Many (though not all) of my patients who have tried marijuana have felt that their tics improved after using it. Such self-treatment is not rare (poster P94 here), and other doctors report similar results (see for example poster P6 here). Pharmacological benefits from cannabis products are plausible, since cannabinoid receptors in the brain's basal ganglia are well positioned to affect movement . Of course, in addition to any real benefit from marijuana, there could be expectation effects, or one could simply care less about tics when high. Random allocation clinical trials with blind rating of benefit (RCTs) are essential to demonstrating whether marijuana has any true benefit for tics. Müller-Vahl and colleagues carried out two RCTs about 15 years ago in Tourette syndrome (TS) using THC (tetrahydrocannabinol), the main intoxicating ingredient in cannabis . Both trials showed benefit, but the trials were relatively small. Two to 3 years ago, the Tourette Association of America funded two pilot studies in this field, but results have not yet been reported. One trial, at Yale, was to study the FAAH (fatty acid amide hydrolase) inhibitor PF-04457845 in TS , but the trial was placed on clinical hold pending results from a different trial. Investigators at Toronto Western Hospital were funded for a trial in TS of medical cannabis products with varying concentrations of THC and cannabidiol . Cannabidiol is being studied in several brain disorders, including epilepsy, with hopes that it may provide benefit without the psychological side effects of THC. Not surprisingly, the paucity of data has led to different viewpoints. Müller-Vahl has argued that THC may be appropriate in some TS patients , whereas an American Academy of Neurology review and a Cochrane-style review in JAMA concluded that the evidence was insufficient to recommend THC for tic disorders . The clinical utility of cannabinoids in TS was one of two clinical controversies debated at the 2015 First World Congress on Tourette Syndrome and Tic Disorders .

Shan H. Siddiqi

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ABSTRACT OBJECTIVE: To compile a comprehensive summary of published human experience with levodopa given intravenously, with a focus on information required by regulatory agencies. BACKGROUND: While safe intravenous use of levodopa has been documented for over 50 years, regulatory supervision for pharmaceuticals given by a route other than that approved by the U.S. Food and Drug Administration (FDA) has become increasingly cautious. If delivering a drug by an alternate route raises the risk of adverse events, an investigational new drug (IND) application is required, including a comprehensive review of toxicity data. METHODS: Over 200 articles referring to intravenous levodopa (IVLD) were examined for details of administration, pharmacokinetics, benefit and side effects. RESULTS: We identified 144 original reports describing IVLD use in humans, beginning with psychiatric research in 1959-1960 before the development of peripheral decarboxylase inhibitors. At least 2781 subjects have received IVLD, and reported outcomes include parkinsonian signs, sleep variables, hormones, hemodynamics, CSF amino acid composition, regional cerebral blood flow, cognition, perception and complex behavior. Mean pharmacokinetic variables were summarized for 49 healthy subjects and 190 with Parkinson disease. Side effects were those expected from clinical experience with oral levodopa and dopamine agonists. No articles reported deaths or induction of psychosis. CONCLUSION: At least 2781 patients have received i.v. levodopa with a safety profile comparable to that seen with oral administration.
IntroductionA colleague recently proposed submitting an article about work to which my lab had contributed to the journal Neurology. I said, Neurology is a fine journal—some of my favorite authors have published there (smile)—but, like many traditional journals, they don't allow authors to re-use their own words for future book chapters. That's true even if a pre-publication version ends up later on PubMed Central. At least, they don't allow this without their deciding whether to deign to grant permission in each case. It may surprise you to know that many traditional / "hybrid" journals that tout an Open Access option—usually an expensive one—allow only a noncommercial license (like the CC BY-NC license). That sounds fine until you learn that adapting your own words to contribute to a book or to a site like eMedicine counts as commercial use! Personally, in an age in which the "Paper User Interface" is almost obsolete, and I almost always find papers from PubMed or Google, giving my rights away to a journal (by copyright transfer or an exclusive license to publish) is just ridiculous.I replied to my colleague suggesting she submit instead to a journal that allowed the authors to re-use their own words freely (as with the CC BY license), and went on to explain other benefits of fully open access publishing. I've discussed some of these advantages elsewhere \cite{25580234}. She replied, "I'm curious to know how publishing in these open access platforms has been received by your department? There's a clear message in mine that they want to see pubs in journals with good impact factors, especially for promotion consideration." This is a reasonable concern, of course, and a common one, and I acknowledged that at my career stage the pressure is not on me to the same extent. But I gave her some thoughts anyway, and then I realized that others might find them interesting. So here they are.The real answerThe real answer is for leaders to judge papers (much less faculty) on different metrics. The JIF was never meant to grade the quality of an individual paper, and it does it poorly. Even collectively, higher impact factor journals are more likely to publish articles that are retracted than are lower impact factor journals (among other reasons, think about this: “novel” results imply a lower prior probability of truth). Besides, if by impact you mean total number of citations, some OA journals are way in front (e.g. Frontiers in Psychology is the most cited multidisciplinary psychology journal in the world, and there have been something over 200,000 citations to articles in PLOS ONE).Being down on the journal impact factor (JIF) is not just my opinion. You can listen to some Nobel laureates criticizing it here.Some young scientists are adopting an open-only policy and let the chips fall where they may, and several of these scientists have been quite successful. In the meantime . . .But in the meantime, here are some options for those in my colleague's position. First, there are open access  journals with a high JIF. Here is a short list of a few open access journals I've published in or considered, to show the wide range of JIFs for journals that allow authors to keep their rights: