prevent biting. Families report that affected individuals are more at ease when restrained. The Matheny Medical and Educational Center in Peapack, NJ, has six Lesch–Nyhan syndrome patients, believed to be the largest concentration of LNS cases in one location, and is recognized as the leading source of information on care issues. Treatment for LNS patients, according to Gary E. Eddey, MD, medical director, should include: 1) Judicious use of protective devices; 2) Utilization of a behavioral technique commonly referred to as 'selective ignoring' with redirection of activities; and 3) Occasional use of medications. An article in the August 13, 2007 issue of The New Yorker magazine, written by Richard Preston, discusses "deep-brain stimulation" as a possible treatment. It has been performed on a few patients with Lesch–Nyhan syndrome by Dr. Takaomi Taira in Tokyo and by a group in France led by Dr. Philippe Coubes. Some patients experienced a decrease in spastic self-injurious symptoms. The technique was developed for treating people with Parkinson's disease, according to Preston, over 20 years ago. The treatment involves invasive surgery to place wires that carry a continuous electric current into a specific region of the brain. An encouraging advance in the treatment of the neurobehavioural aspects of LNS was the publication in the October, 2006 issue of Journal of Inherited Metabolic Disease of an experimental therapy giving oral S-adenosyl-methionine (SAMe). This drug is a nucleotide precursor that provides a readily absorbed purine, which is known to be transported across the blood–brain barrier. Administration of SAMe to adult LNS patients was shown to provide improvement in neurobehavioural and other neurological attributes. The drug is available without prescription and has been widely used for depression, but its use for treating LNS should be undertaken only under strict medical supervision, as side effects are known. Prognosis The prognosis for individuals with severe LNS is poor. Death is usually due to kidney failure or complications from hypotonia, in the first or second decade of life. Less severe forms have better prognosis. History Michael Lesch was a medical student at Johns Hopkins and William Nyhan, a pediatrician and biochemical geneticist, was his mentor when the two identified LNS and its associated hyperuricemia in two affected brothers, ages 4 and 8. Lesch and Nyhan published their findings in 1964. Within three years, the metabolic cause was identified by J. Edwin Seegmiller and his colleagues at the NIH. References External links