Faculty Bibliography

The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti- TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. The panel also recommended using molecular tests to detect rifampicin resistance as a proxy for MDR tuberculosis. Use of such tests could reliably determine XDR in less than two months, compared with the several months that are often needed now, [Karin Weyer] said. Standard tests take weeks to complete because TB bacteria grow slowly. The panel emphasized that laboratory workers needed more experience in interpreting results of the tests. As new laboratories are created in the many countries where drug-resistant tuberculosis exists but testing facilities do not, technicians will need to learn how to do the testing. Refresher training is also needed even in the best laboratories because they are mainly in countries with a low incidence of resistant tuberculosis

'I would recommend taking medication,' Dr. [Gregory L. Barkley] said. 'The intervals tend to get shorter and shorter, and people tend to have recurrent seizures.' He explained: 'The brain learns from practice. The more you practice, the better you get, whether you're playing the piano or having seizures. The more you have, the more you're going to have. Most neurologists feel that the best way to intervene is to get the seizures under control as quickly as possible.' Dr. Robert S. Fisher, director of Stanford University's epilepsy center and a past president of the American Epilepsy Society, said: 'In my view, it would be reasonable not to treat. It sounds like he went 14 years between seizures, and that's a lot of pills to take to prevent the next seizure 14 years from now. The new ones are better than the old ones in terms of side effects, but they all have potential side effects and risks.'

Despite his quick recovery from the seizure he suffered Monday, Chief Justice John Roberts faces a complex diagnosis and a difficult decision. Because the seizure was his second -- he had a similar one in 1993 -- he meets the criteria for epilepsy, and he and his doctors will have to decide whether he should take medication to prevent further seizures, according to neurologists not involved in his care. Neither the chief justice nor his doctors would comment Tuesday

'I would recommend taking medication,' [Gregory L. Barkley] said. 'The intervals tend to get shorter and shorter, and people tend to have recurrent seizures.' He explained: 'The brain learns from practice. The more you practice, the better you get, whether you're playing the piano or having seizures. The more you have, the more you're going to have. Most neurologists feel that the best way to intervene is to get the seizures under control as quickly as possible.' Dr. Robert S. Fisher, director of Stanford University's epilepsy center and a past president of the American Epilepsy Society, said: 'In my view, it would be reasonable not to treat. It sounds like he went 14 years between seizures, and that's a lot of pills to take to prevent the next seizure 14 years from now. The new ones are better than the old ones in terms of side effects, but they all have potential side effects and risks.'

''I would recommend taking medication,'' Dr. [Gregory L. Barkley] said. ''The intervals tend to get shorter and shorter, and people tend to have recurrent seizures.'' ''That said,'' he went on, ''the reason one doesn't immediately put everybody on the medications when they have seizures is that there are side effects to all the medications.'' ''Fifteen percent will have some problem with the first drug that will lead to discontinuation and a different drug,'' Dr. [Hauser] added. ''Virtually everybody will have some side effects.''

He had no lasting effects from the earlier incident and was ''fully recovered'' from the seizure he suffered about 2 p.m. Monday, the court said, adding that the chief justice had undergone ''a thorough neurological evaluation, which revealed no cause for concern.'' Christopher Burke, a spokesman for Penobscot Bay Medical Center, told The Associated Press, ''It's my understanding he's fully recovered.'' In an interview on Monday evening, Dr. David J. Langer, the director of cerebrovascular neurosurgery at St. Luke's-Roosevelt, Beth Israel and Long Island College Hospital, said that medical care after such a seizure should include ''a good M.R.I., CAT scan and EEG.'' All these tests are available at the Penobscot Bay Medical Center, according to the hospital's Web site

Two sets of studies by Dr. Comstock in the 1940s and '50s had a critical impact on the federal government's response to tuberculosis. One set led public health officials to reject the tuberculosis vaccine known as BCG, which had been under consideration for routine use among American children. Dr. Comstock attributed the discrepancies among the trials to variations in different strains of the BCG vaccine and a lack of standard manufacturing techniques. Later, genetics studies documented that there was no uniformity among BCG vaccines, said Richard E. Chaisson, a tuberculosis researcher at Johns Hopkins. In the trial, Dr. Comstock and his family took INH themselves to convince the participants of his belief in the therapy's safety, Mr. Chaisson said. After the trial, Dr. Comstock returned and gave INH to those who had received the placebo

The most celebrated example of such discordant findings involved Andrew Speaker, the Atlanta lawyer who caused an international health scare after traveling to Europe in May with what was believed to be extensively drug-resistant tuberculosis, known as XDR. This month, Speaker's doctors downgraded his type of tuberculosis to multidrug-resistant, or MDR, after repeating tests that initially gave a different result. The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti- TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. Reliable tests to determine resistance to first-line drugs were developed when the drugs were first marketed about a half-century ago. Fewer resistance tests exist for the newer, second-line drugs needed to treat MDR and XDR tuberculosis, and many of them are difficult to perform

The overwhelming majority of tuberculosis cases are caused by bacterial strains that yield to the standard, or first-line, anti-TB drugs. Newer, second-line drugs are used if a strain of tuberculosis is MDR or XDR, which are resistant to the first-line drugs. If tuberculosis strains are not tested for drug resistance as soon as they are found in a patient, the problem may be detected too late to permit a cure. ''But no laboratory test for any disease is 100 percent,'' said one member of the panel, Dr. Karin Weyer of the South African Medical Research Council. ''Labs often have problems and can and do make mistakes,'' Dr. Weyer said. The panel also recommended using molecular tests to detect rifampicin resistance as a proxy for MDR tuberculosis. Use of such tests could reliably determine XDR in less than two months, compared with the several months that are often needed now, Dr. Weyer said. Standard tests take weeks to complete because tuberculosis bacteria grow slowly

In the trial, [George Comstock] and his family took INH themselves to convince the participants of his belief in the therapy's safety, Chaisson said. After the trial, Comstock returned and gave INH to those who had received the placebo. Comstock attributed the discrepancies among the trials to variations in different strains of the BCG vaccine and a lack of standard manufacturing techniques. Later, genetics studies documented that there was no uniformity among BCG vaccines, said Richard Chaisson, a tuberculosis researcher at Johns Hopkins