December 2003

Dr. Curtis Cripe continues his involvement with the Sierra Dove Research Project in Albuquerque, New Mexico. The scope of the project focuses on auditory stimulation and its effects on school age children where auditory training is provided in a school environment. This research project is sponsored by Sierra Dove in cooperation with the State of New Mexico.

Dr. Martha Grout returned from a study trip to China on QiGong (literal translation “energy work”). She has arranged to do an international research project, measuring neurotransmitter levels in patients who are receiving QiGong treatments, and also in the healers who are delivering the treatments.


In addition to that research project she has embarked on a similar research project on neurotransmitter measurements of patients receiving acupuncture treatments.

Dr. Grout's and Dr. Cripe's latest published report will be coming out in Medical Acupuncture journal – a case report of treatment of a patient with severe depression following head injury.

Everyone is somewhere on the Neurodevelopmental Spectrum. Where are you on it .... where do you want to be?

Accelerated neurodevelopment allows us the ability to maximize and use our intellectual, physical, and emotional strengths simultaneously, no matter where we begin on the spectrum.

When accelerating brain power, daily tasks such as working, studying, and sports become easier to do and manage. The brain is functioning at optimal levels and is able to make quick attentional shifts on demand.

This is the state of mind that peak performers call "the zone" and is accessible at will.

Alternative Approach : Future of Medicine Is in a Blend of Approaches Chicago Daily Herald 11/10/2003 by Patrick B. Massey, M.D. When I spoke to a group of young doctors recently, I told them that the way we have practiced medicine for the past 50 years is coming to an end. The future is the integration of traditional and nontraditional approaches. This trend was very evident last week, when I participated in a panel discussion for a local PBS station in Urbana on the use and safety of nontraditional therapies. With me on the panel were a physician who practices traditional medicine, a yoga instructor, a nurse who practices healing touch, a chiropractor, an acupuncturist, a massage therapist, a tai chi instructor and a law professor. Years ago, this would have been the perfect recipe for disagreement and loud discussion. Not so today. In fact, the moderator found it difficult to find any topic of disagreement among the panelists. The physician, chiropractor and massage therapist have been referring patients to each other for years. They have respect for each other and the roles of their therapies in the medical system. The tai chi instructor is working on his Ph.D. in kinesiology, developing tai chi as a form of physical therapy. The yoga instructor already has a Ph.D. and works with patients with chronic medical problems. I had a preview of the national PBS program "Alternative Fix" before it aired recently. A number of internationally recognized physicians argued the merits and failings of nontraditional medicine. I would not call their discussions unfriendly, but they did not seem to be people who can work together well - too many egos. One of the requirements of becoming a good physician, healer or therapist is to leave your ego at the door and do what is in the best interest of the patient. I believe that this is happening, primarily at the local level. Long ago, I realized that great changes in clinical medicine do not happen in the laboratory or at the large medical universities. They happen as a result of someone, in the community, saying "I need to do better for my patient." Changes in clinical medicine are the result of not only thinking outside of the box, but actually taking action. Someone asked me why there is significant resistance to nontraditional medicine at the national level. I believe that the answer is simple: Those physicians do not treat patients. They do research. In many cases, they have never done any clinical medicine and never had lasting contact with patients and their illnesses. While there will be continued debate, at the national level, concerning the benefits and safety of nontraditional medicine, the real medical community has already made its decision and patients are benefiting. - Patrick B. Massey, M.D., Ph.D., is medical director for alternative and complementary medicine for Alexian Brothers Hospital Network. His Web site is www.alt-med.org. (C) 2003 Chicago Daily Herald. via ProQuest Information and Learning Company   Cellular problem discovered behind syndrome of obesity, learning disabilities Provided by NewsRx.com A research team led by Johns Hopkins scientists has discovered a potential new contributor to obesity - faulty cilia. Many a high school biology student has glanced into a microscope to see the planet's smallest animals - paramecia and the like - being propelled by the waving, hair-like projections known as cilia. But cilia are also found in human cells, helping move fluid and mucus around in the brain, lung, eye and kidney, or sticking out from cells to act like antennae. Studying families with a relatively rare condition called Bardet-Biedl syndrome (BBS) - characterized by obesity, learning disabilities and eye and kidney problems - the researchers discovered a new gene involved. Furthermore, the gene's protein, BBS8, is found only at the base of cilia, the scientists reported. "BBS is a relatively rare genetic disorder, but it has traits common to many people," said Nicholas Katsanis, PhD, assistant professor in the McKusick-Nathans Institute of Genetic Medicine at Johns Hopkins. "We don't know yet how the ciliary defect might lead to obesity or learning disabilities, but the finding provides a new avenue to studying these genetically murky traits." Some aspects of BBS have been linked to ciliary defects in other conditions. Cilia are known to play key roles in mammalian development, creating what's known as left-right asymmetry so organs like the heart, lungs and liver end up in the right place. In people with BBS, sometimes left-right asymmetry is reversed. Also, malfunctioning cilia in the back of the eye are known to cause retinal dystrophy and eventual blindness, and problems with cilia in the kidney lead to structural problems in the organ. But even though these primary characteristics of BBS had been tied to ciliary defects, the condition itself and its other traits - obesity, learning disabilities, extra fingers, and diabetes - have never before been linked to cilia. The research finding opens a never-before-pursued avenue to understanding these attributes in the general population (Ansley SJ, Badano JL, Blacque OE, et al. Basal body dysfunction is a likely cause of pleiotropic Bardet-Biedl syndrome. Nature, 2003;425(6958):628-33). ©Copyright 2003, Biotech Week   'Reset Switch' for Brain Cells Discovered Duke University DURHAM, N.C., Oct. 29 (AScribe Newswire) -- Duke University Medical Center neurobiologists have discovered how neurons in the brain "reset" when they are overly active. This molecular reset switch works to increase or decrease the sensitivity of brain cells to stimulation by their neighbors. Such "homeostatic plasticity" is critical for the brain to adapt to changes in the environment -- either to avoid having its neurons swamped by increased activity of a neural pathway, or rendered too insensitive to detect triggering impulses from other neurons when neural activity is low. This plasticity is distinct from the more rapid changes in neural circuits laid down early during the formation of memories, said the scientists. According to the researchers, their basic studies provide long-sought clues to how neurons protect themselves during stroke, epilepsy, and spinal cord injury. Also, their findings may help explain diverse brain changes that occur during early childhood and that go awry in later stages of life in Alzheimer's or Parkinson's disease. The researchers, led by Assistant Professor of Neurobiology Michael Ehlers, M.D., published their findings in the Oct. 30, 2003, issue of the journal Neuron. Other authors are Yuanyue Mu, Ph.D., Takeshi Otsuka, Ph.D., April Horton and Derek Scott. The research was supported by the National Institutes of Health, the American Heart Association and a Broad Scholars Award. According to Ehlers, homeostatic plasticity has long been theorized to exist and recently demonstrated in mammalian neurons, but no mechanism for the process had been discovered. Neuroscientists believed that such plasticity somehow adjusted the global sensitivity of the myriad connections, called synapses, that a neuron makes to its neighbors. At each of these synaptic connections, one neuron triggers the firing of a nerve impulse in another by launching a burst of chemicals called neurotransmitters across a gap called the synaptic cleft. Such homeostatic plasticity takes place over periods of hours or days and adjusts all a neuron's synapses, said Ehlers. In contrast, the synaptic adjustments that underlie rapid learning take place within seconds. "Neurobiologists have understood that a neuron can increase only so much its firing rate in response to inputs from other neurons, and then it saturates," said Ehlers. "There had to be a way for a neuron to recalibrate -- to scale up or down to stay within an optimal dynamic firing frequency range." "Consider when you're driving a car with a manual transmission. As you accelerate, you reach a point where the engine's RPMs are maximal and can go no higher. At that point, you need to switch gears to bring back your RPMs to an optimal range. What we have found is the molecular clutch that allows neurons to shift gears" said Ehlers. "This really is a profoundly important discovery. Imagine if your brain could only operate in 'second gear,'" he said. Although homeostatic plasticity had been a theory, only in the last couple of years has its existence been confirmed functionally, said Ehlers, and its mechanism was a mystery. It was known that the process involved changing the number of neurotransmitter receptors -- the proteins on the surfaces of synapses that serve as receiving stations for neurotransmitters. One key type of receptor implicated in such changes is called the NMDA receptor -- a major component of molecular learning and memory. The level of NMDA receptors was known to increase or decrease over time periods consistent with homeostatic plasticity, said Ehlers. Using an array of analytical techniques, Ehlers and his colleagues showed that the level of NMDA receptors was controlled throughout a neuron by the processing of its initial genetic blueprint -- called messenger RNA (mRNA). Messenger RNA is a copy of the genetic DNA blueprint for a specific protein -- such as the NMDA receptor protein -- that the cell's protein-making machinery uses to manufacture the protein. Specifically, the researchers' experiments revealed that when a neuron needs to increase its overall sensitivity, the stringlike mRNA blueprint for the NMDA receptor is snipped apart and spliced back together slightly differently than when the neuron needs to decrease its sensitivity. This "alternate splicing" causes the production of an NMDA protein differing in one small bit that attaches it to the transport machinery that carries receptors to the synaptic surface, found the Duke neurobiologists. When the overall triggering of a neuron decreases, and the neuron needs greater sensitivity -- and thus more NMDA receptors -- the alternate mRNA splicing yields a receptor protein with a variant of this bit that encourages the receptor to attach to the transport machinery. "It's a very surprising mechanism, and it explains a lot," said Ehlers. "It explains why the process is relatively slow, because the process of changing splicing of new proteins would be slow. And it explains how this process can happen at all the synapses on a neuron, because it happens in the neuron's nucleus, where mRNA splicing happens." According to Ehlers, the findings by him and his colleagues could aid understanding of how brain tissue is damaged during stroke, and altered in pathological states of addiction or following injury. "For example, it's been known for some time that the circuitry of the spinal cord is altered in response to spinal cord injury, enhancing the NMDA receptor-mediated transmission of nerve impulses," said Ehlers. "This aberrant rewiring causes all kinds of problems in patients, including heart arrhythmias and hypertension," he said. "So, our studies could lead to new therapeutic approaches for treating such problems by targeting the alternate splicing of mRNA for NMDA receptors." More broadly, said Ehlers, "these findings could open a floodgate of studies to determine where else in the brain alternate splicing is used as a central control mechanism. It is known that the brain uses alternate splicing more than any other organ, but until now there has not been an experimental system in which a specific alternate splicing event could be controlled and studied." "We have identified a completely new cellular signaling pathway, and it's going to be quite exciting to unravel how it works," said Ehlers. "Potentially this could open a whole new window into a very fundamental aspect of neuronal function."

Hormone Shows Promise for Treating Celiac Disease Provided by Medinews.com Results from a recent study suggest that a synthetic form of alpha-melanocyte-stimulating hormone (alpha-MSH) has an anti-inflammatory effect on celiac mucosa and may lead to the first medical treatment for celiac disease. The study appeared in the February 20, 2003, issue of NeuroImmunoModulation. Alpha-MSH is a naturally occurring molecule that modulates inflammatory and immune responses. Data confirming the presence of alpha-MSH in celiac mucosa suggest the presence of a local reaction of the molecule to control the inflammatory response elicited by gliadin. Gliadin is the subfraction of gluten that acts as a toxin in people with celiac disease, causing an immune reaction and resulting in damage to the small intestine. Our research suggests that locally produced alpha-SH modulates inflammation and perhaps limits epithelial damage in patients with celiac disease, said James M. Lipton, Ph.D., study investigator and chief scientific officer of Zengen, Inc. (Woodland Hills, CA, USA). We are particularly excited by these findings as these data, coupled with abundant evidence of the anti-inflammatory and anti-infective activity of Zengens novel molecules based on alpha-MSH, further validate our research and development efforts in numerous areas, including celiac disease.   Brain cells tougher than we thought Charlotte Observer 11/16/2003 The human brain contains more than 100 billion nerve cells called neurons. Until a few years ago, neuroscientists said thousands of brain cells died every day, year after year, decade after decade, eventually culminating in an enormous, inevitable loss of good mental function. Fortunately, this bleak view was misguided. Recent research shows that few neurons are lost and that, in reality, the brain is highly capable of reorganizing and rebuilding itself, even into old age. Although there is some loss, it's far less than once believed and appears to be confined to certain highly select areas. Those areas essential for memory, though, largely are spared. Better yet, the evidence strongly suggests that certain good habits and simple lifestyle measures can preserve and even boost mental well-being. The long-held belief that nerve cells cannot regenerate also is inaccurate. In 1998, researchers proved that the adult brain contains cells capable of dividing and becoming healthy new nerve cells. Instead of dying, these cells seem to shrink. Although the shrinkage appears to contribute to the general slowdown of mental function associated with aging, it does not seem to cause disability. Serious mental impairment seems to occur only when vast clusters of neurons are destroyed by a major disorder, such as a stroke or Alzheimer's disease. It also appears that a reduction in the production of specialized brain chemicals needed to conduct signals from one nerve cell to another contributes to age-related memory changes. That may be good news. If the neurons still are intact and only the specialized brain chemicals are lacking, we might be able to enhance the speed of mental processing by treating the chemical deficiency. What these and other recent findings show is that the brain is not hard-wired but remarkably plastic, even when challenged by stress. For example, in the wake of a stroke, the brain often can compensate for damage to speech or motor centers by rerouting nerve signals through new pathways. There are several ways that we can keep our minds sharp. These activities include mental stimulation, physical exercise and social connections. These things are important: ** Education and mental activity. Repeated rehearsal of information and the developing critical thinking skills promote plasticity, increasing both the number and the strength of synapses (electrochemical connections between neurons). ** Physical activity. The brain requires more oxygen than any other organ. It utilizes about 25 percent of all the oxygen taken in by the lungs, yet it has no oxygen storage capability. Thus, brain cells need a continuous supply of oxygen. Regular, vigorous aerobic exercise enhances circulatory health, which, in turn, promotes adequate oxygen delivery. ** Emotional well-being. Having a strong sense of purpose and meaning is a key characteristic of people who thrive in their later years. Frequent contact with family and friends, community activities and satisfaction with one's accomplishments are important. ** Managing stress. Stress triggers the release of hormones that can block the production of new brain cells and, over prolonged periods, kill nerve cells. Stress hormones also can lead to chronic medical conditions capable of undermining brain health. Regular exercise, yoga, meditation and seeking help from support groups or a professional counselor can help defuse stress. ** Limiting alcohol and caffeine intake. Excessive alcohol consumption quickly can destroy large numbers of brain cells, which can lead to confusion, impaired balance and coordination, sleep disturbances and depression. While a little caffeine temporarily seems to enhance concentration, too much can cause jitters and confusion. ** Not smoking. ** Treating chronic physical and mental problems. Certain health problems can lead to secondary brain function problems. For example, overly aggressive treatment of diabetes can produce low blood sugar, which starves the brain of the glucose it needs to function properly. Similarly, untreated heart disease can reduce the brain's blood supply. ** Limiting television. Watching television is not as stimulating as reading, conversation, playing word games and working puzzles. ** Getting adequate sleep. As we age, we need fewer hours of sleep per night and tend to awaken more frequently throughout the night. It is nonetheless crucial to get enough sleep, generally at least six hours per night. ** Eating right. Although there is no compelling evidence that any foods or nutrients will enhance normal memory or intelligence, a well-balanced, low-fat diet is essential for good circulatory health. Women might consider hormone replacement therapy. Although studies have yielded conflicting results, some research indicates an association between HRT and decreased risk of Alzheimer's disease. It is believed that estrogen may promote the production of specialized brain chemicals and the learning process is improved. Breaking routine also is helpful. Simple tricks such as occasionally brushing your teeth with the nondominant hand, taking a different route on your errands, and finding your car keys by touch instead of sight can help sharpen mental skills. Periodically review your medication. Memory problems can be a side effect of many drugs. Furthermore, some drugs that would be fairly harmless when taken alone may cause problems when combined with other drugs. Copyright ©2003 Charlotte Observer. All Rights Reserved. Hippocampal gene expression profiling in spatial discrimination learning Yolanda Robles, Pablo E. Vivas-Mejía, Humberto G. Ortiz-Zuazaga, Jahaira Félix, Xiomara Ramos and Sandra Peña de Ortiz Neurobiology of Learning and Memory, 2003, 80:1:80-95 Abstract Learning and long-term memory are thought to involve temporally defined changes in gene expression that lead to the strengthening of synaptic connections in selected brain regions. We used cDNA microarrays to study hippocampal gene expression in animals trained in a spatial discrimination-learning paradigm. Our analysis identified 19 genes that showed statistically significant changes in expression when comparing Naïve versus Trained animals. We confirmed the changes in expression for the genes encoding the nuclear protein prothymosin and the -1 opioid receptor (DOR1) by Northern blotting or in situ hybridization. In additional studies, laser-capture microdissection (LCM) allowed us to obtain enriched neuronal populations from the dentate gyrus, CA1, and CA3 subregions of the hippocampus from Naïve, Pseudotrained, and spatially Trained animals. Real-time PCR examined the spatial learning specificity of hippocampal modulation of the genes encoding protein kinase B (PKB, also known as Akt), protein kinase C (PKC), cell adhesion kinase (CAK, also known as Pyk2), and receptor protein tyrosine phosphatase/ (RPTP/). These studies showed subregion specificity of spatial learning-induced changes in gene expression within the hippocampus, a feature that was particular to each gene studied. We suggest that statistically valid gene expression profiles generated with cDNA microarrays may provide important insights as to the cellular and molecular events subserving learning and memory processes in the brain.   Dangers of Prednisone, and How to Avoid Steroids By Dr. Joseph Mercola with Rachael Droege Millions of people are taking prednisone, the corticosteroid drug that is widely prescribed for conditions such as asthma, emphysema, allergies, Crohn's disease, multiple sclerosis, herniated spinal discs, acute muscular pain syndromes, rheumatoid arthritis, autoimmune diseases, and to reduce inflammation from a variety of medical problems. This immunosuppressive drug, though necessary in some cases, is associated with serious long-term side effects such as cataracts, bone loss, weakening of the immune system, and many others. One of the most serious complications from prednisone is the risk of osteoporosis, which occurs from the bone loss. As I said earlier, prednisone is indeed occasionally needed and can actually be life saving. It is, though--like most all drugs--nearly always a poor choice to use for the long term. Prednisone will cover up the disease, but it is the underlying dysfunction--the cause of the disease--that must be repaired. While the specifics on how to do this vary from patient to patient, in a very general sense the same approach would have prevented the disease in the first place. As many newsletter readers know, the focus in the traditional model of medicine is to wait until you get a disease and then treat it with drugs like prednisone. But the need for this and all drugs can be dramatically reduced over the course of anyone's life if they adopt a healthy diet and take a host of other preventive measures such as: Eliminating sugar and grains from the diet Increasing omega-3 fats, primarily EPA and DHA Optimizing vitamin D levels Removing any excess iron from the system Resolving past emotional traumas Eliminating all excess sugars and grains is a very important step to optimizing your diet and preventing disease. Also important is to be sure you are eating the correct amount of macronutrients (proteins, fats and carbohydrates) for your Metabolic Type. Most people don't realize that there is a specific amount of macronutrients that they should be eating according to their body's specific metabolic type. If you are following a diet plan you are probably following a one-size-fits-all approach. But in the same way people look and act different on the outside, their insides, down to the genetic level, are different and we all require different amounts of nutrients to feel our best. Eating the proper amount of macronutrients according to metabolic type is a crucial step in optimizing the body's ability to fight the diseases that are treated with prednisone. Meanwhile, emotional traumas and barriers are a major, but often ignored, factor in fostering and maintaining physical disease. In my experience, bioenergetic techniques, such as EFT, that address the emotional traumas tend to be the most effective at restoring the body's innate ability to restore itself back to health. While traditional cognitive therapies are useful for insights, they are rarely effective at normalizing one's physiology and reversing autoimmune disease. When the underlying causes of a disease are addressed, the body is also more likely to repair and recover from the negative influences of the prednisone itself. Generally, the earlier you start implementing the approaches mentioned above, the more effective your recovery will be. I have used these natural-focused approaches to address underlying causes of illness for over 10 years and have treated many hundreds of patients on steroids like prednisone. It is the rare person I have seen who has not been able to significantly reduce their reliance on these dangerous medications through my approach. You will likely be able to get off of the prednisone and have the disease go into remission. However, individuals should NOT take themselves off of prednisone without guidance from a health care professional. Doing so could cause a severe exacerbation of the underlying problem and/or cause the adrenal glands to go into failure if done improperly. The key is to find a trained health care professional who understands and practices the techniques I mentioned. Usually no single professional has all the tools, so you may need to do some searching. A good first step would be to find an outstanding nutritionist who focuses on food rather than supplements, and reviewing Dr. Patricia Carrington's guidelines on how to find an EFT practitioner near you. In the meantime, there are some aspects you can begin on your own, such as cleaning up your diet. Check out my nutrition plan and you'll be off to a great start.

ALZHEIMER'S RESEARCH

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Gene Controls Age at Onset of Alzheimer's and Parkinson's Diseases Duke University Medical Center 10/21/2003 DURHAM, N.C. - By applying a new technique that combines independent lines of genomic evidence, Duke University Medical Center researchers and colleagues have identified a single gene that influences the age at which individuals first show symptoms of Alzheimer's and Parkinson's diseases. Such genes that can impact patients' age at onset for the two very prevalent neurological disorders are of particular interest as alternative targets for treatment, said Margaret Pericak-Vance, Ph.D., director of the Duke Center for Human Genetics. Drugs that delay the onset of Alzheimer's or Parkinson's diseases beyond the normal human lifespan would effectively prevent them in patients at risk for the disorders, she added. Alzheimer's disease is the most common cause of dementia among people over the age of 65, affecting up to 4 million Americans. Parkinson's disease -- characterized by tremors, stiffness of the limbs and trunk, slow movements and a lack of balance -- afflicts approximately 50,000 Americans each year. Both are complex disorders involving multiple genes. "Although physicians generally consider Alzheimer and Parkinson diseases to be distinct disorders, the two exhibit a lot of overlap both clinically and pathophysiologically," said Jeffery Vance, M.D., director of Duke's Morris K. Udall Parkinson's Disease Research Center and associate director of the Duke Center for Human Genetics. "This study emphasizes the similarity between the two diseases by highlighting a single gene that influences their age of onset." The team reports their findings in the Dec. 15, 2003, issue (available online Oct. 21) of Human Molecular Genetics and will present the work as a keynote paper at the annual meeting of the American Society of Human Genetics, which will be held Nov. 4-8, in Los Angeles. The major funding for the study was provided by the National Institute on Aging, the National Institute of Neurological Disorders and Stroke, the Alzheimer's Association, the Institute de France, and the American Federation for Aging Research. The team's earlier work identified a broad chromosomal region linked to the age at onset of Alzheimer's and Parkinson's diseases. The new research -- led by Pericak-Vance, Vance, John Gilbert, Ph.D. and Yi-Ju Li, Ph.D., of the Duke Center for Human Genetics and Jonathan Haines, Ph.D., of Vanderbilt University Medical Center -- narrows that region of the genome, which contained many hundreds of genes, to a single gene known as glutathione S-transferase omega-1 or GSTO1. The researchers overlaid three independent lines of genetic evidence to reveal those genes more likely to play a role in the disorders' age at onset -- a method, called genomic convergence, which the Duke team developed. The researchers first focused on Alzheimer's disease by comparing the activity of genes in the hippocampus -- a part of the brain affected by the disorder -- of unaffected individuals and Alzheimer's patients. The experiment uncovered four genes, including GSTO1, located in the region of the genome earlier linked to age at onset, the researchers report. An additional analysis involving 1,773 patients with Alzheimer's disease and 635 patients with Parkinson's disease later found that of those four genes, only GSTO1 showed genetic differences associated with age at onset. "By combining evidence based on gene expression and genetic association, we found a gene that modifies when the diseases start," said Li, the study's first author. "Understanding the role this gene plays in Alzheimer and Parkinson diseases may, in the future, lead to a means to delay the disorders' onset," she added, noting that even a short delay would benefit at-risk patients. The Center for Human Genetics is one of five centers within Duke's Institute for Genome Sciences and Policy. The institute represents Duke University's comprehensive response to the broad challenges of the genomic revolution. The international research team included scientists representing 17 institutions in the United States, the United Kingdom and Australia. Drug Improves Brain Structure In Alzheimer's Patients 11/1/2003 Duke University Medical Center Researchers at Duke University Medical Center have determined that a medication commonly prescribed for mild to moderate Alzheimer's disease (AD) appears to cause physical improvements in the hippocampus and other brain regions of patients with the disease. These improvements could explain why the drug, donepezil (trade name Aricept), a cholinesterase inhibitor, is beneficial in treating the symptoms of some Alzheimer's patients, the researchers said. The findings were made by using magnetic resonance (MR) technology to track brain changes among patients taking the drug. According to the researchers, this is the first time MR has been used to observe the effects of a medication on brain structures of patients living with AD. The feasibility of using MR for such studies is likely to improve future research into treatments for AD and other brain disorders, the researchers said. The study results appear in the Nov. 1, 2003, issue of the American Journal of Psychiatry. "We wanted to know if the drugs available for Alzheimer's disease alter the brain or the progression of the disease in any way," said Ranga Krishnan, M.D., lead author of the study and chief of psychiatry at Duke University Medical Center. "We discovered that, among the patients taking donepezil, levels of a brain chemical called N-acetylaspartate increased and the hippocampus deteriorated more slowly than among the patients who received a placebo. The implication is that we may be able to do something to change the progression of this disease." The researchers believe the drug may have a protective effect on the brains of Alzheimer's patients because it appears to slow the progression of the disease by reducing atrophy in the hippocampus, a region of the brain that is critical to memory function and is affected earliest in AD. "When someone has Alzheimer's disease, the brain begins to deteriorate as the gray matter shrinks and the disease progresses," Krishnan said. "We are unsure of why and how donepezil slowed the loss of hippocampal volume but we think the drug may help to improve cognition by increasing the levels of N-acetylaspartate in the brain, at least temporarily." This is important, the researchers say, because the data raise the possibility that a medication could affect the progression of brain changes in Alzheimer's disease. According to the researchers, this is the first longitudinal study to use magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (MRS) to assess brain function and the impact of a medication upon brain structures of patients with AD. The study is a follow up to the team's 1999 report that MRS could be used to track levels of the brain chemical called N-acetylaspartate, an amino acid found in the neurons of the central nervous system in patients with AD. The team had determined that the chemical could serve as a useful "marker" of the functional and structural integrity of neurons when proton magnetic resonance spectroscopy is used to view brain structures. Since MR had already proven to be an excellent tool for observing function and the changes in brain structures affected by AD, Krishnan and his team wondered if it would be possible to see how a drug affects those same structures. In the patients enrolled in this study, the researchers discovered that hippocampal volume decreased by 8.2 percent in the placebo group compared with a 0.4 percent decrease in those taking donepezil. Those on placebo also showed evidence of declining concentrations of N-acetylaspartate along with some cognitive decline. Those in the donepezil group showed evidence of increasing levels of N-acetylaspartate concentrations in two brain regions, the subcortical gray matter and the periventricular matter, which peaked between weeks six and 18. Donepezil treatment was associated with significantly greater improvements in cognition, relative to placebo, at every point during the study. Among those on placebo, the researchers found a significant relationship between the decline in N-acetylaspartate concentrations in the noncortical gray matter region of the brain and reductions in the patients' scores on cognition tests. The drug appeared to increase concentrations of N-acetylaspartate, although the mechanisms that underlie this are uncertain. The researchers are also unsure why donepezil appears to slow the deterioration of hippocampal tissue, uncertainty they say is compounded by a general lack of understanding about the cause of neuron loss in Alzheimer's disease. The researchers enrolled 67 patients aged 50 and older with a diagnosis of mild to moderate AD. Prior to the study, all of the participants received a comprehensive medical examination and verification of an Alzheimer's disease diagnosis. At baseline, the physical exam was repeated and an MRI scan of the brain was performed. Patients were administered two identical pills - either donepezil or placebo - each evening for 24 weeks. Patients in the donepezil group received 5 milligrams per day (a 5 milligram pill plus a dummy pill) for the first 28 days and 10 milligrams (two 5 milligram pills) per day thereafter. Daily doses consisted of two identical tablets so as to not reveal the dosage scheme. The randomized, double-blind, placebo-controlled study was conducted over a 24-week period followed by a six-week period in which all participants received only placebo pills. Each participant was treated and clinically evaluated at one of three outpatient sites – Duke University Medical Center, the Medical University of South Carolina or a private psychiatrist's office in Raleigh, N.C. All of the MR scans were performed at Duke University Medical Center and all data were processed by the Duke Image Analysis Laboratory. Patients were required to return at 6-week intervals for routine physical examinations, laboratory assessments, a medication compliance check, adverse events monitoring and an MRI scan. Of the 67 participants who enrolled, 34 received donepezil and 33 were given placebo. Fifty-one patients (76 percent) completed the study. Ten patients (30 percent) in the placebo group discontinued the study compared with six (18 percent) from the donepezil group. "The study was challenging in that subjects were required to be scanned every six weeks and the MRI methods needed to be standardized," said Cecil Charles, co-director of the Center for Advanced Magnetic Resonance Development at Duke. "This study will set the stage for more effective studies of medications used for Alzheimer's disease. "Clearly, more effective treatments are needed for Alzheimer's disease," Charles added. "This study further suggests that MRI and MRS may be useful tools to assess brain changes in patients with Alzheimer's disease." The researchers stressed the limitations of their study, saying additional placebo-controlled studies with larger numbers of patients are necessary to confirm and expand their findings. Alzheimer's disease is the most common form of dementia among Americans over the age of 80. Donepezil is one of four drugs currently approved by the Food and Drug Administration for the treatment of mild to moderate Alzheimer's disease. Research funding for the study was provided by Eisai Inc., Teaneck, N.J., and Pfizer Inc., New York. Additional study investigators include Duke's P. Murali Doraiswamy, M.D.; Jacobo Mintzer, M.D., Medical University of South Carolina; Richard Weisler, M.D., an adjunct professor at Duke in private practice in Raleigh, N.C.; Xin Yu, Ph.D., University of Washington, St. Louis; Carlos Perdomo and John R. Ieni, Ph.D., Eisai; and Sharon Rogers, Ph.D., who was employed by Eisai at the time of the study.

SENSE OF SMELL

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Alternatively Speaking: Working with Sense of Smell Daily Post 10/14/2003 by Valerie HILL AROMATHERAPYis one of the most respected and widely-practised of all complementary therapies. In common with many other forms of alternative medicine it considers the "whole person" and treats both physical and emotional symptoms. Eachof us has an individual sense of smell,as unique as our DNA. It is an extremely powerful and instinctive sense, used from earliest times to warn us of danger,choose our food and select a mate. In a more sophisticatedage, we still use aromas to project our personalities and emotions, for example through the perfumes we use and the after-shaves we give as gifts. When we take flowers to someone in hospital we're using a simple form of aroma therapy to help them feel better. Theessential plant oils that give the bouquet its smell contain ingredients that relax the nervous system and instantly improves spirits. Aromatherapy is so successful because the use of essential oils from plants, either in massage or diffused into the atmosphere, or in baths,allows for quick access to the circulation and the limbic system, the part of the brain which deals withemotions. When you peel an orange you're probably aware of the tangy bitter- sweet citrus smell that fills theair. This is thefruit's essential oil being released. Many other plants also contain valuableessentialoils,each with their own special characteristics and healing properties. Virtually allessentialoils have antibacterial properties and some have antifungal properties. The oils work in two ways; directly by smell and also by being absorbed through the skin into the bloodstream in minute quantities. You should select pure essential oils according to their general effects and their traditional uses. For example,if you want a refreshing and up-lifting pick-me-up, choose grapefruit essential oil. If you have problems sleeping, a few drops of lavender oil on the pillow will help you to relax. Tired muscles or aching limbs will benefit from juniper berry and the colds and flu can be treated withafew drops of tea tree oil in adiffuser. It is important to remember that essential oils are pure extracted plant oils and as such a rehighly concentrated. For example, it takes around 60,000 rose blossoms to make one drop of pure essential oil. All essential oil fragrances fall into one of the five fragrance families:green, citrus, floral, spicy or woody. One or more of these fragrance families will instinctively appeal to you. For instance, the floral family includes geranium, which can help and soothe menstrual problems and ylang ylang, which can help balance thebody's nervous system. The green family embraces rosemary, effective for refreshing the nasal passages and marjoram which can help soothe digestive problems. Essential oils cannot be used directly onto the skin and should always be diluted in a carrier oil, such as grapeseed,first. Pregnant women and anyone with epilepsy or a person taking medication for high blood pressure should consult a qualified aroma therapist rather than treat themselves. Dendritic processing within olfactory bulb circuits Nathan E. Schoppa and Nathan N. Urban Trends in Neurosciences, (August 07, 2003), 10.1016/S0166-2236(03)00228-5 Abstract Odors elicit a well-organized pattern of activation in glomeruli across the surface of the olfactory bulb. However, the mechanisms by which this map is transformed into an odor code by the bulb circuitry remain unclear. Recent physiological studies in bulb slices have identified several synaptic processes that could be involved in sharpening odorant signals. Mitral cells within a single odorant receptor-specific network can be synchronized by dendrodendritic excitatory interactions in a glomerulus, whereas mitral cells in different networks engage in long-lasting lateral inhibition mediated by dendrodendritic synapses with interneurons. The emerging picture is one in which groups of mitral cells use a unique set of mechanisms to accomplish computational functions similar to those performed by analogous modular structures in other sensory systems.

BRAIN RESEARCH

Neuro-cognitive impairment following acquired central nervous system infections in childhood: a systematic review Julie A. Carter, Brian G.R. Neville and Charles R.J.C. Newton Brain Research Reviews, 2003, 43:1:57-69 Abstract The morbid consequences of central nervous system (CNS) infections are often overlooked in the face of high mortality rates. However, neurological impairments not only affect the child's development and future prospects but also place an economic and social burden on communities and countries that often have few resources to deal with such problems. We conducted a systematic review to investigate the occurrence and pattern of persisting neurological impairment after common CNS infections. A comprehensive search of MEDLINE, EMBASE and PsycINFO databases, supplemented by hand-searches of key journals, resulted in forty-six eligible studies, five of which gave information on the spectrum of developmental domains. Despite the lack of comprehensive, methodologically-sound studies, the results show that postinfectious neurological impairment persists, most commonly in cognition and motor functions. Deficits include more subtle problems, which can be difficult to detect on gross neurological assessment but may still be deleterious to the child's social and educational functioning. Higher morbidity for similar mortality in acute bacterial meningitis compared with cerebral malaria in the epidemiological data may suggest future research directions for clinical research to devise more effective interventions.

NEUROTRANSMITTER NEWS

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Enhancement of noradrenergic neurotransmission in the nucleus of the solitary tract modulates memory storage processes Teiko Miyashita and Cedric L. Williams, Department of Psychology, University of Virginia, 102 Gilmer Hall, P.O. Box 400400, Charlottesville, VA 22904-4400, USA Abstract These studies examined whether posttraining activation of 1-noradrenergic receptors in the nucleus tractus solitarius (NTS) influences neural processes that are involved in encoding information into memory. Different groups of male Sprague–Dawley rats were trained in two separate learning tasks. In experiment 1, rats were given either a control solution or the 1-noradrenergic agonist phenylephrine (0.5, 1.0, 5.0, or 10 g/0.5 l) directly into the NTS immediately after they were given a footshock (0.35 mA, 0.5 s) in the dark compartment of an inhibitory apparatus. In a retention test given 48 h later, groups that received either 5.0 or 10.0 g of phenylephrine avoided the dark compartment for a significantly longer period of time than the PBS control group (P<0.05 and P<0.01, respectively). In experiment 2, identical doses of phenylephrine were infused in the NTS following footshock delivery in one alley of a Y-maze. Animals given either 1.0 or 5.0 g of phenylephrine performed significantly better than PBS controls on several different measures that served as indices of retention. The results indicate that activation of 1-noradrenergic receptors in the NTS plays a critical role in the transmission of signals from the periphery to brain systems that process memory for emotionally significant experiences.

AUTISM

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Therapeutic nutrition clinic unveils web site to help autistic children Provided by NewsRx.com on 11/20/2003 Nutrition Care for Children (NCFC) unveiled its new web site, www.nutritioncare.net, to help children with autism, and announced its collaboration with Lorraine Hurley, MD, and Pam Ferro, RN. "The latest U.S. Department of Education statistics show that over 118,000 children ages six and up were diagnosed with autism from 2002 to 2003, a 21.21% increase in 1 year," said Judy Converse, MPH, RD, founder, Nutrition Care for Children. "Most children in the Nutrition Care for Children practice are younger than five, so this figure will unquestionably increase," she continues. "Early, aggressive medical nutrition therapies can work to prevent, reverse, or diminish a serious developmental outcome like autism; however, these tools can be complex and require much commitment; parents should not go it alone," she continues. "Through collaboration with Dr. Hurley and Pam Ferro, Nutrition Care for Children can work with these families through tailored nutrition therapy programs." Judy Converse, a licensed, registered dietitian, founded NCFC in 1999, as a private practice specializing in pediatric nutrition therapies. Current research shows that children with autism and other developmental issues typically suffer from bowel disease and nutrition problems more frequently than their typical peers. Using diet and nutrition as treatment tools for developmental, learning, behavioral, allergy, and growth issues, Converse has helped hundreds of families proactively manage their struggle with autism and other developmental issues. The Nutrition Care for Children team recognizes that families in Massachusetts and beyond face challenges presented by autism. Today, the practice serves the northeastern U.S., providing effective nutrition and medical therapy programs. Ms. Converse also is a contracted service provider with the Cape and Islands Early Intervention Program, a federally funded program serving children, ages 0 to 3 with developmental delays, to provide nutrition services to families enrolled in the program. The clinic's new web site, www.nutritioncare.net, is designed to inform, educate, connect with, and empower families from all over the nation who struggle daily with autism. Located in Bourne, Massachusetts, NCFC has served the Cape Cod community and, now increasingly, the Massachusetts community, providing effective therapeutic nutrition therapy programs to treat developmental issues, such as autism, developmental delays, sensory integration disorder, attention deficit disorder, hyperactivity, poor sleep, frequent infections, allergies, asthma, eczema, chronic bowel problems, irritability, colic and tantrums. NCFC provides individualized nutrition therapy for each child, based on medical history, clinical signs and symptoms, current nutrition status, feeding skills or restrictions, developmental status, and laboratory data. This article was prepared by Health & Medicine Week editors from staff and other reports. ©Copyright 2003, Health & Medicine Week via NewsRx.com & NewsRx.net Study Finds No Link Between Vaccines, Autism But Critics Charge Fact Manipulation ATLANTA (Reuters) - U.S. researchers said on Monday that they had found no significant link between childhood vaccines containing the mercury-based preservative thimerosal and neurological problems such as autism and attention-deficit disorder in a study of more than 140,000 kids. But critics charged that the study, which was published in the November, 2003 issue of Pediatrics, had been manipulated to protect the federal government and vaccine manufacturers from embarrassment and potential lawsuits. Thimerosal, an organic compound that is 49 percent mercury, was used routinely in the United States between the 1930s and the 1990s to prevent bacterial and fungal contamination of a wide range of infant vaccines, including hepatitis B. The American Academy of Pediatrics and the U.S. Public Health Service recommended removing it from childhood vaccines in 1999 as a precaution. Studies have linked ingestion of mercury to neurological and renal problems in humans. In a study of records from three U.S. health management organizations, researchers from the Centers for Disease Control and Prevention (news - web sites) and the private sector found conflicting data when they screened for a connection between vaccines and neurological disorders in children born between 1991 and 1999. One group of children who had received routine vaccines containing thimerosal had a higher incidence for tics, while a separate group had a higher rate of language delays, according to the study. NEUROLOGICAL DISORDERS A second phase of the study showed no significant links to such problems in another group. "The final results of the study show no statistical association between thimerosal vaccines and harmful health outcomes in children, in particular autism and attention-deficit disorder," said Dr. Frank DeStefano, a CDC researcher who helped carry out the study. But public health activists, including those who work with autism sufferers, said that neurological disorders had been found at significantly high rates in the original analysis of the study in 2000, but had been watered down in the final version. In a statement released on Monday, Moms on a Mission for Autism accused CDC researchers and others of "conspiring to deliberately deceive the American people by minimizing the ill-affects of thimerosal." Critics also noted that Dr. Thomas Verstraeten, the lead author of the study, left the federal agency two years ago to join GlaxoSmithKline Plc., which manufactures vaccines. The article in Pediatrics failed to note that Verstraeten was employed by the European pharmaceutical giant. "This revelation undermines this study further," U.S. Rep. Dave Weldon, a Republican and physician from Florida, wrote in a letter to CDC Director Dr. Julie Gerberding. Weldon called for an independent review of the study. A GlaxoSmithKline spokeswoman said the company had never asked Verstraeten to change the study's data. Brain Anatomy of Asperger Syndrome Examination of the brain structure of individuals with ASD is a growing area of study. Recent articles included controlled studies comparing the brain structure of adults with Asperger syndrome with that of normal adults. Structural differences have been found between these two groups in the fronto-striatal and cerebellar regions, with individuals with Asperger syndrome having less gray matter than controls.[43*] Differences in prefrontal lobe metabolite levels have also been found between adults with Asperger syndrome and controls, with adults with the syndrome having higher concentrations of certain metabolites.[44] Functional imaging research has shown less activation of certain areas of the brain (e.g. medial prefrontal cortex, temporal poles and superior temporal sulcus) for adults with Asperger syndrome or HFA when engaged in mentalizing tasks.[45*] Finally, post-mortem brain analyses of adults with Asperger syndrome have indicated abnormalities in the minicolumnar organization of some areas of the right hemisphere.[46]

EEG/ERP

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Personality and the EEG: arousal and emotional arousability Stenberg, George Journal: Personality and Individual Differences Volume: 13 Issue: 10 Pages: 1097-1113 Abstract: Eysenck's theory asserts that low cortical arousal accompanies extraversion (or the sub-component impulsivity). In Gray's theory, impulsivity is associated with high sensitivity to signals of reward, and anxiety with high sensitivity to signals of punishment. These hypotheses were tested by recording EEG signs of arousal and phasic arousability in emotional imagery, using 17 EEG channels and frequency analysis by Fourier transform. Three conditions were used: a neutral control task, and two emotional conditions involving imagery about pleasant and unpleasant personal memories. Forty subjects participated (23 men, 17 women; median age 23 years). Orthogonal personality dimensions of impulsivity and anxiety were derived from a joint analysis of the EPI and KSP questionnaires. The results showed, as expected, lower arousal, defined by more posterior theta activity, in impulsive subjects than in non-impulsives. These differences extended across all conditions. The EEG responses to the emotional conditions, in relation to the neutral one, consisted primarily of a right-lateralized frontal theta increase and changes in temporal beta activity (an increase in the positive condition, and a decrease in the negative one). These responses were expected to be amplified for impulsive subjects in positive emotion, and for anxious subjects in negative emotion. The right-sided frontal theta activity was stronger in high-anxious subjects than in low-anxious ones across all conditions, suggesting higher overall emotionality. For the temporal beta activity, the expected amplification of the response to negative emotion in the high anxiety group was confirmed, but the corresponding prediction for impulsives and positive emotion was not upheld. It is concluded that anxiety is related to EEG signs of heightened emotionality, especially in negative affect, and that impulsivity is associated with lowered arousal. Effects of nicotine in a bi-modal attention task Lindgren, M; Stenberg, G; Rosén, I Journal: Neuropsychobiology Volume: 38 Pages: 42-49 Abstract: Fifteen male users of oral snuff participated in an experiment where we used an auditory-visual vigilance task to study nicotine effects on P300 and response parameters. Quantitative EEG was also studied. Fifteen male non-users served as a control group. We found some decrease of response times, and slightly improved signal detection. P300 parameters were not affected in this study. Quantitative EEG-analysis indicated an expected increase of arousal, as activity within the alpha band shifted towards higher frequencies. EEG and event-related potential correlates of personality Stenberg, Georg; Bartussek, Dieter; Hagemann, Dirk; de Pascalis, Vilfredo; Stelmack, Robert Symposium at the ISSID conference in Århus, Denmark Abstract: The excellent time resolution of electrophysiological methods allows a fine-grained study of brain reactions to important stimuli, reactions to which are widely thought to reveal characteristic individual differences. These include affectively laden stimuli, as well as situations demanding regulation of arousal and attention. The symposium will present a number of studies where these possibilities have been exploited in investigations of personality-related differences in brain wave patterns - both event-related potentials and EEG frequency content. The studies have been inspired by Gray's and other theories which relate personality to affective reactivity, as well as by theories concerning the regulation of arousal. Lastly, principles and theoretical guidelines involved in this type of research will be discussed.

Brain activity linked to treatment-resistant depression NewsRx.com 10/23/2003 Around 5 million people in the U.K. experience depression at any one time, and approximately 30% to 40% of people are resistant to conventional therapies. An international team of researchers have discovered that brain activity differs significantly between healthy individuals and those suffering from treatment-resistant clinical depression. Announcing their results in Biological Psychiatry, the researchers were led by consultant psychiatrist, Professor Tonmoy Sharma, director of the Clinical Neuroscience Research Centre in Dartford. He says, "This is a significant step in unravelling the reasons why these people may not be responding to the antidepressant drugs currently available." The study, the most significant to date to have investigated dysfunction in different parts of the brain in treatment-resistant depression, also heralds a new era in drug development. There are already benchmark drugs for treatment-resistant schizophrenia, but there is currently no equivalent treatment for treatment-resistant depression. This development in the understanding of the biological basis of treatment-resistant depression gives hope to scientists searching for a much-needed "atypical" antidepressant. Six women with treatment depression were recruited to the study, alongside six healthy female volunteers. The participants viewed a series of images that contained a picture and a caption while the researchers observed their emotional reaction using a brain imaging technique, known as functional magnetic resonance imaging. This procedure is invaluable in tracking brain activity, and can pinpoint areas of the brain used in specific tasks. The team found that people with depression processed their emotional response to the images differently from the healthy individuals. Some parts of the brain were less active in people with depression than the control group, while other areas showed greater activity. For instance, activities in some regions of the brain, such as the rostral anterior cingulate, were reduced in people with depression compared with the healthy participants. However, the team noticed that an area of the brain, the subgenual cingulate, associated with sadness in healthy people, was activated by the positive images shown to the participants with depression. The Clinical Neuroscience Research Centre's mission is to help improve the lives of people with mental illnesses. The centre is dedicated to innovative research into more accurate diagnoses of, and more effective treatments for, a range of conditions, including depression, schizophrenia, bipolar disorder (manic depression), memory loss, dementia, Alzheimer's disease, anxiety and sleep disorders. This article was prepared by Health & Medicine Week editors from staff and other reports.

The Effectiveness of Vision Therapy in Improving Visual Function Report by the American Optometric Association Documentation on the Clinical Research and Scientific Support Underlying Vision Therapy  Note: There is a tremendous amount of literature available which documents the effectiveness of vision therapy in treating binocular vision (eye coordination and alignment), oculomotor (tracking and eye movements), and accommodative (focusing) problems. The following is a copy of a report published by the American Optometric Association entitled “The Efficacy of Vision Therapy.”  "The Efficacy of Optometric Vision Therapy" The purpose of this paper is to offer supporting documentation for the efficacy and validity of vision therapy for modifying and improving vision functioning. Optometry is an independent primary health care profession. Its scope of practice includes the prevention and remediation of disorders of the vision system through the examination, diagnosis, treatment, and/or management of visual efficiency and eye health as well as the recognition and diagnosis of related systemic manifestations, all of which are designed to preserve and enhance the quality of our lives and environment. Optometrists examine the eyes and related structures to determine the presence of vision problems, eye disease, and other abnormalities. They gather information on the vision system during the optometric examination, diagnose any conditions discovered, and prescribe individual or combinations of interventions such as corrective lenses, prescription drugs, contact lenses, and vision therapy. The American Optometric Association considers vision therapy an essential and integral part of the practice of optometry (1). Forty-three states specifically describe vision training, orthoptics, or some synonym in their definitions of the profession of optometry .The Institute of Medicine of the National Academy of Sciences (2), the Dictionary of Occupational Titles of the Employment and Training Administration (3), the U .S. Public Health Service (4), the U.S. Dept. of Labor, Employment and Training Administration (5), the National Center for Health Statistics (6), the Bureau of Labor Statistics (7), The Dept. of Health and Human Services (8) and the Association of Academic Health Centers (9) all include vision therapy in their definitions of the profession of optometry. The theory and procedures underlying the diagnosis and management of vision disorders are taught in all the schools and colleges of optometry (9). In addition, the National Board of Examiners in Optometry (10) and the majority of the various state licensing agencies examine applicants for their theoretical and clinical knowledge in vision therapy.   What is vision therapy / visual training? Vision therapy (also called vision training, orthoptics, eye training, and eye exercises) is a clinical approach for correcting and ameliorating the effects of eye movement disorders, nonstrabismic binocular dysfunctions, focusing disorders, strabismus, amblyopia, nystagmus, and certain visual perceptual (information processing) disorders. The practice of vision therapy entails a variety of non-surgical therapeutic procedures designed to modify different aspects of visual function (11). Its purpose is to cure or ameliorate a diagnosed neuromuscular, neurophysiological, or neurosensory visual dysfunction. Vision therapy typically involves a series of treatments during which carefully planned activities are carried out by the patient under professional supervision in order to relieve the visual problem. The specific procedures and instrumentation utilized are determined by the nature and severity of the diagnosed condition. Vision therapy is not instituted to simply strengthen eye muscles, but rather is generally done to treat functional deficiencies in order for the patient to achieve optimal efficiency and comfort. The treatment may appear to be relatively uncomplicated, such as patching an eye as part of amblyopia therapy. Or, it may require complex infrared sensing devices and computers, which monitor eye position and provide feedback to the patient to reduce the uncontrolled jumping of an eye with nystagmus. Treatment of strabismus, or turned eye, can involve complex optical and electronic instruments or such simple devices as a penlight or a mirror. The particular procedures and instruments are dependent on the nature of the visual dysfunction and the doctor's clinical judgment.   Who can benefit? Vision therapy is utilized for conditions, which include oculomotor dysfunctions, non-strabismus binocular coordination problems, accommodative disorders, strabismus, amblyopia, and nystagmus. These disorders and dysfunctions have a prevalence rate second only to refractive conditions, such as myopia and hyperopia, and are far greater than most ocular diseases (12-16). Graham (17) reports overt strabismus in almost 4% of over 4,000 school children. Among clinical cases, Fletcher and Silverman (18) found 8% of 1,100 to be strabismic. Other studies have generally found rates between these two levels (19). The reported prevalence of amblyopia varies somewhat depending upon the specific criteria used, with low estimates at approximately 2% (20), and ranging up to 8.3% in the Rand HIE report (21), and also in the study by Ross, Murray and Steed (22). The National Society to Prevent Blindness estimates 127,000 new cases of amblyopia per year in the United States (23). Non-strabismic binocular coordination anomalies have an even higher incidence. Convergence insufficiency is reported in 15% of adults by Duke-Elder (24). Graham (l5) reports high heterophorias in over 13%, while Hokoda (25) found fusion or accommodative problems in 21% of a non-presbyopic clinical population. The recently developed New York State Vision Screening Battery probes oculomotor, binocular, accommodative, and visual perceptual function. Testing of 1,634 children with this battery revealed a failure rate of 53% (27). When "special" populations are considered, the incidence of ocular coordination and visual processing problems becomes very high. Among children who are reading disabled, as many as 80% show deficiency in one or more basic visual skills (26). Grisham (28) has recently reported that children with reading problems showed greater than a 50% prevalence of visual deficiencies in accommodation, fusional vergence or gross convergence, compared to their normally achieving peers. Cerebral palsied patients show an incidence of strabismus as high as 50%. (29,30) The hearing impaired (31.32), emotionally impaired (33), and developmentally disabled (34,35) also demonstrate unusually high prevalence rates of visual problems. This is of particular importance because almost 11% of the school population has been identified as having one of the above handicapping conditions (36). Our culture continues to foster higher educational standards and produces work related tasks, which are increasingly visually demanding. This is evident in the difficulties encountered by video display terminal (VDT) operators. A majority of surveys have shown that more than 50% of VDT workers report they experience some type of ocular discomfort or blurring (37,38). The National Academy of Sciences (39) concluded that the oculomotor and binocular vision changes noted at video display terminals are similar to those that occur during standard nearpoint tasks. What are oculomotor skills and oculomotor dysfunctions?  [Tracking and eye movements] Clear vision occurs when a precisely focused image of the object of regard is centered on the fovea and when accurate eye movements maintain this relationship. The components of the oculomotor or eye movement system include fixations, vestibular and optokinetic movements, saccades, and pursuit movements (40). Each one of the components has its own distinct and different neuroanatomical substrate and functional neurophysiology (41).  There are times when several components interact. An example of this occurs when the pursuit system interacts with other systems to create the ocular stabilization or position maintenance system (42) to hold the eyes steady. Nystagmus, a to-and-fro involuntary movement of the eyes, is caused by disturbances in the mechanisms that hold images steady (position maintenance) and may be exhibited in over a dozen different clinical patterns of movement (43). This loss of ability to maintain central fixation and eye position with the foveal area is one of the characteristics of pathological nystagmus. Patients with amblyopia represent another class of individuals with impaired central fixational ability. Lack of ability to steadily fixate with the fovea is accompanied by reduced visual acuity and is commonly observed in anisometropic and especially strabismic amblyopes. Their characteristics have been described extensively (44-46).  Abnormal saccadic and pursuit eye movements are exhibited in strabismic amblyopes and appear to be related to dysfunctions in the monocular motor control center for position maintenance (47-49). When nystagmus or nystagmoid movements are present, the clinical identification of fixation pauses, regressions, and progressions during reading become difficult. The erratic eye movements interfere with efficient visual information processing (50,51). During reading, the function or behavior of the eye movement system involves more than the physical movement of the eyes alone. This functional component involves the integration of the eye movements with higher cognitive processes including attention, memory, and the utilization of the perceived visual information (52). Clinical and research evidence strongly suggest that many children and adults who have difficulty with both reading and non-reading visual information processing tasks exhibit abnormal eye movements (53-66). Numerous studies (67-69) indicate that there is a distinct difference in the oculomotor (eye movement) patterns between children with reflective strategies or styles of processing visual information and those with impulsive styles. There is evidence that children and adults with attentional difficulties and hyperactivity exhibit inefficient eye movement patterns that interfere with visual information processing (70-74). In summary, there are a variety of dysfunctions in the oculomotor system. Their clinical manifestations are quite often related to problems with functional visual performance and the efficient processing of information.   Can eye movement skills be modified? Improvement in eye movement control and efficiency has been reported in individual case studies following vision therapy (75-77). Wold et al (78) reported on 100 consecutive optometric vision therapy patients whose eye movement skills were rated on the Heinsen-Schrock Performance Scale (79). This is a 10-point observational scale for scoring saccadic and pursuit eye movement performance. Only 6% of the children passed the eye movement portion prior to therapy.  Post-therapy reevaluation revealed that 96% of the children were able to pass. Heath (80) discussed the influence of ocular-motor proficiency on reading. Sixty third and fourth graders who scored below the 40th percentile on the Metropolitan Reading Test and failed the ocular pursuit subtest of the Purdue Perceptual Motor Survey were divided into control and experimental groups. Results of the study showed significant improvement in ocular pursuit ability for the experimental compared to the control group. In addition, those children receiving therapy were found to score significantly better on a post-test of the Metropolitan Reading Test. Fujimoto et al (81) compared the use of various techniques for saccadic fixation training. In this controlled clinical trial, both of the treated groups showed a statistically significant improvement in speed and accuracy of eye movements compared to an untreated control group. A controlled study of pursuit eye movements was conducted by Busby (82) in an enhancement program for special education students. The subjects were rated on their ability to maintain fixation on a moving target. The rating procedure was shown to have a high interrater reliability. The results showed statistically significant improvement by the experimental group in pursuit eye movement and persistence of the therapeutic effect on retesting at a 3-month interval after conclusion of the therapy. Punnett and Steinhauer (83) conducted a controlled study investigating the effects of eye movement training with and without feedback and reinforcement. There were clear post-training differences between the eye movement skills of the control and experimental group of reading disabled students. This demonstrated that the use of reinforcement in training oculomotor facility could improve those skills. There was an improvement in reading performance following the oculomotor training as well. Similar results demonstrating the trainability of eye movements have been obtained in studies employing behavior modification and reinforcement (84,85). Modifying and improving the oculomotor ability to maintain central fixation and eye position in nystagmus patients has been reported over the years in various studies. The use of after-images (86,87) and Emergent Textual Contour training to provide visual biofeedback regarding eye position and stability has had some success in improving fixational ability. Orthoptics, as well as verbal feedback techniques, have helped some patients in reducing their nystagmus (88-90). More recently, the application of eye movement auditory biofeedback in the control of nystagmus has shown positive results. Ciufredda et al (91) demonstrated a significant reduction in the amplitude and velocity of eye movements in congenital nystagmus patients. Vision was improved, and positive cosmetic and psychological changes were reported as well. Abadi et al (92) reported reduction in nystagmus and improvement of contrast sensitivity after auditory biofeedback training. In addition to nystagmus, the use of auditory biofeedback has been successfully used in expanding the range of eye movement in gaze limitations (93). There is evidence (94) that large and unsteady eye movements occur in the eyes of amblyopic patients during attempted monocular fixation. A number of studies report the successful treatment of amblyopia resulting in improved vision and oculomotor control (95-98). Occlusion therapy, a passive procedure, has been a standard and relatively successful approach for many years (99-111).  However, there are individuals that either do not or cannot respond to occlusion therapy. There is evidence that occlusion with active vision therapy is more effective than occlusion alone (112).  Pleoptics (113,114) is an active vision therapy procedure in which patients receive visual feedback about their position of fixation and direction of gaze. These procedures are designed to correct the positional fixation problem and thereby improve the vision of the patient. Pleoptics has been used successfully in treating eccentric fixation in individuals not responding to regular occlusion therapy (115-118). Vision therapy for amblyopia incorporates a broad spectrum of procedures, including occlusion techniques, pleoptic techniques, and visual-motor spatial localization feedback techniques using after-images and entoptic phenomena (45,79) with a high success rate (119-124). The question of age and its influence on the efficacy of amblyopia therapy has been addressed in a number of studies and reviews. These indicate that a significant improvement in oculomotor and vision function can be achieved even in adulthood (125).  It is clear from the evidence that amblyopia and its oculomotor components can be successfully treated with occlusion and active vision therapy for a wide range of patients of all ages. Studies have demonstrated that it is possible to change and improve inefficient and inadequate visual information processing strategies and visual attention patterns. Many of these changes have been accompanied by enhanced eye movements (126-138). A number of techniques used to improve these poor visual scanning and attention problems in children and adults, e.g., tachistoscopic procedures, pursuit and fixation activities, and eye-hand coordination techniques have been described and utilized professionally for many years (79,139-143).   What are accommodative dysfunctions and their remediation?   [Focusing] Accommodative (focusing) dysfunctions have been described in detail (144-146) in numerous sources and are clinically classified as accommodative spasm, accommodative infacility, accommodative insufficiency, and ill-sustained accommodation. There are also clearly defined syndromes associated with accommodative dysfunctions (147-155). The literature discusses many symptoms common to accommodative dysfunctions as a group. These have been described as reduced nearpoint acuity, a general inability to sustain nearpoint activity, asthenopia, excessive rubbing of the eyes, headaches, periodic blurring of distance vision after prolonged near activities, periodic double vision at near, and excessive fatigue at the end of the day (152,154,156-160). The efficacy of applying vision therapy procedures in improving accommodative functioning has considerable basic science and clinical research support.  Studies have shown that accommodative findings, although under autonomic nervous system control, can respond to voluntary command (161-163) and can be conditioned (164).  These studies demonstrate that voluntary control of accommodation can be controlled, trained, and transferred. Once pathological or iatrogenic causes have been eliminated, the treatment of accommodative deficiencies includes plus lenses for near work and vision therapy aimed at improving the functioning of the accommodative mechanism (165-168). Levine et al (156) established baseline statistics for diagnostic accommodation findings which differentiate symptomatic from asymptomatic patients. Their findings were in close agreement with a similar study by Zellers and Rouse (152). The significant element of these studies is the relationship between symptoms and inadequate accommodative facility. Wold (78) reported on 100 children who had undergone accommodative vision therapy procedures. These clinically selected cases showed an 80% rate of improvement in accommodative amplitude and 76% in accommodative facility using a pre- and post-treatment ordinal criterion referenced scaling method. These results are similar to those reported by Hoffman and Cohen (168) a in which 70 patients were successfully treated for accommodative insufficiency and infacility based on clinical findings. Liu et al (169) investigated accommodative facility disorders by objective laboratory methods using a dynamic optometer with an infrared photomultiplier. They objectively identified the dynamic aspects of the accommodative response that were improved by vision therapy. Young adults with symptoms related to focusing difficulties were treated by procedures commonly used in orthoptic or vision therapy practice. Significant improvement in their focus flexibility occurred and these changes correlated with marked reduction or elimination of symptoms. Standard clinical measures of accommodative facility were found to correlate well with the more objective measures. Bobier and Sivak (l70) replicated the work of Liu et al (169) using a greater degree of recording precision with a dynamic photorefractor (television camera and monitor with light-emitting diodes}. They found no evidence of regression in improved focusing flexibility during an l8-week interval after cessation of training. The subjects' symptoms also abated as accommodative function normalized. Hung et al (l71) demonstrated the efficacy of accommodation, vergence, and accommodative vergence orthoptic therapy using a dynamic binocular simulator. This experiment objectively validated optometric vision therapy procedures through use of photoelectric eye movement recording systems and an optometer. There is a higher prevalence of accommodative insufficiencies and infacilities in persons with cerebral palsy (172). Duckman demonstrated that accommodative abilities can be modified and improved in a cerebral palsy population using vision therapy techniques (173,174). Since accommodative changes take place when looking from near to far and back to near, Haynes and McWilliams (175) investigated the effects of training this near-far response on school age and college students. Their results indicate that this near-far response ability is trainable and can be improved with vision therapy. Weisz (l76) has shown that improvement in accommodative ability transfers to improvement in near point task performance. In a double blind clinical study following vision therapy, her experimental group was found to improve significantly in accuracy of performance on a Landolt-C resolution task as compared with the controls. Hoffman (160) investigated the impact of accommodative deficiencies on visual information processing tasks. He compared the results of vision therapy for the accommodative problems in an experimental and control group of school age children. This study indicated that by improving accommodative skills, there was a concomitant improvement in his subject's visual perceptual skills. Recently, in a detailed series of analyses involving retrospective studies, Daum (177-180) investigated the full range of accommodative disorders. He used a stepwise discriminant analysis of regression variables in patient care records, to establish a model to determine the length of treatment necessary, and to predict the success of treatment for accommodative disorders. In conclusion, these studies demonstrate that accommodative disorders can cause significant discomfort, inefficiency or avoidance of nearpoint tasks. They further demonstrate that when diagnosed and treated appropriately, these dysfunctions may be ameliorated or eliminated through vision therapy.     What are binocular vision disorders and their remediation?  [Eye coordination and alignment] Normal and efficient binocular vision is based on the presence of motor alignment and coordination of the two eyes and sensory fusion. The range of binocular disorders extends from constant strabismus with no binocular vision present to non-strabismic binocular dysfunctions, e.g., convergence insufficiency (146). The first category is non-strabismic binocular disorders. Standard techniques and diagnostic criteria in the assessment of the vergence system and binocular sensory fusion ability have been described in detail elsewhere (181-185). Patients exhibiting non-strabismic anomalies of binocular vision quite often report feeling ocular discomfort and asthenopia (186).  Some of the patient complaints include eyestrain, soreness of the eyes, frontal and occipital headaches, and ocular fatigue which result in an aversion to reading and studying (187,187a). Vision therapy has long been advocated as a primary intervention technique for the amelioration of non-strabismic anomalies of binocular vision (188-194). Suchoff and Petito (l46) have concluded that vision therapy for these conditions is directed toward several therapeutic goals: First, to increase the efficiency of the accommodative system so as to facilitate a more effective interaction between this system and the vergence system. Second, to maximize the functioning of the fusional vergence system (i.e., divergence and convergence) and the binocular sensory system. Since the training of accommodation has been covered in the previous section, the remainder of this section will be devoted to the evidence of the modifiability of the vergence system. Clinical vision therapy procedures are intended to improve the patient's ability to compensate for fusional stress which may result in asthenopia, headache, and/or diplopia. A number of studies will be reviewed showing that improvements can be made in fusional vergence skills by vision therapy procedures. The clinical assumption that fusional vergences can be trained is not a new one. Over 50 years ago, Berens et al advocated the use of this aspect of orthoptics for all non-strabismic anomalies of binocular vision (195). Within the past several years a number of investigators have sought to determine experimentally whether the clinical assumption of the trainability of the vergence system was a valid one. Daum (196) prospectively studied a group of 35 young adults. The results of daily vision therapy showed statistically significant improvement in convergence ranges. The gains persisted on post-testing 24 weeks after completion of the therapy program. The conclusion was that relatively short periods of training can provide long-lasting increases in vergence ability. Daum (l97) conducted a retrospective study of 110 patients who received treatment for convergence insufficiency. The patients were classified according to the effectiveness of the treatment program into total success, partial success or no success categories. Post training diagnostic findings and changes in patient symptomatology were used to define the classification categories. A comparison of pre- and post-training findings revealed statistically significant improvement. In a companion report, (198) a portion of the above data (l97) was used to investigate and identify which of 14 common diagnostic measures best predicted the success of the vision training program. These measures were 75% accurate in predicting efficacy of the vision therapy program. Another study (l99) utilized tonic and phasic vergence training and demonstrated impressive changes in convergence and divergence abilities. The 34 subjects were randomly assigned in a double crossover design, wherein subjects served as their own controls, and learning effects were controlled. In another study, Veagan used a motor-driven prism stereoscope (ophthalmic ergograph) to train divergence and convergence (200). Forty- seven adults were divided into convergence and divergence experimental and control groups. The findings led Veagan to conclude that sustained divergence and convergence training showed large and significant immediate and stable improvement in the trained vergence ranges of the experimental groups. Vaegan and McMonnies (201) utilized a recording device that measured eye movements during vergence activity. They were able to objectively demonstrate that convergence training with prism-induced changes resulted in sustained improvement of convergence ability. In a companion study, Vaegan (202) demonstrated substantial long-lasting gains in convergence and divergence ability from both tonic and phasic vergence training. Pantano (203) studied over 200 subjects with convergence insufficiency who underwent vision therapy and evaluated them 2 years later. The majority remained asymptomatic with normal clinical findings. Those subjects who had learned to control convergence and accommodation together had the best success. Grisham (204, 205) used vergence latencies, velocity, and step vergence tracking rate by measuring them objectively with infra-red eye monitor recordings; He reported improved step vergence tracking after vision therapy of 4 to 8 weeks. Cooper and Duckman, in their extensive review of convergence insufficiency, stated that 95% of the patients reported in these studies responded favorably to vision therapy for this binocular disorder (206). Cooper and Feldman (207) investigated the role and clinical use of operant conditioning in vision therapy based on random dot stereograms (RDS). They demonstrated that response-contingent positive reinforcement, immediate feedback, and preprogrammed systematic changes during discrimination learning improves convergence ability. Control and experimental groups were formed with subjects matched in baseline convergence ability and randomly assigned to each group. The convergence ranges of the experimental group improved significantly while there were little or no increases for the control group. Cooper et a1 (208) conducted a controlled study of vision therapy and its relationship to symptomatology for a group of patients with convergence insufficiency. A vision therapy program of fusional vergence activities was administered in a matched-subjects control group crossover design to reduce placebo effects. They used a written assessment scale for rating asthenopia in terms of discomfort and/or fatigue, and conclusively demonstrated that the symptoms were eliminated or relieved. Clinical findings also improved, corroborating the subjective assessments. Dalzie1 (209) reported on 100 convergence insufficiency patients who did not meet Sheard's criterion, and were given a program of vision therapy. After vision therapy, clinical findings were again assessed and 84% of the patients successfully met Sheard's criterion. Eighty-three percent of the patients reported they had symptoms of discomfort or loss of efficiency prior to treatment. Only 7% reported these symptoms after therapy. The post-training group who failed to meet Sheard's criterion correlated well with those still reporting subjective symptoms. Wold (78) reported on the results of 100 patients who underwent vision therapy.  Based on standard clinical tests, only 25% of the children had adequate binocular sensory fusion prior to vision therapy and 9% had adequate binocular fusional vergence. Post-training evaluation showed 96% had achieved appropriate sensory fusion findings and 75% demonstrated adequate fusional vergence ranges. Wittenberg et al (210), along with Saladin and Rick (211), used slightly different techniques and demonstrated that stereopsis thresholds could be improved in normal subjects. In Dalziel's (212) study there was a statistically significant improvement in stereopsis after vision therapy. Another category of binocular vision disorders is strabismus. Strabismus may be described as a misalignment of the eyes (referred to as crossed-eyes, eye turn, weak eye muscle, etc.). Many forms and variations of strabismus exist, depending upon direction and amount of the eye turn, the number of affected nerves or muscles, and the degree to which it is associated with reduced vision. The clinical characteristics and diagnostic criteria have been described in detail (212-215). Numerous comprehensive reviews and studies relating to the success of vision therapy for strabismus exist. Flom (216) reviewed studies and used detailed multifactorial analysis. This revealed an overall functional cure rate for strabismics receiving vision therapy of 50%, with esotropia less responsive than exotropia. Ludlam (217) evaluated a sample of 149 unselected strabismics who received vision therapy and determined a 73% overall success rate utilizing the rigorous criteria established by Flom. In a longitudinal follow-up study of this population, Ludlam and Kleinman (218) found 89% of these patients had retained their functional cure (binocular vision present). The long-term overall success rate of vision therapy was calculated at 65%. If one adopts a less stringent definition of "success, " such as the cosmetic criterion of "straight-looking eyes" employed in some less precise studies, the success rate increases to 96% of the re-analyzed population, or a 71% long- term success rate. Flax and Duckman, (219) in their literature review of treatment for strabismus, found strong support for the efficacy of vision therapy for strabismus. They gathered data from numerous studies, each of which met rigorous criteria for success, and reported an overall success rate of 86%. In a controlled study of 100 cases (220) Gillan reported that 76% of strabismic patients attained a cosmetic cure with orthoptics. None of those in the control group, treated with glasses alone, showed a spontaneous cure. In a series of controlled studies conducted by Guibor (221-223), 50% of the experimental group achieved alignment of the eyes with glasses and vision therapy (orthoptics) as compared with only 12.5% of the control group who received glasses without vision therapy. More recently, Ziegler et al (224) conducted a literature review of the efficacy of vision therapy for strabismus. An important contribution is their comparative analysis of published papers using the functional cure criteria defined by Flom. They noted the study conducted by Etting (225) in which he reported a 65% overall success rate in patients with constant strabismus (57% of esotropes and 82% of exotropes), 89% success rate with intermittent strabismus (100% of esotropes and 85% of exotropes), and a 91% success rate when retinal correspondence was normal. In a study designed to investigate the effectiveness of vision therapy utilizing computer generated stereo graphics for subjects with strabismus, Kertesz and Kertesz (226) reported a 74% success rate in 57 strabismics. They combined traditional vision therapy techniques with computer generated stimuli as successfully applied by CooperO7 to the remediation of non-strabismic binocular vision anomalies. The functional cures obtained persisted on long-term follow-up visits for a period of up to 5 years. Sanfilippo and Clahane (227) designed a prospective study of the results of orthoptic therapy for divergent strabismus (exotropia). Of the patients who completed the study, 64.5% attained a functional cure upon completion, and 51.7% retained this status on an average follow-up interval of 5 years and 4 months. In two studies on the effectiveness of orthoptics (vision therapy) for intermittent and constant exotropes, Altizer (228) and Chryssanthou (229) found the majority of their patients had significant improvement in clinical findings as well as relief of symptoms. Goldrich (230) reviewed records of patients completing a vision therapy program for exotropia of the divergence excess type. Of the patients reviewed, 71.4% attained a functional cure following approximately 5 months of standardized sequential therapy procedures used in-office as well as at home. Several studies have applied biofeedback in vision therapy to assist in training patients to align their eyes (231-236). The use of biofeedback to enhance traditional vision therapy, provide reinforcement, and increase motivation was supported in these studies. Strabismic patients exhibiting esotropia with anomalous correspondence tend to be the most difficult to successfully treat. The use of more aggressive and sophisticated techniques for vision therapy has been reported with a better success rate for anomalous correspondence and esotropia than earlier studies (237,238). In general, the treatment period tends to be longer for anomalous correspondence and esotropia than other types of strabismus.   Summary and conclusion Vision is not simply the ability to read a certain size letter at a distance of 20 feet. Vision is a complex and adaptable information gathering and processing system which collects, groups, analyzes, accumulates, equates, and remembers information. In this review, some of the essential components of the visual system and their disorders which can be physiologically and clinically identified. i.e., the oculomotor, the accommodative, and the fusional vergence systems have been discussed. Any dysfunctions in these systems, can lessen the quality and quantity of the initial input of information into the visual system. Deficiencies in one or more of these visual subsystems have been shown to result in symptoms, such as blurred or uncomfortable vision or headaches, or behavioral signs such as rubbing of the eyes, eyes turning inward or outward, reduced job efficiency or reading performance, or simply the avoidance of near point tasks. In addition, these signs/symptoms may contribute to reducing a person's attention and interest in near tasks. The goal of vision therapy is to eliminate visual problems, thereby reducing the frequency and severity of the patient's signs and symptoms. Vision therapy should only be expected to be of clinical benefit to patients who have detectable visual deficiencies. In response to the question, "How effective is vision therapy in remediating visual deficiencies?," it is evident from the research presented that there is sufficient scientific support for the efficacy of vision therapy in modifying and improving oculomotor, accommodative, and binocular system disorders, as measured by standardized clinical and laboratory testing methods, in the majority of patients of all ages for whom it is properly undertaken and employed. The American Optometric Association reaffirms its long-standing position that vision therapy is an effective therapeutic modality in the treatment of many physiological and information processing dysfunctions of the vision system. It continues to support quality optometric care, education, and research and will cooperate with all professions dedicated to providing the highest quality of life in which vision plays such an important role (1). Corresponding author: Allen H. Cohen, O.D. SUNY State College of Optometry 100 E. 24th St., New York. NY 10010

Anti-AIDS Chinese medicine expected to enter market this year Provided by Xinhua Economic News BEIJING, Nov 17, 2003 (Xinhua via COMTEX) -- A pure natural anti-AIDS Chinese medicine jointly developed by China and Thailand is expected to obtain permission from the Thai Ministry of Public Health to enter market in 2003. The medicine has passed three-stage clinical tests by the Thai health ministry. The Kunming Institute of Botany of the Chinese Academy of Sciences, the researcher on the Chinese side, is also applying to China's drug administration for permission, a Chinese health ministry official said here recently. Shen Zhixiang, a senior official with the State Administration of Traditional Chinese Medicine, said at the sixth meeting on health cooperation between China and Thailand that the clinical tests showed that the preparation could effectively kill the HIV virus, increase the vitality of immunocyte and improve the human body's immune system, with no toxic or side effects. Gao Qiang, executive vice-minister of health, congratulated the researchers of the two sides and said he hoped they could continue to explore the advantages of Chinese medicine and present the medicine to the AIDS patients of China and Thailand as well as the world as soon as possible. Gao said China and Thailand have carried out fruitful cooperation in health and curing research, covering the areas of cancer, herbal medicine and mental health. The health officials from China and Thailand agreed at the meeting to cooperate in the future in the fight against AIDS and severe acute respiratory syndrome (SARS), and on unifying standards for food and drug imports. Copyright 2003 Xinhua News Agency. The combined treatment of amblyopia by the methods of acupuncture reflexotherapy and traditional pleoptics Pasmanik ED, Nizovtseva TR. Fifty-two children (75 eyes with amblyopia) were treated by acupuncture and traditional pleoptics. This complex of treatment was found more effective as against traditional pleoptics alone (70 children, 118 eyes with amblyopia) on the whole and in the treatment of high amblyopia. The best results were attained in children previously treated by pleoptic methods with special equipment (older children). Of the 17 eyes with amblyopia resistant to common treatment multiple-modality treatment resulted in improvement in 10 (58.8%). The effect of treatment persisted for 3 months. The first course of such treatment proved to be the most effective in the treatment of high amblyopia; starting from the second course the condition grew resistant to such treatment, this resistance gradually augmenting.

Sage Herb 'Can Boost Memory' Universities of Newcastle and Northumbria Centuries-old theories that the herb sage can improve memory appear to be borne out by modern research. Scientists at the Universities of Newcastle and Northumbria in England tested 44 people, who were either given the herb or a dummy placebo pill. They found that those given the sage oil tablets performed much better in a "word recall test". Experts believe the active ingredient may boost levels of a chemical that helps transmit messages in the brain. The Medicinal Plant Research Centre (MPRC) at the universities are testing many old-fashioned claims about the healing powers of herbs and flowers. Sage is often referred to in ancient texts - in 1597 the herbalist John Gerard said that it was "singularly good for the head and quickeneth the nerves and memory". Researcher Nicola Tildsley said the results of the study proved that, in some cases at least, the herbalists should be taken seriously. She adds, "This proves how valuable the work by the old herbalists was, and that they shouldn't just be ignored because they were writing centuries ago."

NUTRITIONAL NEWS

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Hot Cocoa Really Is Good For You Provided by United Press International on 11/7/2003 GENEVA, N.Y., Nov 06, 2003 (United Press International via COMTEX) -- Just in time for winter, here's good news from the nutrition front: A Cornell study shows hot cocoa delivers more antioxidants than even tea or red wine. Researchers at Cornell University have shown that the popular winter beverage contains more antioxidants per cup than a similar serving of tea or red wine. The study adds to growing evidence of the nutritional value of cocoa's antioxidants, widely believed to fight cancer, heart disease and aging, the researchers say. Their study will appear in the Dec. 3 issue of the Journal of Agricultural and Food Chemistry, a peer-reviewed journal of the American Chemical Society. "Although we know that antioxidants are important for good health, nobody knows the exact daily amount required per person," says Chang Yong Lee, head of the study and a professor of food chemistry in Cornell's Department of Food Science and Technology. "Nevertheless, a cup or two of hot cocoa every once in a while can provide a delicious, warm and healthy way to obtain more antioxidants."   Research Is Serving Up the Evidence for Brain Food Provided by The Dallas Morning News on 11/18/2003 by Tom Siegfried NEW ORLEANS - Eating a spinach salad for lunch every day might be smarter than you think - it could make you think smarter. If you don't like spinach, try a cup of blueberries instead. Unless you plan on flying to Mars - or otherwise exposing yourself to cosmic rays. In that case forget the blueberries - snarf down a daily pint of strawberries. OK, this all sounds a little suspiciously like the dietary advice you get from those paid TV or radio shows pushing "mi