Moreover, according to a study from the Hospital Necker-Enfants Malades in Paris, the risk of transplant-related death is high. A 1960 recording of Maria Callas with the La Scala orchestra and chorus is heard singing selections from Bellini's Norma at several points. To reduce glare of the surroundings, the windows of some department stores, rather than being vertical, slant inward at the bottom. Furthermore, it also addresses the impact of a neurological disease in a social environment . It is based on the true story of Augusto and Michaela Odone, parents who search for a cure for their son Lorenzo 's adrenoleukodystrophy (ALD), leading to the development of Lorenzo's oil. MedlinePlus also links to health information from non-government Web sites. Neurochem Res 1994;19:1073-82. Lorenzo's oil can inform students about many biological topics and problems linked to intensive care. raphina 1 yr. ago. CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. Mr. and Mrs. Muscatine. It can be definitively diagnosed with a genetic test able to detect a mutation known as ABCD1 on the X chromosome. It takes a heartbreaking story and pushes it to the limit, showing us the lengths of courage and imagination that people can summon when they must. . This treatment halts the progression of his disease and is dubbed "Lorenzo's Oil". So, when the ALD gene was discovered in 1993, it was a surprise that the corresponding protein was in fact a member of a family of transporter proteins, not an enzyme. The oil is named after Lorenzo Odone, a boy with ALD whose parents discovered . Moser HW. Explain Augusto's use of paper clips to represent good and bad fatty acids. All rights reserved. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you. [11] Subsequent research with Lorenzo's oil has not clearly proven its long-term effectiveness in treating ALD after its onset. The four most common male phenotypes can be broadly described as follows:, Many boys with ALD under the age of 8 will not experience the cerebral form of the disease but instead develop Addison's disease, a disorder in which the adrenal glands do not produce enough hormones for the body to function normally. 2001 How do analogies help you to understand the scientific problem? Other music include Barber's Agnus Dei and Mahler's Symphony No. Lorenzo's oil is a combination of glyceryl trierucate (an ester of erucic acid, a 22-carbon monounsaturated fatty acid) and glyceryl trioleate (an ester of oleic acid, an 18-carbon monounsaturated fatty acid), which are generally combined in an approximate ratio of 1:4 (glycerol trierucate:glycerol trioleate) when used for clinical evaluation. Are they correct? Genetic and Rare Diseases Information Center. Shimozawa N, Honda A, Kajiwara N, et al. It also directly impairs the function of the adrenal glands and testicles, both of which produce hormones. 2. # # # # # # # $ , , Film Guide For Lorenzo's Oil Please read these questions over before you see the film!!! Though it was a box office disappointment, grossing $7.2 million against its $30 million budget, the film was generally well received by the critics and garnered two nominations at the 65th Academy Awards. If a couple has a boy, the mother will contribute the X chromosome with the ABCD1 mutation, while the father will contribute the Y chromosome. The prevalence of X-linked adrenoleukodystrophy is 1 in 15,000 individuals worldwide. The movie Lorenzo's Oil is about a family's struggle to find a cure for their young son's fatal genetic disease, an illness that usually kills boys before they reach their eleventh birthday. The following doses have been studied in scientific research: Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Mediterranean, Low-Fat Diets Are Best for Heart Problems, Least Amount of Exercise You Need to Stay Healthy, Nerve 'Pulse' Therapy May Help Ease Sciatica, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox, The Role Gut Bacteria Plays on the Overall Body. ALD is a caused by a known gene. Lorenzo Odone, a Virginia 5-year-old, develops a degenerative nerve disease so rare that nobody is working on a cure, so his parents decide to immerse themselves in research and tackle the p Read allLorenzo Odone, a Virginia 5-year-old, develops a degenerative nerve disease so rare that nobody is working on a cure, so his parents decide to immerse themselves in research and tackle the problem themselves.Lorenzo Odone, a Virginia 5-year-old, develops a degenerative nerve disease so rare that nobody is working on a cure, so his parents decide to immerse themselves in research and tackle the problem themselves. Revell P, Green A, Green S. Platelets in treated adrenoleukodystrophy: a brief report. Lorenzo's oil is used to treat an inherited disorder that affects the nervous system and adrenal glands (adrenoleukodystrophy or ALD), and an inherited condition that affects the spinal cord. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. You may have heard that "Lorenzo's Oil" is a harrowing movie experience. Additional signs and symptoms of the cerebral form include aggressive behavior, vision problems, difficulty swallowing, poor coordination, and impaired adrenal gland function. What is erucic acid? 1986 Mar;36(3);357-61, biomedical efforts to heal myelin damage in patients, Best Screenplay Written Directly for the Screen, "Pittsburgh - City lands good share of movies", "Producer excited about Ben Avon as site for movie 'Lorenzo's Oil', "Complicated lessons: Lorenzo Odone and medical miracles", "Lorenzo loses battle for life but legacy of hope lives on", "Hugo Moser, 82; neurologist's portrayal in 'Lorenzo's Oil' belied his real character", "The 65th Academy Awards (1993) Nominees and Winners", "1992 New York Film Critics Circle Awards", https://en.wikipedia.org/w/index.php?title=Lorenzo%27s_Oil&oldid=1151078258, Short description is different from Wikidata, Articles with unsourced statements from September 2022, Articles containing potentially dated statements from September 2020, All articles containing potentially dated statements, Creative Commons Attribution-ShareAlike License 3.0, Eliot Brinton as William B. Rizzo, original discoverer of Lorenzo's oil, This page was last edited on 21 April 2023, at 19:15. Adrenoleukodystrophy. What are the probable genotypes of the family members listed? (modern). J Neuropathol Exp Neurol 1995;54:740-5. 2012 It is for this reason that HSCT is only performed if symptoms of cerebral ALD develop, namely in boys or men. cosmic_quest 7 August 2006. Specify the premises and the conclusion, adding implicit premises where needed. Other symptoms include loss of vision, seizures, poor speech, difficulty swallowing, deafness, incoordination and progressive dementia. Lorenzo's Oil is a movie that clearly outlines the science behind medical discovery and highlights the challenges and tribulations associated with the search for therapeutic options to rare diseases. Failing to find a doctor capable of treating their son's rare disease, Augusto and his wife, Michaela, set out on a mission to find a treatment to save their son. The childhood cerebral form of X-linked adrenoleukodystrophy typically occurs in boys. U.S. Department of Health and Human Services. Long-term outcomes of allogeneic haematopoietic stem cell transplantation for adult cerebral X-linked adrenoleukodystrophy. The film was shot in Pittsburgh, Pennsylvania, primarily from September 1991 to February 1992. Eligible. The Odones sponsor an international meeting of scientists doing research on ALD, requiring two conditions ahead of time. While it might seem hard to swallow, many researchers defend the position that diseases that affect a small % of the population should not get as much money for research as the big killers like cancer and heart disease. patients with adrenoleukodystrophy treated with Lorenzo's oil. Lorenzo's oil is a combination of two chemicals called erucic acid and oleic acid. A heart-breaking yet up-lifting film of family ties and a determination that knows no bounds. ALD is an X-linked recessive disorder, meaning that the genetic mutation is located on the X chromosome, one of two that determine a person's sex. Biochim Biophys Acta. which were cured by "Lorenzo's Oil". r What is Lorenzo's Oil? Philosophy. Julie S Snyder, Linda Lilley, Shelly Collins, Medical Terminology for Health Professions, Ann Ehrlich, Carol L Schroeder, Katrina A Schroeder, Laura Ehrlich, Barbara T Nagle, Hannah Ariel, Henry Hitner, Michele B. Kaufman, Yael Peimani-Lalehzarzadeh. [12] However, it prevented the onset of ALD in two-thirds of the susceptible boys. Very long chain fatty acids in X-linked adrenoleukodystrophy brain after treatment with Lorenzo's oil. People use Lorenzo's oil as a medicine. What was the purpose of the ALD Symposiums? If the mother tests positive, the father can also be tested, but it is extremely unlikely that he, too, would carry the ABCD1 mutation unless he has ALD and has not been diagnosed. Brought to the world's attention via the 1992 film Lorenzo's Oil, ALD is sometimes also called Lorenzo's Oil disease. J Neuroesterorol. BT. What are the probable genotypes of the family members listed? X-linked adrenoleukodystrophy. Bethesda (MD): National Center for Biotechnology Information (US); 1998-. Girls are rarely affected with this type. Generally speaking, males are most affected by an X-linked recessive disorder, while women are generally carriers of the mutation. Some individuals with the asymptomatic form may develop features of other types of X-linked adrenoleukodystrophy later in life. Over the years, the treatment has gained tremendous recognition thanks to ongoing scientific research, the Myelin Project, and the 1992 feature film, Lorenzo's Oil. As the scene ends, Michaela Odone is shown beginning the effort to find someone able and willing to produce the same oil Dr. Rizzo gave to his cells. Tran C, Patel J, Stacy H, Mamak EG, Faghfoury H, Raiman J, Clarke JTR, Blaser But they persist, setting up camp in medical libraries, reviewing animal experiments, enlisting the aid of Professor Gus Nikolais, badgering researchers, questioning top doctors all over the world and even organizing an international symposium about the disease. Biochim Biophys Acta. Trace the developments in the different kinds of oils discovered. If VLCFA values are high, genetic testing would be performed to confirm the presence of the ABDC1 mutation. Specifically, it is made from oleic acid (extracted from olive oil) and erucic acid (extracted from rapeseed oil). The film is an excellent introduction to the medical research establishment and the ethics of clinical trials. Therapeutic Research Faculty 2020. People with X-linked adrenoleukodystrophy whose only symptom is adrenocortical insufficiency are said to have the adrenal insufficiency only form. -imuran: drugs. [13] The actual subject of the film, Lorenzo Odone, died of pneumonia in May 2008 at the age of 30, having lived two decades longer than originally predicted by doctors. There are some individuals with the ABCD1 mutation who do not develop any ALD symptoms at all. What are the probable genotypes of the family members listed? Additionally, there is no evidence that Lorenzo's oil can either prevent or delay the development of ALD in people with the ABCD1 mutation who do not have symptoms, further highlighting how much we still need to learn about the disease. View abstract. Melhem ER, Dubey P, Bezman L, Brereton NH, Odone A. Lorenzo Odone, a Virginia 5-year-old, develops a degenerative nerve disease so rare that nobody is working on a cure, so his parents decide to immerse themselves in research and tackle the p Lorenzo Odone, a Virginia 5-year-old, develops a degenerative nerve disease so rare that nobody is working on a cure, so his parents decide to immerse themselves in research and tackle the problem themselves. The goal of this problem is to find the temperature and pressure of the gas after 16.0 kJ of thermal energy is supplied to the gas. This information may not fit your specific health circumstances. If the couple has a girl, it is extremely rare that the mother and father will both contribute the ABCD1 mutation. Lorenzo's oil can be used as a treatment for adrenoleukodystrophy . The Exercise 1.4 Identify the moral arguments in each of the following passages. View abstract. Adrenoleukodystrophy (ALD) is an inheritable degenerative disorder in which the membrane around nerve cells, called myelin, begins to break down. State the problem, ask a question and use examples from the film to illustrate the steps. Orphanet J Rare Dis. When performed in men, HSCT appears to stop rather than reverse symptoms of ALD. Doctors had predicted he would not live beyond childhood when he was diagnosed with the incurable disease . Since the file is text-only you will need to add the relationship . This condition occurs with a similar frequency in all populations. p 9. "Lorenzo's Oil" (1992) is a true story about a married couple's (Nick Nolte, Susan Sarandon) refusal to wait for doctors' and science's snail-like progress to save their son (Zack O . 145 times. The professor told us about this film and urged the staff to watch it. Moreover, high VLCFA concentrations in the blood don't necessarily correspond to ALD symptoms. Lorenzo's oil is named after a child, Lorenzo Odone, who developed ALD. When Dr. William B. Rizzo mentions his studies in which the addition of oleic acid to cultured cells blocked accumulation of the factors which cause ALD, the Odones jump into the conversation, asking if this oil might help their son. Why did olive oil not work completely? Aunt #1, Aunt #2, Aunt Dee, Michalla, Augusto, Lorenzo. The life expectancy of individuals with the adrenal insufficiency form depends on the severity of the signs and symptoms, but typically this is the mildest of the three types. Give another example of how a model was used to help you understand any concept in a science class. ALD is a recessive sex-linked or X-linked disease. Moser HW, Mahmood A, Raymond GV. Nat Clin Pract hMg CJ hMg B*ph . But now the moving story is finally over, writes Peter Beaumont. Adrenocortical insufficiency may cause weakness, weight loss, skin changes, vomiting, and coma. Lorenzo's Oil is a combination of a 4:1 mix of oleic acid and erucic acid, extracted from rapeseed oil and olive oil designed to normalize the accumulation of the very long chain fatty acids in the brain thereby slowing the progression of adrenoleukodystrophy (ALD). 3. Brain. View abstract. What is Lorenzo's Oil? The treatment, comprised of rapeseed oil and olive oil, was initially believed to halt, and even reverse, the course of the disease. Variants (also known as mutations) in the ABCD1 gene cause X-linked adrenoleukodystrophy. Arch Neurol. The life expectancy of individuals with this type depends on whether early diagnosis and treatment are available. Nick Nolte and Susan Sarandon star in this powerful drama based on the true story of one family's extraordinary quest to save their son after he's diagnosed with a rare . Director George Miller Writers George Miller Nick Enright Stars Nick Nolte Susan Sarandon Peter Ustinov What did his dream help him understand? Moser HW, Raymond GV, Lu SE, Muenz LR, Moser AB, Xu J, Jones RO, Loes DJ, adrenoleukodystrophy: A retrospective cohort study. Adrenocortical insufficiency may cause weakness, weight loss, skin changes, vomiting, and coma. What was found out from the Polish biochemist? The film uses Allegri's Miserere, Edward Elgar's cello concerto, as well as Barber's Adagio for Strings and Mozart's Ave verum corpus K.618. 2018 Oct 12. How does it work? First they insist that the meeting focus on potential treatments and second, they require that they be allowed to participate, despite being non-scientist laypeople. Adrenoleukodystrophy (ALD) is a rare, inherited metabolic disorder that afflicts the young boy Lorenzo Odone, whose story is told in the 1993 film "Lorenzo's oil." In this disease, the fatty covering (myelin sheath) on nerve fibers in the brain is lost, and the adrenal gland degenerates, leading to progressive neurological disability and death. Despite research dead-ends, the horror of watching their son's health decline and being surrounded by skeptics (including the coordinators of the support group they attend), they persist until they finally hit upon a possible therapy. Affected individuals develop progressive stiffness and weakness in their legs (paraparesis), experience urinary and genital tract disorders, and often show changes in behavior and intellectual function. An MRI, which uses magnetic fields and radio waves to visualize organs, is able to measure minute changes in the white matter of the brain. Clinical and therapeutic aspects of adrenoleukodystrophy and adrenomyeloneuropathy. (May 29, 1978 - May 30, 2008) Lorenzo Odone, whose parents' battle to save him from a rare nerve disorder was depicted in the 1992 film Lorenzo's Oil, has died from pneumonia aged 30. h* CJ From the description of the disease, ALD, (adrenoleukodystrophy) sketch what Lorenzo's neurons most likely looked like after a year. By Mary Kugler, RN Lorenzo's Oil. Deon M, Garcia MP, Sitta A, et al. Kanakis G, Kaltsas G. Adrenal insufficiency due to X-linked adrenoleukodystrophy. However, after relocating with his parents to the United States, he begins to show signs of neurological problems (such as falling, loss of hearing, tantrums, etc.). National Center for Biotechnology Information (US). Arch Neurol 2005;62:1073-80. Lorenzo's oil | Genetics Quiz - Quizizz Play this game to review Genetics. Why these cells are affected and not others is still unclear given that the VLCFA concentration will be the same throughout all the body. Duchesne N, Dufour M, Bouchard G, et al. It was 17 years ago that Odone's son, Lorenzo, started bumping into furniture and was diagnosed as having just two years to live. The resulting accumulation of VLCFA appears to have an inflammatory effect, gradually destroying the myelin sheath of the cells that comprise the white matter of the brain. Sep;1822(9):1465-74. doi: 10.1016/j.bbadis.2012.03.012. 7th - 8th grade . When this protein is lacking, the transport and subsequent breakdown of VLCFAs is disrupted, causing abnormally high levels of these fats in the body. 'Lorenzo's Oil' is a rare film that is intelligently produced in a manner that portrays the sadness, poignancy, hope, triumph and courage of the story it tells. h@&. ; < ? "Lorenzo's Oil" is an enthralling medical detective story. National Center for Advancing Translational Science. Lorenzo's oil is a combination of two fats extracted from olive oil and rapeseed oil. Lorenzo's oil is a special formulation of extracts taken from two different oils. Arq Neuropsiquiatr. Over time the symptoms can worsen, and children may have difficulty reading, writing, understanding speech, and comprehending written material. This includes attention-deficit/hyperactivity disorder (ADHD) and multiple sclerosis (MS), another disease caused by nerve demyelination. Brain Dev 1992;14:409-12. What is the coordination number for platinum in this complex, and what is the coordination geometry? Chai BC, Etches WS, Stewart MW, Siminoski K. Bleeding in a patient taking Lorenzo's oil: evidence for a vascular defect. Lorenzo's battle is fought with courage and strength and he identifies with so many important subtopics in our class such as: disease and illness, death and dying, and the body. The treatment changed the fatty acid composition of Lorenzo's blood, and Lorenzo then gained the ability to communicate by rolling his eyes and . ALD was added to the Recommended Uniform Screening Panel (RUSP), the federal list of genetic diseases recommended for state newborn screening tests, in 2016. Hum Mutat. The changes, if any, can be measured by a system known as the Loes score which rates the severity of brain abnormalities on a scale of 0 to 34. Racing against the clock, Odone and his wife pestered. Lorenzo's oil DRAFT. The performances, by Susan Sarandon and Nick Nolte, are daring, too: They play a married couple sometimes too exhausted and obsessed to even be . pathogenetic aspects. People with ALD accumulate high levels of saturated, very long chain fatty acids in their brain and adrenal cortex because the fatty acids are not broken down by an enzyme in the normal manner. 4.7star. Include a sketch of a normal neuron. It can serve as a motivator in the study of the scientific method, chemistry, biology, neurology, and genetics. In males (who have only one X chromosome), one altered copy of the ABCD1 gene in each cell is sufficient to cause X-linked adrenoleukodystrophy. [10], Though the film seemed to accurately portray the events related to the boy's condition and his parents' efforts during the time period covered by the film, it was criticized for falsely painting a picture of a miracle cure. National Center for Biotechnology Information (US), Bethesda (MD). Maeda K, Suzuki Y, Yajima S, et al. % &. 'The doctors were unanimous,' Cristina has written: '"Go home, resign yourselves." Lorenzo had only a few more months to live.'. About this movie. Appl Clin Genet. doi: 10.1186/1750-1172-7-51. [1] The opening song is "Kijana Mwana Mwali" (Swahili, "Song about a Young Lady"), sung by the Gonda Traditional Entertainers. Additionally, affected females have a 50 percent chance of passing the altered gene to each of their children.. [15], The film grossed $7,286,388 domestically with a budget of around $30 million.[1][2]. Adrenal Insufficiency & Addisons Disease: Treatment. His parents discovered a mixture of fatty acids that seemed to slow progression of the disease. "[8] On Metacritic, the film has a weighted average score of 80 out of 100, based on 21 critics, indicating "generally favorable reviews". Peroxisomes are small sacs within cells that process many types of molecules, including VLCFAs. Mary Kugler, RN, is a pediatric nurse whose specialty is caring for children with long-term or severe medical problems. This suggests that VLCFA plays less of a role in the progression of the disease once it has been established.. The bottom line. 87 times. Lorenzo at age 6 develops a classic childhood case of Adrenoleukodystrophy. Lorenzo's oil, a 4:1 mixture of glyceryl trioleate and glyceryl trierucate, has been used to reduce the saturated VLCFA level in the plasma of X-ALD patients; however, the mechanism by which this . LORENZO'S OIL Directed by George Miller; written by Nick Enright and Mr. Miller; director of photography, John Seale; edited by Richard Francis-Bruce, Marcus D'Arcy and Lee Smith; production. It is an awesome and straight-up honest account of the true story of Lorenzo's Oil. metabolic, genetic and pathophysiological aspects. Muscular Dystrophy Facts and Statistics: What You Need to Know, Lupus Facts and Statistics: What You Need to Know, Adrenal insufficiency due to X-linked adrenoleukodystrophy, Clinical manifest x-linked recessive adrenoleukodystrophy in a female, X-linked adrenoleukodystrophy in heterozygous female patients: women are not just carriers, An unusual presentation of X-linked adrenoleukodystrophy, The genetic landscape of X-linked adrenoleukodystrophy: inheritance, mutations, modifier genes, and diagnosis, Stem cell-transplantation therapy for adrenoleukodystrophy: current perspectives, Long-term outcomes of allogeneic haematopoietic stem cell transplantation for adult cerebral X-linked adrenoleukodystrophy, X-linked adrenoleukodystrophy: diagnostic and follow-up system in Japan. The build-up of these fatty acids is thought to cause many serious problems throughout the. X-linked adrenoleukodystrophy. Explain Augusto's use of paper clips to represent good and bad fatty acids. The movie Lorenzo's Oil is about a family's struggle to find a cure for their young son's fatal genetic disease, an illness that usually kills boys . s Augusto and Michaela Odone work tirelessly with little assistance from the medical community and the parent support group to find a therapy to stop the progression of this devastating disease. Effect of erucic acid on platelets in patients with adrenoleukodystrophy. X-linked adrenoleukodystrophy (X-ALD): clinical presentation and guidelines These and other molecular biology approaches should further our understanding of ALD and hasten our progress toward effective therapies. What are the probable genotypes of the family members listed? Original reporting and incisive analysis, direct from the Guardian every morning, 2023 Guardian News & Media Limited or its affiliated companies. Sign in to rate and Watchlist for personalized recommendations. The destruction of these tissues leads to the signs and symptoms of X-linked adrenoleukodystrophy. info. ALD symptoms in females tend to develop only in adulthood and will be considerably milder than males. Information from this source is evidence-based and objective, and without commercial influence. Also, the film is recognized by American Film Institute in these lists: Language links are at the top of the page across from the title. Explain why. 1992 135 minutes. Start studying Lorenzo's oil. Lorenzo's last name is Lorenzo's oilDRAFT 7th - 8th grade 143 times Biology 71%average accuracy 2 years ago ghsbiology 0 Save Edit Edit Lorenzo's oilDRAFT 2 years ago by ghsbiology Played 143 times 0 7th - 8th grade Death usually occurs within 1 to 10 years of onset. Write the formulas for the four ionic compounds that can be made by combining the cations Mg2+\mathrm{Mg}^{2+}Mg2+ and Fe3+\mathrm{Fe}^{3+}Fe3+ with the anions PO43\mathrm{PO}_4{ }^{3-}PO43 and NO3\mathrm{NO}_3{ }^{-}NO3. Lorenzo died in 2008 at the age of 30, living many years beyond his initial prognosis. In the end, there can be many different variations of the mutation (genotypes), each of which corresponds to a different expression of the disease (phenotype). 3. hU$ CJ Wanders RJ, Moser HW. Lorenzo's oil is a treatment developed for childhood cerebral adrenoleukodystrophy (ALD), a rare and typically fatal degenerative myelin disorder. [14], Hugo Moser, on whom the character of Professor Nikolais was based, called the film's portrayal of him "an abomination". Although the scientists play down their hope, pointing out that it would take years of work to produce the oil and test in clinical trials, the Odones seize the promise of this possible curative treatment. Lorenzo's oil is a treatment developed for childhood cerebral adrenoleukodystrophy (ALD), a rare and typically fatal degenerative myelin disorder. Description Oscar nominee Nick Nolte and Academy Award winner Susan Sarandon star in this powerful and unforgettable drama based on a true story. How does it work? The website's consensus reads, "A harrowing tribute to the heroism of parental love, Lorenzo's Oil is kept from abject misery by George Miller's sensitive direction and outstanding performances from Nick Nolte and Susan Sarandon. Lorenzo's Oil is a 1992 American drama film directed by George Miller. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. Ann Neurol 1994;36:741-6. Mary Kugler, RN, is a pediatric nurse whose specialty is caring for children with long-term or severe medical problems. Endocrinol Diabetes Metab Case Rep. 2015;2015:150098. doi:10.1530/EDM-15-0098. 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