmost the desperate hopethat often attends mediacoverage of a procedurethat would appear dramatically to retard or temporarilyarrest the progress of degenerative andacute neurologic disease. But the reality is thatdespite promising drugs and surgery, there is atthe moment no course of action for Parkinson’sDisease that will stop its slow, erratic andimplacable course. In fact, by the time mostpatients realize they have P.D. they havealready suffered 70 – 80% loss of vital braincells. Is timely diagnosis of any value then?Indeed it is, he replies. Though diagnosis maybe difficult, because there is no test, anddelayed until symptoms have set in—slowedmovements and stamina, halting gait, stiffeningof muscles and “mask like” facial expression—the difference between knowing and not knowingis critical for the way one lives. Much canbe done.A first step for those who suspect they mayhave a neurological problem, Dr. Black advises,would be to see a good old-fashioned neurologistwho will do a close hands-on examination.As for the cells that have already suffereddamage or died, Dr. Black explains in sympathetictones that “the brain is fault tolerant,”explaining that even where a great preponderanceof nerve cells has been damaged ordestroyed, it is possible to replace them. This isimportant information for P.D. patients to hear,especially as the debate continues on the directionof stem cell research. Meanwhile, there isgood argument to be made for taking advantageContinued on page 27ADD children show undiagnosed vision problemsA free screening may find the cause of yourchild’s concentration problems and thesesymptoms:1) Avoids reading, incomplete work, eyestrain, restless. This is often caused byfocus disorder or problems with eyeteaming.2) Loses place while reading or uses fingerto follow. Omits, inserts, or rereadswords. Poor control of eye movementswill bring this result.3) Slow work, poor handwriting (may evenbe a detailed artist). This can be the resultof poor eye-hand coordination.4) Poor word recognition, poor spelling,reverses letters, poor reading comprehension.This is often the result of poor visualization.RELIEF FROM HOMEWORKFRUSTRATIONThe Vision Improvement Program (VIP), anationally-known program developed by anoptometrist, an educator and a psychologist,corrects visual deficiencies that interfere withDr. Ettinger assists student with aprocessing speed procedurelearning. The 10-week program has resulted inimprovements of 4+ years in concentration insome cases. And this is without medication.“Reading involves more than 20/20 sight.Readers must have a variety of scanning,focusing and visualization skills” states Dr.Henry Ettinger, director of a local VisionImprovement Program. “Many of my patientshave gone from failing or special ed to A’s andB’s by the 10th week of therapy.”FREE EVALUATIONThe VIP offers free testing for learning-relatedvision problems. It’s a wonderful opportunityfor parents to determine if poor vision isaffecting their child’s learning. Call theManhattan office, (212) 265-4609.“We were at our wits end. Our daughter waseasily distracted and was at risk of failing.Handwriting was messy. Homework becamean all-night burden. Now her improvement isremarkable. She loves to read and write nowlike never before. Her self-esteem has soaredand family time together has improved. Yourprogram is literally a God send.”-Lillian Sanchez-Perez212-265-4609 Manhattan • Brooklyn • Queens • Westchester www.nyvision.org
JULY <strong>2002</strong> ■ EDUCATION UPDATE ■ MEDICAL UPDATE13Risky Teen BehaviorDepression in TeenagersBy RICHARD FRANCES, M.D.Early detection and treatment of major psychiatricdisorders that afflict young people,including addiction, depression, bipolar disorder,anxiety disorder, attention deficit disorder,and schizophrenia can be the best way to preventthe serious consequences of mental illness,including suicide.Teenage suicide has doubled in the last 20years and 70 percent of suicides among youngpeople involve chemical abuse or dependence.Normal youngsters rarely attempt or succeed insuicide, and most suicides are associated withtreatable psychiatric conditions includingaddiction. Parents, teachers and peers need towatch for signs of low self-esteem, hopelessness,social isolation, smoldering anger, cripplingsadness and anxiety, use and abuse ofalcohol, marijuana and other drugs, impulsivity,poor judgment, and poor communicationwith family, peers and teachers.Screening and early treatment for psychiatricproblems helps prevent the progression andworsening of conditions that can lead up to disaster.Other important signs include a positivefamily history of major illnesses, includingaddiction, depression, bipolar illness, anxietydisorders, and suicide. Watch for signs of theseproblems in first degree relatives, includingsiblings. Most of the major psychiatric illnessesbegin in the teenage and young adult years,and the earlier they are detected and treated, thebetter the result. A variety of cognitive behavioraland psychodynamic treatments are availableand are most effective when combinedwith medications in the treatment of these disorders.For young people with substance abuseand additional psychiatric diagnosis, it is crucialto make sure that both diagnoses are welltreated and that the individual is substance freewhile engaged in medication treatment andpsychotherapy.By HARVEY K. FRIEDLAND,J.D., B.E.E.It started with a twitch in one of my fingers. Itpulsated then quickly abated. For reasons thenbeyond my comprehension, it started again.This is what I told my physician half a decadeago. She immediately told me “You haveParkinson’s disease. I’ll make an appointmentDO YOUHAVE ASTHMA?Volunteers NeededFor Asthma Study.Harlem Hospital & ColumbiaUniversityAre Studying WaysTo ImproveThe Treatments Of AsthmaAt No Costs To YouYou Can EarnUp to $1100 For ParticipatingFor Information Please Call:212-939-8360Twelve step, peer led and group, family andnetwork therapy techniques can be very helpfulin working with this age group. An especiallycritical time is the adolescent’s first year awayfrom home at college with its often concomitantincrease in substance use and decrease inparental presence. One example of a psychiatricillness that has a 15 percent mortalityrelated to suicide is manic depressive disorderwhich can be effectively treated with lithiumand mood stabilizers, and which is frequentlyassociated with alcohol and drug problems.Both problems must be successfully treated toavoid the roller coaster ride of relapse. Welltreated individuals with this disorder can go onto productive lives and are often among ourmost creative and effective people. Undetectedor untreated bipolar illness leads to enormoussuffering in patients and their families. Somecharacteristics for evaluating suicide riskinclude presence of suicidal or homicidalideation, intent or plans; access to means forsuicide and the lethality of those means; presenceof command hallucinations, other psychoticsymptoms or severe anxiety; presence ofalcohol or substance use, history and seriousnessof previous attempts and family history ofor recent exposure to suicide. Abuse of substancesincreases impulsivity and worsensjudgment which can add fuel to self-destructiveimpulses.It is important that schools, parents and themental health community work closely togetherto provide better screening, detection andpreventative treatment for major psychiatric illnesses.This will lead to reduction of the devastatingeffects of suicide on family, schools andcommunity. #Dr. Richard Frances is President andMedical Director of Silver Hill Hospital in NewCanaan, Connecticut.with our neurologist, a young physician whowent to Harvard Medical School. He’ll examineyou, perform exclusionary tests, make an officialdetermination and put you on a schedule formedication. Okay?”It’s now four years later. I’ve been on the usualParkinson’s medications–Elderpryl and L-dopa.I recently entered the advanced stage ofParkinson’s, which means that those hours of theday when I become rigid and lethargic are arrivingat increasing intervals. During the cherished“on” times, when the medication is working theway it’s intended, PD sufferers such as myselffeel normal and energetic, but these hours dwindleto mere moments and become more elusiveand fleeting as the disease progresses and thebody deteriorates. New symptoms have startedoccurring; I’ve now found myself plagued withAttention Women21 - 28 Years OldLooking to earn extra income.Help a loving couple have a baby.Become an Egg DonorCharacteristics:Attractive, Caucasian, Brunette, Big Brownor Hazel eyes. Small or Medium boned.105 - 125 Lbs.Intelligent, Compassionate anda Good Temperament/Personality.Excellent CompensationFor More Info:E-mail: Gratefulwomen@aol.comCall: 917-747-5016Choices: Perspectives of a Patient With Parkinson’s Diseaseshuffling, dizziness and intermittent loss ofequilibrium.When I was first diagnosed with PD, I read atremendous amount about the disease. As Ifamiliarized myself with PD by following cutting-edgeresearch, attending lectures (such asthose given by Dr. Jeff Bronstein, Director ofMotion Disorders at UCLA) and going to supportgroups, I found that: there are really only afew options available to the Parkinson’s sufferer.A patient can opt to take medication and letthe disease take its ineluctable toll on his body,or he can elect to have DBS – Deep BrainStimulation – a serious surgical procedure thathas shown promising results but is still a far cryfrom a cure. DBS only lessens certain symptoms(such as tremor) and still requires somepatients to maintain their regimen of drugs.Also, DBS sometimes requires patients toundergo the procedure more than once.There is a third choice – a third hope – on thehorizon. “Spheramine”, a procedure not yetauthorized by the FDA (but on the fast-track forapproval and granted funds by the NationalInstitute of Health), utilizes cell-coated microcarriers(CCM) to inject human retinal pigmentedepithelial cells into a person’s brain sothat a patient can begin regenerating thedopamine-producing cells that have been dyingsince he began suffering from Parkinson’s. Ifand when approved by the FDA, spheramineoffers the best hope to patients such as myself,since it is a site-specific, minimally invasiveprocedure and has the potential of emancipatingthe PD sufferer from both his symptomsand his dependence on side-effect causingBy GLENN S. HIRSCH, M.D.Adolescence and the beginning of adulthoodis a developmental phase burdened with stressfulevents: high school, starting college, pursuingcareer goals, forming relationships withfriends and significant others, coping withchanging family roles. These stresses can precipitatelife-threatening illnesses and behaviorssuch as depression, anxiety disorders, substanceabuse, eating disorders and even suicide.Schizophrenia and bipolar disorder often havetheir onset during this time.During adolescence there is a rapid increase inthe number of youngsters who suffer fromdepressive illness and have suicidal thoughts.Several studies indicate that up to 8.3 percent ofadolescents suffer from depression, 20 percentof America’s teens have had thoughts about endingtheir lives and suicide is the third leadingcause of death among teens and young adults.The most important risk factor in teenage suicideis having a psychiatric illness. About halfof youngsters who kill themselves have adepressive disorder. Other disorders that placeteens at high risk include aggression, behavioraldisorders and substance abuse.While twice as many girls attempt suicide asboys, boys are more than ten times as likely tokill themselves. This difference appears to bemainly due to the method used. Girls tend tooverdose with pills which is often less lethalthan the use of guns which has been implicatedin more than sixty percent of teen suicides.Since depressive disorders are implicated inthe majority of teen suicides, an importantpathway to preventing suicide is the identificationand treatment of mood disorders. Some ofthe signs that a teen or young adult is sufferingfrom depression include: persistent sadness,irritability or boredom, complaints that nothingis enjoyable or a decrease in interest in activitiesor peers, sleep or appetite changes, difficultyconcentrating and poor school performance.Youngsters with these symptoms shouldhave a diagnostic evaluation with a mentalhealth professional for possible interventionand treatment. The two treatments that showthe most promise include antidepressant medicationand specialized psychotherapies. Theyinclude cognitive behavioral and interpersonaltherapy. (For further information about mentalillness and its treatment in children and adolescentssee www.AboutOurKids.org.)The National Institute of Mental Health iscurrently sponsoring a treatment study ofteenagers age 12-17 who are suffering fromdepression. The NYU Child Study Center isone of the sites in NY. For further informationcall 212-263-8613.For some teens and young adults outpatienttreatment may not be sufficient or the danger ofsuicidal behavior may be great. For them hospitalizationmay be necessary. The Young AdultProgram at the New York University ChildStudy Center was established several years agoto help older teens and young adults whosepsychiatric condition requires hospitalization.It is an intensive psychiatric inpatient program,which serves the mental health needs of theoften-neglected population of 15 to 24 yearolds.Experts from NYU in the fields of psychiatry,psychology, social work and nursing,draw on leading-edge therapeutic techniquesand breakthrough pharmacological research intreating patients. Emphasizing rapid assessmentand individualized attention, this team ofexperts strives to restore balance to a young lifein turmoil and help the young adult return toactive life. For further information about theprogram call Dr. Naomi Weinshenker at 212-263-5956.#Glenn S. Hirsch, M.D. is the DeputyDirector of the NYU Child Study Center andAssistant Professor of Psychiatry.drugs. The true innovative genius ofspheramine, which was pioneered by the brilliantneurologist Dr. Ray Watts of EmoryMedical School, is that the replacement cellsinjected into a patient don’t eventually witherand die. They maintain their potency for anextremely long time. What’s more, as many as10,000 patients could be treated by a singlebatch of retinal cells!My personal neurologist, the aptly-named Dr.Donna Masterman of UCLA, firmly believes Iam making the right choice in pursuingspheramine therapy versus DBS or another formof treatment. Dr. Masterman is expertly familiarwith the tribulations of Parkinson’s and feels thatreplacement cell technology is right for my bodyand stage of the disease. Replacement cell technologybears such unique promise that MichaelJ. Fox’s foundation has donated over four milliondollars to its furtherance.During my intensive research in the lastfew years, I learned that spheramine is the firstproduct of a company called TitanPharmaceuticals. Though spheramine has yet tocomplete the necessary clinical trials to attainFDA approval, it has completed phases I and IIof safety and efficacy and all six patients inthe clinical trial of spheramine have demonstratedmarked improvement. In an April 18,<strong>2002</strong> news release, Alison Roselli, Titan’s directorof corporate communications, reported onthe six individuals in the pilot study, “Patientsexperienced an average of 48 percent improvementin motor “Universal Parkinson’s DiseaseResearch Score” (UPDRS) over all otherParkinson’s medications. [They also experienced]an average of 43 percent improvement incontinued on page 30
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