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Discussion archive

Previous resolved or inactive discussion topics can be found in the archive feel free to reopen any issues you believe require further discussion.

Article Title - Huntington's Disease vs Huntington Disease

I was very surprised to see this page titled "Huntington's Disease", rather than "Huntington Disease". This is a significant error that should be addressed - the disease was named after George Huntington, but it does not 'belong' to him - therefore, the use of "'s" is incorrect. This is a fundamental principle of disease and syndrome nomenclature, not just my opinion (see [1] if you need convincing) - although this mistake is frequently made, even in scientific and medical publications (and not just on Wikipedia!).

I strongly recommend that the article is re-named "Huntington Disease" and that "Huntington's Disease", "Huntington's Chorea" and "Huntington Chorea" are all disambiguated to the new name. Cjones586 (talk) 14:19, 9 January 2009 (UTC)

Per Wikipedia:Manual_of_Style_(medicine-related_articles)#Naming_conventions, we use ICD-10 in most cases, and the World Health Organization uses the possessive. --Arcadian (talk) 06:11, 10 January 2009 (UTC)
Unless otherwise will probably be fixed in ICD-11, but that isn't due out for a few more years yet. LeeVJ (talk) 12:35, 11 March 2009 (UTC)

Usage of HTT for gene, HTT for protein and mHTT for mutant form of protein

Hi Lee- really nice work on the HD article by the way. I stopped by today to make some scattered revisions particularly on the genetics parts. One thing I noticed is the gene symbol/protein symbol issue (discussed here[2]). I switched the gene name to all-caps italics wherever I saw it and the protein name to all-caps non-italics. To my best knowledge, this is the "proper" way to distinguish gene names and protein names. What I don't know is how the mutant protein is designated (mHtt or mHTT). My guess is you can find examples of both usages, but probably mHTT is more consistent with the typical protein designations in humans (as opposed to mouse, where the gene is Htt and the protein is Htt).

Thankyou :) When I looked into it a year ago, there didn't seem to be a concensus in journals etc, but what I did get the gist of was that genes where capitalised, and proteins they produced weren't i.e. HTT the gene, Htt the protein, seemed right so I stopped looking into it. As for mhtt makes sense to me that since it is actually a form of Htt it is just a lower case 'm' denoting 'essentiall htt but altered' also seems right - but I have been known to be wrong! LeeVJ (talk) 00:02, 14 August 2008 (UTC)

Are there other sections that you think could benefit from additional work? I'd be happy to help you get this one GA status. Medical geneticist (talk) 22:38, 13 August 2008 (UTC)

Great! Your copyedits and additions have already been magnificient! As for GA there are a couple of trickies - full details for the citations and some of the short sections. I've reduced the technical jargon over time to something readable and understandable (hopefully) but some of them now need expanding on! An essential piece mentioned yonks ago in peer review that would add help start rounding off the article is about DNA replication! Someone asked about how dna had problems replicating long sequences, ie.e cleavage points and such, but I got lost in translation ;( (sorry) I think they meant for the protein generation - initially I was looking at how the repeat expansion can change as it is passed on, but I think both would be an excellent addition...if there are two functions, like I said I got a bit lost which is why the other wiki articles still need some work! LeeVJ (talk) 00:02, 14 August 2008 (UTC)

Capitalization of huntingtin

Huntingtin is inconsistently capitalized; I suspect it's appropriate to capitalize it, but wasn't sure, and there are a few instances where it is uncapitalized ( Maralia (talk) 03:03, 16 March 2009 (UTC) )

As far as I know it seems if it's the gene its uppercase -'Huntingtin', if it's a product of the gene ( i.e. the protein) its lower-case -'huntingtin', I think I looked at before but could find no definate answer. L∴V 14:39, 16 March 2009 (UTC)
I've applied the following rule for now 'for consistency - Capitalisaztion of Huntingtin gene, lower case for protein whilst avoiding 'huntingtin protein' which could be either'. On a cursory search got scared - [3] as when you say huntingtin protein you could mean 'protein product of Huntingtin' or simply 'the huntingtin protein', seems there are conventions vary for species too, then I briefly thought about the capitalisaztion of article titles, that's when I ran away. L∴V 14:18, 3 April 2009 (UTC)

HD Management - Nutrition

In this article, it is said, "Most HD sufferers need two to three times the calories of the average person to maintain body weight", yet I have never seen any source that validates this. The largest supplement I have come across suggested by any particular study is 473 kcal/d in the study by Trejo et al. Conorcosgrave (talk) 17:52, 24 November 2007 (UTC)

Part of answer: 24hr energy expenditure increased 11% due to movements. ( Gaba AM, Zhang K, Marder K, Moskowitz CB, Werner P, Boozer CN (2005). "Energy balance in early-stage Huntington disease". Am. J. Clin. Nutr. 81 (6): 1335–41. PMID 15941884. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) )LeeVJ (talk) 10:30, 2 May 2008 (UTC)

Um, well, I found a site called omnimedical search that says they need high calorie diets, but I have not seen anything stating 2-3x the normal amount of calories. —Preceding unsigned comment added by 64.147.23.130 (talk) 05:25, 13 January 2009 (UTC)

This information has been simplified to 'nutritional management' until such time as a review-type ref is found and deemed noteworthy. L∴V 13:54, 3 April 2009 (UTC)

Commercial

Since there are many trials and companies performing trials, didn't seem right to pick one out or list them all in main article, so maybe a list of companies conducting HD research is needed - need to trawl through manuals of style to find out if this is the wikipedia way...and have removed following recent link from article; --Leevanjackson (talk) 23:50, 15 March 2008 (UTC)

2008 Clinical Trials: Avicena's HD-02 to Proceed to NIH Sponsored Phase III Huntington's Disease Trial

lay organisations

There are a large number of lay organisations; initially some were removed as per 'wikipedia is not a link farm, these are listed here in case someone comes up with a genius idea of how to use them. L∴V 12:56, 2 April 2009 (UTC)

  • Huntington Project - worldwide umbrella organization for the clinical research efforts for HD
It may be an interesting site for investigators; but wikipedia is not a link directory; and this site has no encyclopedic value
Same as above
I do not think that an site where they put the most recent abstracts on HD is suitable for wikipedia; but in this case I am not as sure as in the others.
They barely give any info. They comment what they have published as a group and some clinical trials.
A link to an ongoing study has no encyclopedic value
Our article has much more than what they give

Bests.--Garrondo (talk) 09:07, 26 March 2009 (UTC)

Definition of aggregates and inclusions

I've copied this from /Archive_1#Accuracy_and_presentation_of_data by User:Matstuff: 'Uncleaved fragments of mHTT aren't called aggregates. The coalescence of mHTT fragments is thought to form 'protofilmanets' which further coalesce (aggregate) to form inclusions. Inclusions can be nuclear OR cytoplasmic (where they are sometimes called aggregates)' L∴V 23:39, 2 April 2009 (UTC)

St Vitus Dance

Having failed to find the original reference used for the following fact have moved from the article:

The only references I can find state St Vitus Dance as being Sydenham's chorea, but it is feasible that HD was also known in the past so I will leave here for future ref/ comment.LeeVJ (talk) 22:24, 21 September 2008 (UTC)

I think we should try to present the history of Huntington's, and not that of chorea. Sydenham's occurs specifically after streptococcal infections, while St Vitus' dance occurs after exposure to ergot-containing wheat. JFW | T@lk 16:43, 22 September 2008 (UTC)

Gillick Competence

The law regarding Gillick competence is not a worldwide law. Wikipeida's own article on Gillick Competence only lists several countries in which the law applies, and in explicitly states that the law/standard should be contrasted with the "stricter age-limit approach used in the U.S." This article on Huntington's makes it seem that Gillick Competence is a law/standard that can be applied everywhere. I recommend rewording this section of this article to reflect the differing laws worldwide, or at least mention that Gillick Competence is only valid in certain countries. —Preceding unsigned comment added by Mhadjiosif22153 (talk • contribs) 06:21, 17 September 2008 (UTC)

Noted. As for laws, the recommended guidelines on testing aren't law anywhere (as far as I know), just the common good practice recommendations, will check wording reflects this... LeeVJ (talk) 21:53, 17 September 2008 (UTC)

Previous GA Reviews

The order of GA reviews is a little complicated - so here's the explanation First GA review /GA0 was written before sub-pages were used. The second GA review is then found at GA1 (as transcluded below) Note: incorrect use of GAR resulted in /GA2 and /GA3 being created.

GA review

This article generally does a good job covering an important topic on which there is a ton of material, so kudos to the writers. However, I think it does need a thorough copy edit and needs many citations; there are a bunch of sections that are unreferenced. Here are my suggestions. This looks like an awful lot but it's really mostly quick, easy fixes.

  1. The following sections have no citation: "Symptoms", "Cognitive", "Mechanism", "Pathophysiology", "Diagnosis", "Management", "Medication", "Social impact", and "Others".
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  2. The following paragraphs have no citations: The first paragraph under "Genetics", the second and third under "Inheritance".
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  3. I would leave the complicated epidemiology data out of the very first sentence, maybe put it in the second or third. Rather, I'd have the first sentence be about what the disease is like: "Huntington's is characterized by..." That way you could introduce the idea of the varied epidemiology at the beginning of a new sentence: "the number of people varies with ethnicity: 1 in 100,000..."  Done LeeVJ (talk) 23:04, 23 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  4. "The disorder has been heavily researched in the last few decades" might be a problem per WP:DATED  Done LeeVJ (talk) 22:14, 23 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  5. "late forties/early fifties" - I would write this out rather than using the slash, and make the spelled out number/numeral thing consistent.  Done LeeVJ (talk) 15:51, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  6. "usually at around 40-50 years" Use en dashes (–) rather than hyphens (-) for number ranges per WP:DASH. This is a repetition of the 2nd paragraph, too.  Done LeeVJ (talk) 15:54, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  7. " psychiatric changes, which pre-empt the physical ones, are overlooked" what does this mean? What does it mean to pre-epmt a symptom? Is that how you spell pre-empt? (I really don't know)  Done LeeVJ (talk) 17:24, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  8. "Physical symptoms are almost always evident" Does this mean "almost everyone with Huntington's gets physical symptoms?" Or something about how obvious the symptoms are? Maybe reword for clarity.  Done LeeVJ (talk) 17:24, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  9. "cognitive symptoms which can lead to psychopathological problems exhibit differently from person to person." would have a different meaning from "cognitive symptoms, which can lead to psychopathological problems, ..." The former is a more specific type of cognitive problem. Which is it?  Done LeeVJ (talk) 21:16, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  10. "some uncontrollable movement of the lips, chewing and swallowing (Dysphagia) which commonly causes weight loss" Some can usually be dropped without changing the meaning (see User:Tony1/How to satisfy Criterion 1a: redundancy exercises). Also, "uncontrollable movement of the lips, chewing and swallowing..." doesn't really make sense. Maybe "uncontrollable movement of the lips, problems with chewing and swallowing"?  Done LeeVJ (talk) 22:49, 23 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  11. "Continence, eating and mobility are extremely difficult if not impossible." Impossible is a strong word. This would require a citation.  Done LeeVJ (talk) 17:36, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  12. "to date neither of this have been supported". Per WP:DATED, avoid "to date", replacing it with "As of [whenever]".  Done LeeVJ (talk) 15:51, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  13. I believe citation style calls for a capital letter after a colon in refs.  Done LeeVJ (talk) 15:51, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  14. "The latter can cause or worsen addictions such as alcoholism and gambling, or hypersexuality." is hypersexuality an addiction? If not, you could have "The latter can cause or worsen hypersexuality or addictions such as alcoholism and gambling." a cite would be good here too ..5  Done cite is left tagged LeeVJ (talk) 01:34, 27 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  15. Making that table float to the right would reduce whitespace (e.g. in rotavirus).  Done LeeVJ (talk) 15:01, 22 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  16. Explain or at least wikilink "penetrance". { Done LeeVJ (talk) 18:24, 23 May 2008 (UTC)
    Good. delldot talk 04:41, 12 August 2008 (UTC)
  17. "to have an increased mortality, progressively interfering with their functioning." Yeah, I guess dying would interfere with their functioning. :P Also, is there a simpler way to reword this for laypeople?  Done LeeVJ (talk) 17:54, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  18. You can do et al. for >3 or 6 names in a ref per WP:MEDMOS  Done LeeVJ (talk) 15:51, 22 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  19. "Generally, but not always, the greater the number of CAG repeats..." doesn't really fit at the end of that paragraph, maybe you can fit it in the previous one.  Done LeeVJ (talk) 18:24, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  20. Image:Autosomal Dominant Pedigree Chart.svg could stand to be smaller. I'd recommend cropping the image and increasing the size of the text so it's still legible if you make it smaller (it's an svg so this won't be hard. I can do it if you need me to, I like doing junk like that).
     Done What do you think? Actually, I think I may have made the key box too big, I can shrink it and make the elements closer together if you think it's a good idea. delldot talk 07:05, 24 May 2008 (UTC)
    Much better! Still not sure about it's understanability to anyone who doesn't know what it means ! e.g. (I,II,III?) but at least it can be read now ..LeeVJ (talk) 11:34, 25 May 2008 (UTC)
    I don't think it's a problem, but could add clarifications to the caption if necessary. delldot talk 04:41, 12 August 2008 (UTC)
    I can't put my finger on it, I think it's because each of the generations has differing number of possibilities, i.e. 1st gen has five offspring, 2nd then has 2,3,and 4, I think 1st gen have 4, then second have two sets off four one from an affected and one from a wild type, sounds like hassle though and not sure how pedigree charts are usually depicted .LeeVJ (talk) 21:35, 12 August 2008 (UTC)
    User:Medical geneticist has added a description which improves the situation. LeeVJ (talk) 15:04, 18 August 2008 (UTC)
  21. "and are finally cleared up in a process called degradation" cleared up?  Done LeeVJ (talk) 17:45, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  22. "The exact mechanism in which mHtt causes or affects the biological processes of DNA replication and programmed cell death (apoptosis) remains unclear, so research is divided into identifying the functioning of Htt, how mHtt differs or interferes with it, and the proteopathic effects of remnants of the protein (known as aggregates) left after degradation." - long and hard to follow. Is there a simpler way to say proteopathic?  Done LeeVJ (talk) 23:59, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  23. " This loss of BDNF may contribute to striatal cell death, which does not follow apoptotic pathways as the neurons appear to die of starvation." Can you reword into simpler terms for the layperson? This section could be fleshed out more anyway. Is this really all there is to say about their function?
    Good delldot talk 04:41, 12 August 2008 (UTC)
  24. With mHtt, how are we supposed to deal with starting a sentence with a lower case letter? My instinct would be to reword so it doesn't come first (e.g. "The protein mHtt..." or "The erroneous protein mHtt" if there's an official thing known as an erroneous protein). You may want to look at featured protein articles if there are any to see how they handle the problem.  Done LeeVJ (talk) 20:24, 21 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  25. "polyQ dependent transcription" should probably be "polyQ-dependent transcription". Can you check?  Done LeeVJ (talk) 20:24, 21 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  26. "The aggregates also interact with SP1, thereby preventing it from binding to DNA,the normal functioning of these proteins" Unclear. Maybe "the way proteins normally do" or something.  Done LeeVJ (talk) 20:24, 21 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  27. "Huntington mice models exposed to better husbandry techniques, especially better access to food and water, lived much longer than mice that were not well cared for." Citation needed here. The sentence should say "in a 1998 study..." or some such, since these are findings from a particular study, not something general. A review article that discusses the study should be used, not the study itself.
    This is OK, I think I was being too strict insisting on no primary sources. As I now understand it, some are ok. I think I was also wrong about using "in a 1998 study"; I've since been told that if the source is reliable you can state just the results. So this is fine. delldot talk 04:41, 12 August 2008 (UTC)
    Not sure about this one either , couldn't find a decent ref for it, aside from the fact it's pretty damned obvious that access to correct levels of food, water and ideal environment will positively affect longevity! LeeVJ (talk) 21:35, 12 August 2008 (UTC)
    Ah, found a relevant study <ref name="pmid14999077">{{cite journal |author=Spires TL, Grote HE, Varshney NK, ''et al'' |title=Environmental enrichment rescues protein deficits in a mouse model of Huntington's disease, indicating a possible disease mechanism |journal=[[J. Neurosci.]] |volume=24 |issue=9 |pages=2270–6 |year=2004 |month=March |pmid=14999077 |doi=10.1523/JNEUROSCI.1658-03.2004 |url=http://www.jneurosci.org/cgi/pmidlookup?view=long&pmid=14999077 |issn=}}</ref> so could reinstate statement,maybe. LeeVJ (talk) 13:14, 9 September 2008 (UTC)
  28. "This is a significant find for Huntington's." What is a "significant find"? This sounds like opinion, though it's good that there's a ref. Don't know if this sentence adds anything though, without further explanation.  Done LeeVJ (talk) 17:41, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  29. I don't think the paragraph on Juvenile HD belongs in the prognosis section, it's more about symptoms or classification. Could merge with the mention under epidemiology as a last resort; at least this would cut down on repetition.  Done LeeVJ (talk) 23:26, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  30. Is there really only one sentence to be written about medication, in the treatment section? If so, this section should maybe be merged into another one. I would think, though, that more needs to be written here to adequately cover the subject.
    Still very short, is medication just not an important part of treatment? delldot talk 04:41, 12 August 2008 (UTC)
    Hard to find huntington's specifically tested classical medicine, mostly broken down by health service as medicine per symptom as it would be treated on it's own, other's used don't seem to be official endorsed yet, but I am delving, should the drugs used just be listed e.g. drug for psychotic episode, apathy etc. or maybe better if I drag in a summary from each of the symptoms articles... LeeVJ (talk) 21:35, 12 August 2008 (UTC)
  31. There are a number of very short paragraphs and sections. These are discouraged and should probably be merged or expanded.
    Improved, but still quite a few. delldot talk 04:41, 12 August 2008 (UTC)
    just started on this one...LeeVJ (talk) 21:35, 12 August 2008 (UTC)
  32. " An intracellularly expressed single-chain Fv against the amino-terminal end of mutant huntingtin (mHtt) has been shown to reduce mHtt aggregate formation and increase turnover of the mHtt fragments in tissue culture models of HD." Can the wording be simplified for the lay reader?  Done LeeVJ (talk) 01:00, 27 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  33. "Intensive therapy: A pilot study on July, 2007, of inpatient rehabilitation for the Italian Welfare system, of speech, mind and body showed no motor decline in the two-year study." This needs rewording.  Done LeeVJ (talk) 17:41, 23 May 2008 (UTC)
    Good delldot talk 04:41, 12 August 2008 (UTC)
  34. The sentence under "Others" under "Research directions" needs a citation or citations.
    Good delldot talk 04:41, 12 August 2008 (UTC)
  35. Any time you have a statistic, it requires a citation. For example, "The prevalence is, on average, between 5 and 8 per 100,000", and "...screening now make it possible (with 99 percent certainty) to have an HD-free child"
  36. It looks like there are an awful lot of primary sources, not the best per WP:MEDRS. Be careful when citing trials to be clear that it's a specific study and not general results, and use review articles or other secondary or tertiary sources whenever possible instead.
    Good delldot talk 04:41, 12 August 2008 (UTC)
  • find references for all 'citations needed'.
  1. Good delldot talk 04:41, 12 August 2008 (UTC)
I have incorporated all the above points regarding missing references here, having tagged sections with 'fact' where required. LeeVJ (talk) 01:34, 27 May 2008 (UTC)
 Done LeeVJ (talk) 16:48, 9 August 2008 (UTC)

I'm failing this for now because I think finding all the needed citations will take more than the week usually allotted for a hold. Please feel free to nominate it again once that has been dealt with, though. I'm glad to give it another look when you want me to to let you know if I think it's ready to go up again. Sorry to be so picky, it really is a very nice article, so I decided to use a very fine toothed comb with the prose. Most of my points are very minor, however the citation needed issues need to get dealt with first and foremost. I'd also recommend having a copy editor look over the article, because there were a bunch of minor wording things that made me think the whole article could use a copy edit. It also looks like some of the areas I pointed out need a little expanding. Please don't hesitate to drop me a note if you need any help or explanation. delldot on a public computer talk 07:18, 21 May 2008 (UTC)

Get down with your bad self Leevanjackson! You're making great progress! delldot talk 07:05, 24 May 2008 (UTC)
thankyou! :) LeeVJ (talk) 21:35, 12 August 2008 (UTC)

Rechecking for new GA review

Update: Leevanjackson's done terrific work, addressing all my concerns from the earlier review. I came across a few more things while re-reviewing (very minor):
  • This sentence is a fragment and too technical: Profound neuronal degeneration in the striatum with some additional atrophy of the frontal and temporal cortices. Done
  • This sentence is confusing: Testing of a descendant of a person, who is 'at risk', has serious ethical implications because a positive result automatically diagnoses one of the parents. Who is at risk, the parent or the descendant? Everyone's a descendant. Possibly just a comma issue (Testing of a descendant of a person who is 'at risk') but the whole sentence should be reworded. Done
  • Only the first word after periods and colons and proper nouns need to be capitalized in article titles.
Not sure about this one, do you mean in the article content? LeeVJ (talk) 22:07, 13 August 2008 (UTC)
  • Some refs need to be expanded, e.g. "Achievements of Hereditary Disease Foundation"--publisher needed, as well as date and author if available.
Some of the refs just don't have this info - do I need to find new ones that do ? LeeVJ (talk) 22:07, 13 August 2008 (UTC)
  • Confusion with its in the following sentence: The precise way it does this is unknown but a reduction in its level increases neuron cell death and creation, leading to atrophy of areas of the brain. - the first it is mHtt, and the second is BDNF, right?  Done
  • Under Social impact, This sentence needs rewriting: Whether or not to have the test for HD Genetic counseling may provide perspective for those at risk of the disease.  Done
Overall, looks great! delldot talk 04:41, 12 August 2008 (UTC)
Article as when this was written [[4]]. LeeVJ (talk) 17:12, 12 January 2009 (UTC)

Categorisation - proteins category

A quick wiki search for 'huntingtin interacting' turns up a fair few proteins, many of which aren't categorised as proteins yet, possibly due to the comlpexity of the protein category structure, which at first look soesn't seem to be fully formed. It's desired structure semms to hinted at and I am just bookmarking the possible category/section for these proteins as Whole_proteome_analysis#protein_binding, requires more indepth investigation, I'm looking for images at the moment... LeeVJ (talk) 13:58, 11 March 2009 (UTC)

MCOTW

Welcome once again! Just a quick nudge / pointer to the GA Review which has a number of suggestions still to address, not to exclude any fresh perspectives / ideas of course, I'll try and sort out the images. LeeVJ (talk) 10:49, 11 March 2009 (UTC)

Possible images

More images would be great. I have found 3 tangentially related images (Better than nothing): Tetrabenazine structure and 2 images on aspiration pneumonia (There are more on pneumonia in commons). Bests.--Garrondo (talk) 18:05, 13 March 2009 (UTC)

I located another candidate in my travels, which shows a neuron with intranuclear inclusions (stained) amongst other neurons . (it's on a .gov site so I'm assuming is available to use - but think I have to email ninds to double check.) LeeVJ (talk) 01:24, 14 March 2009 (UTC)
I would add the MRI of pneumonia; but I do not know what can be seen in it... It would be great to be able to point out what is the important feature in the picture. I have also added the structure of tetrabenazine.--Garrondo (talk) 11:43, 16 March 2009 (UTC)
Not sure about the pneumonia either, I suppose an image of it would add by emphasising one of the most common cause of mortality. HAve added another possible image of a lab mouse possibly for research section. Another note George Huntington portrait would be better placed in history section when a better image to replace him is found ... L∴V 17:24, 16 March 2009 (UTC)
That was my intention; emphasising a cause of mortality however what I meant with my question is that the image has to mean something for a lay person who knows nothing of MRI (I know nothing); so we would have to point out what a radiologist sees; how does the image show it is an aspiration pneumonia.--Garrondo (talk) 08:26, 17 March 2009 (UTC)

Re:image of neuron. Dr. Finkbeiner, has given permission to use the neuron image - I have to check that the release fits in with copyright for WP, but he also asked if there were any other images we wanted to use ! quote 'If you have specific ideas in mind of features you want to illustrate, let us know. Otherwise, members of my lab may send you images themselves, and you can see if any interest you. However, I suspect most of the images we have readily available are ones that were generated to demonstrate a very specific scientific point and therefore may be at a level of detail that is beyond your target for this article.' food for thought! L∴V 23:58, 16 March 2009 (UTC)

Wow, that's great. What kind of research do they make? Maybe a video of a Huntington mouse would be great (although I am not very sure of the symptomatoloy in mice) if they could give us one. I also agree with having a better lead image and moving Huntington to History.--Garrondo (talk) 08:23, 17 March 2009 (UTC)
Slight delay while Dr Finkbeiner runs the license past his institution, seems WP requires part of licence to be 'free for commercial use', legal stuff eh! L∴V 13:28, 18 March 2009 (UTC)
We now have permission to use the image, thanks to Dr. Steven Finkbeiner, Gladstone Institute of Neurological Disease, The Taube-Koret Center for Huntington's Disease Research, and the University of California San Francisco ! He also sends his compliments on our work to the article :) L∴V 00:47, 3 April 2009 (UTC)

Another thing: Regarding the pubmed graph: I do not feel its a valid image: I suppose it was created to imply that much more research is being done right now; which I am sure its true; however in pubmed articles before its creation (in the nineteens I suppose) only appear when they have been cited; so if you made this graph in any other disease it would have the same form with less articles as you go back on time. I would say it is WP:Synth: "The graph shows more articles in pubmed so that means research is increasing"--Garrondo (talk) 08:23, 17 March 2009 (UTC)

That's interesting - I thought they were putting all papers up - hope this doesn't mean we miss any of those hidden gems that are uncited for years -as seems to happen so often in history! I ran a few tests on other conditions and it is the same graph - we'd better get all these articles written before the pubmed database so big we get lost travelling its corridors, so I have replaced the image with an image of Huntington's original paper as a stop-gap measure, top marks for diligence! L∴V 10:02, 17 March 2009 (UTC)

Just spent the day learning svg editing / reinstalling computer to convert the basal ganglia diagram, now I notice it's not mentioned in the article - although looking at the structure of the brain there appear to be varying ways of describing it's groups of structures, I've added it to the gallery for now. (at least I'm better with svg, and basal ganglia has a cleaner image for the efforts!) L∴V 23:56, 23 March 2009 (UTC)

Maybe it could be of use: If you could eliminate all lines and letters, eliminate the superposition of the globus pallidus and maybe also convert the green of the cerebellum into yellow what would be left in pink would be the striatum; which is the main affected structure. I am not sure if I am explaining myself clearly enough; but maybe the image in this link may be of use: [5] (it is probably copyrighted). The globus pallidus is deeper in the brain (more centred) and that is why in the original file (File:Brain structure.gif) it appears with a dotted line so if you eliminate it from your drawing we will have a nice diagram of the affected structured (putamen and cuadate). Bests. --Garrondo (talk) 12:51, 24 March 2009 (UTC)
Great, I'll get to it - will post up tomorrow - thanks Garrondo! L∴V 23:01, 24 March 2009 (UTC)
Second draft - is this what you meant ? L∴V 20:59, 25 March 2009 (UTC)
Exactly: looks great. --Garrondo (talk) 08:31, 26 March 2009 (UTC)
I do not know much about image making; but the size of the image is quite small. I do not know if it could be made bigger from the start so when we put it in the article as "thumb" it is the same size as the others.--Garrondo (talk) 08:41, 26 March 2009 (UTC)
Being svg, image size doesn't matter - it scales to whatever size you like, to change it's size we can just add |250px into the paramters ( 250 is an axample can be anything, (see http://en.wikipedia.org/wiki/Wikipedia:IMGSIZE#Displayed_image_size manual of style allows resizing for diagrams and detailed images) note: the standard size for thumbs is 180. L∴V 10:56, 26 March 2009 (UTC)

I found the first one and created the other two: it is not of high quality (a low resolution gif) but it is a nice picture. I plan to add the one with the arrows to the pathophisiology section; moving the striatum schema to the infobox and Huntington's portrait to history. If somebody believes the second one (no arrows) is better I do not really care. Bests. --Garrondo (talk) 14:57, 27 March 2009 (UTC)

Coping With the Disease

Although dealing with death can be very difficult no matter what the situation, dealing with death due to Huntington's Disease is also hard. Dealing with death from Huntington's can be a challenge because the patient doesn't die only because of the disease, but because of other factors that contribute to the patients health due to the disease. Building a strong relationship with the person affected by Huntington's Disease while you still can always helps, also to make positive memories that a person can always remember. Learning about the disease and what will happen to the person affected while it is still early really helps the coping process and will in turn make it much easier (Mayo Clinic) (Clbratt (talk) 01:05, 26 March 2009 (UTC))

I have been looking at the Caregiving and dementia article - I think it could be expanded to cover HD and would provide better coverage of these issues - not to mention it could then be linked to by other disorders with similar issues. L∴V 00:51, 3 April 2009 (UTC)

bibliography section clean up

There are too many external links: I am going to try to clean up the sections. In order to do so I will post here what I eliminate and why.

Is a very short biography: does not add anything
Already in the article in the disease infobox
Huntingtons disease-Like 2 is a different disease; so articles on it are not really relevant
Another biography: this one is larger and of better quality. Additionally it was published in a peer-review journal and has historical importance. However this is the article about the disease and not about the person who gave name to it. The link is already in the George Huntington article; but since it is a document maybe it could be moved to wikisource. I doubt it will be copyrighted but we would have to make sure it is not. Nevertheless this one is the only one I am not really sure about eliminating it. More opinions would be welcomed.

Bests. --Garrondo (talk) 08:55, 26 March 2009 (UTC)

All good, if someone is interested in the material covered by the last reference they will find their way to the george huntington article and hence the ref. L∴V 00:55, 3 April 2009 (UTC)

Is it time for GA??

The past weeks the article has received an important revamping: See before the begining of the MCOTW. Right now almost every sentence is referenced to reliable-sources: while the number of inline citations has multiplied the number of sources has been actually reduced from 140 to around 90. All sections have been converted to prose, there are images, and the lead covers the whole article... I believe that it should easily pass a good article nomination; and with the comments of the reviewer head towards a FAC in the short term. I believe its time of finishing the MCOTW and nominating the article. Comments??? --Garrondo (talk) 15:29, 1 April 2009 (UTC)

I'm going to have to roll over the MCOTW article soon, but on a cursory review I think it is high time this article goes for GAC. I can't promise that I will review it, but at the moment there's only some really minor grammarcruft to deal with. Good luck! JFW | T@lk 20:31, 1 April 2009 (UTC)
I believe it's ready - thanks to your hard work :) and I've been busy but have plenty of spare time in the coming week to address any issues. It would be nice to get the article to GA whilst being MCOTW as a feather in the collaborations cap. Feel free to nominate it Garrondo - I have had a little tidy up so we're ready for visitors, just need to do a an in-depth read / copyed of the article - but I'm sure it is in good shape - there are a couple of outstanding issues from the JFW's previous review which I'd like to address (listed below) - but they shouldn't be show stoppers . L∴V 01:49, 2 April 2009 (UTC)
  • Genetics: Do we know why only paternal CAG repeats exhibit expansion and cause anticipation? If not, perhaps we should say that this is unknown -which I believe has something to do with the male gamete duplication of dna being more volatile.
Done: I have added: This occurs because instability is greater in spermatogenesis than oogenesis (obtained from lancet seminar)--Garrondo (talk) 08:18, 2 April 2009 (UTC)
  • Signs and symptoms - Physical: "slurring of speech" - can anything be said about the nature of the dysarthria? "Slurring" is nonspecific and could be bulbar, ataxic etc.
The wording slurring of speech does not appear any more in the article. What is left is "any function that requires muscle control is affected, resulting in physical instability, abnormal facial expression, and difficulties chewing, swallowing and speaking" Is it enough?--Garrondo (talk) 08:18, 2 April 2009 (UTC)
Done √ Sorry missed the question amongst the others - good point in that context I think it's ok L∴V 00:12, 6 April 2009 (UTC)
  • Signs and symptoms - Physical: when do bradykinesia & dystonia occur? Instead of, or in addition to, the choreatiform movements? Can anything be said about their signifcance, or should they just be mentioned alongside the chorea?
Done √ Explained a bit more detail,L∴V 00:12, 6 April 2009 (UTC)

Request for new GA review

This discussion is transcluded from Talk:Huntington's disease/GA3. The edit link for this section can be used to add comments to the reassessment. I believe that, since "prior suggestions not implemented" isn't a quick-fail criterion, the page should have remained at GAC until reviewed.Bettering the Wiki (talk) 20:15, 7 September 2008 (UTC)

This is a misrepresentation of the facts. I reviewed this article in August 2008 and failed it when the editors were unable to implement all the recommendations in time. As is clear on your talkpage, Leevanjackson is not yet ready for another GAN. You are causing unnecessary chaos by insisting that your review is actioned. JFW | T@lk 21:21, 7 September 2008 (UTC)
"My review is actioned"? I think you misphrased your response, as there as obviously been little action here.Bettering the Wiki (talk) 21:37, 7 September 2008 (UTC)
To be clear, in Talk:Huntington's disease/GA2 I didn't quick fail the article. I regular failed it. I agree with JFW that this GAR is counterproductive, but I appreciate that the reverting has stopped. Goodone121, can you clarify which problems outlined in the second GAN review you don't feel are important to resolve and why? Thanks much, delldot on a public computer talk 03:37, 9 September 2008 (UTC)

I listed.Bettering the Wiki (talk) 01:32, 20 September 2008 (UTC)

Which you shouldn't have, because nobody has actually reviewed the article. You cannot list by default. Either conduct a proper review, or withdraw this request. I have left a message on your userpage clarifying why I have undone your actions. JFW | T@lk 19:46, 21 September 2008 (UTC)

The template said that the initiating editor should close, and no, I am not using this as a "backdoor". I am simply adhering to policy. BTW, I reverted .Bettering the Wiki (talk) 19:53, 21 September 2008 (UTC)

GAR is for articles that are presently GA but need to be reassessed in view of major changes. It is not the way to get an article to GA status without due process. Your activities have been called "disruptive" by several editors and I would strongly counsel you to stop changing the status of this article. It puts contributors off making any significant contributions, and I believe you are thereby interfering with its improvement. JFW | T@lk 14:19, 23 September 2008 (UTC)
For the record, this GAR is now archived and Goodone121 has been blocked for using it as a tool in disruptive activities. The article is well on its way to becoming a good article, but that would be despite (rather than because of) this contributor's effort. JFW | T@lk 18:02, 24 September 2008 (UTC)

I, again, have reverted. JFW, you may override me with a Community WP:GAR, which I reccomend. If you do, I will gladly back down.Bettering the Wiki (talk) 03:08, 25 September 2008 (UTC)

I'm doing no such thing. You have been asked to leave this article alone, by myself and various previously uninvolved people. GAR, as has been explained to you, is not a way to have articles listed. It is a way to get articles delisted because they are listed as GA and shouldn't. JFW | T@lk 05:39, 25 September 2008 (UTC)

Classification and Genetics Sections

I suggest

1. combining the Genetics section with the Classification section and

2. placing the result after the Signs and Symptoms section.

There is some repetition of material and I need help understanding the motives behind doing so. I understand the Medical Manual of Style suggests that we employ these specific headings (see WP:MEDMOS) I guess I'm questioning the MOS. How bold of me. I'm no expert, but the way I see it, the Classification is often based on etiology unless the cause is unknown. So I think it's redundant to have one section titled Classification and another called Cause or Genetics Again, I'm a layperson and new at this, so I have little regard for any established convention. But I do respect the need for convention, in general, especially if it aids the reader. If you wish to argue this way, I respect that. But I don't see the benefit in maintaining strict adherence to a convention that serves to muddle things. Danglingdiagnosis (talk) 06:58, 17 April 2009 (UTC)

I may agree with you; but lets see what other editors think. Bests. --Garrondo (talk) 07:39, 17 April 2009 (UTC)
Never stop questioning DanglingDiagnosis, nothing is set in stone! As it happens the MOS does cover this, to quote: "Establishing the forms of the disease (Classification) can be an important first section. However, if such classification depends heavily on understanding the etiology, pathogenesis or symptoms, then that section may be better moved to later in the article.". Looking at the introduction of terminology and flow, your suggestion would be a great improvement... L∴V 13:45, 17 April 2009 (UTC)
Afterthought, I wonder if the HDlike and genetic chorea information should be placed in the Diagnosis section? L∴V 14:03, 17 April 2009 (UTC)
Agreed; since it is differential diagnosis; and if classification dissapears it would better fit under that section.--Garrondo (talk) 14:33, 17 April 2009 (UTC)
I have given it a shot. I think no info has been lost.--Garrondo (talk) 07:45, 20 April 2009 (UTC)

Senile chorea

Senile chorea exhibits the same movement symptoms as late-onset HD, but without any pyschological changes. PMID 8797208. The reference is a case study in a japanese journal: both reasons would be enough to eliminate the sentence from the article. On the other hand chorea is by itself a symptom, not a disease (i.e: it can appear with different diseases), so the sentence does not seem to really fit into the section. Comments?--Garrondo (talk) 07:39, 28 April 2009 (UTC)

I don't see it specifically in the ICD, so it should probably go. I was looking to cover any differential diagnosis - but chorea without pyschological changes is probably alrady inferred or should be cast into a more general statement. L∴V 11:32, 28 April 2009 (UTC)

Ideas for further improvements towards attaining FA status

Following a successful GA promotion here are a few ideas that could be implemented to improve the article, I won't put them into the todo list yet as some will be a matter of opinion - that said a FA article should cover all opinions, feel free to add your own... L∴V 15:19, 2 May 2009 (UTC)

  • Age of onset modifiers section, the link between CAG repeats and severity is there but doesn't follow on to age of onset concretely, in travels around the references there where plenty of references to the inability to predict from CAG accurately, but somewhere I saw a paper that said it accounted for 50%, and listed other potential genetic modifiers. Also inheritence of haplotypes could be explained here.L∴V
  • Related: Merging of huntingtin protein and gene articles for a better support article. These have been merged by User:boghog2 today, but are still pending cleanup and a copyed.L∴V
  • I don't feel the caregiving aspects and strains on family members are emphasised enough, although the references for these aspects may be harder to find than the current hard science ones we have for mechanism etc. L∴V
  • Related: Caregiving and dementia might add support for above point - I am hoping to expand it to cover HD (and other degenerative conditions) L∴V
  • Another look at possible relevant images (as always), possible including depictions of the movements / postures if that's appropriate. L∴V
  • Possibly a chart of areas of brain affected / their general functions / maybe in order of prominence of damage. L∴V
I would not do this: would be really hard to name all damaged areas or order them in order of prominence and I do not think that it will add much to the article.--Garrondo (talk) 16:57, 5 May 2009 (UTC)
  • Similarly a chart for causes of mortality, if that's appropriate. L∴V
I wanted to expand the epidemiology section, being one of my ideas to include a chart with different prevalences; however after searching for new references (pubmed, google scholar and google) I have not found any new data we could use. It seems we summarize most important findings regarding epidemiology, and that any missing gaps in the section are also in the scientific field. Bests.--Garrondo (talk) 12:04, 5 May 2009 (UTC)
HD third edition states that prevalence studies have found it cumbersome to perform classical epidemiology studies so most data is obtained using detailed family studies. It then goes on to summarize the ones available at the time. Regions covered (-d denotes more detailed) are US total, US white, US non-white, Venezuela-d, About 50% of Europe (Belgium, Denmark, England-d, Finland, France, Germany-d, Iceland, Italy=d, Malta, Norway, Poland, Sweden, Switzerland, Wales-d, and Yugoslavia), Ociana (Australia, New Zealand), Asia (India, Hong Kong, Japan-d), Africa and South Africa, the Pacific Islands, and Mauritius ( which is cited as an good example of the founder effect). It may be possible to integrate these but as you point out we have no really good source that gives a world view (aside from this book of course). Also noted that the book lists five areas of High prevalence = these are Lake Maracaibo, Tasmania, but also Moray Firth (Scotland - Lyon 1962),Gwent (South Wales - Walker et al 1981), and Northern Sweden (Sjorgen 1936).
The book was published 2002 so there may be a few more gaps filled in, but it's a starting point. L∴V 14:33, 5 May 2009 (UTC)
I do not have access to the book but while I was searching several articles said it was one of the best sources at the moment. How did you get to the book? (Do you have it in paper or a accessed via web?). Maybe we could create a chart with some of the prevalence rates? The danger is that as we would have to select which countries to include in some way it would be a minor OR, but if we title the chart as "Examples of national prevalence rates" such danger would be partly diminished. Thoughts? --Garrondo (talk) 15:30, 5 May 2009 (UTC)
Alas it is a hard copy (and was 200 miles away from me while we were in the process of GA)! L∴V 21:51, 5 May 2009 (UTC)
I have added the high prevalence areas and reworded the founder effect using the ref you give; however, could you add the pages for the epidemiology chapter? Bests.--Garrondo (talk) 16:24, 5 May 2009 (UTC)
√done L∴V 21:51, 5 May 2009 (UTC)

Can I get a decision on capitalization and text style for Htt and mHtt? Even if it turns out to be the 'wrong' way, it has to be better than inconsistency: I'm seeing allcaps, mixed case, all lowercase, plain text, and italics in various combinations. One way or another, I'm gonna standardize that formatting the next time I give this a full copyedit. Is it time for that copyedit yet? I don't want to tackle it too early, if significant content changes are still to come. Maralia (talk) 15:26, 6 May 2009 (UTC)

I propose we use HTT or huntingtin fot the gene, HTT or huntingtin for the protein, and mHTT or mutant huntingtin for the altered protein. I am also wondering if we should consider not using the abbreviation which might help with readability. As for differing styles for other species, I think we ignore that for now - there seems to be an understanding of these complications amongst experts, and it doesn't really matter to the article L∴V 00:03, 7 May 2009 (UTC)
Reasoning::MedicalGeneticist suggested HTT for gene, HTT for protein and mHTT for mutant form of protein, I use Huntingtin for full gene and huntingtin for protein names, but that may be wrong. The official genenames [[6]] states HTT / huntingtin for the gene name. Some confusion may appear in papers since genes named after people are initially capitalized [7], but since it isn't exactly his name then it is not capitalized. Another line of confusion will be that the mouse gene is lowercase (htt) and a lot of research papers will be using this. The manual of style states that gene names should be italicized and takes http://www.genenames.org/guidelines.html as the authoritive source for any conventions - although it doesn't state explicitly that the full name is italicized too. As for the protein, all caps HTT, the genebank and omim etc use lowercase huntingtin for full name. Genenames cites [genome society] for nonclemanture of variations of these proteins which do have case of lower case suffixes describing the alteration so mHTT is probably correct.L∴V 00:03, 7 May 2009 (U
AS for the copyedit, I'd leave it for a week or two, and we'll definitely take you up on the offer before nominating, p.s. if you find any areas that could be improved or expanded upon that would make copyeditting easier, just shout! L∴V 00:21, 7 May 2009 (UTC)

Is it needed?

Is the following sentence really needed (Macroscopic changes due to mHTT)? it is unreferenced and does not really add much...: Depending on the precise distribution of damage, the intrusive behaviors may consist of complex patterns such as walking motions, simple movements such as twitching a limb, or many other combinations of motor elements. Bests. --Garrondo (talk) 14:08, 6 May 2009 (UTC)

I think I added that. The reason I did is because one thing that seems to be missing from this article is a sense of what chorea is like. Readers can of course look at chorea, but it would be nice to have at least a sketchy description in the article. It isn't just simple twitches and jerks, it's a lot more complicated than that. User:looie496
Definitely need a comprehensive description of the chorea in the article somewhere, we might be able to use a less scientific reference for a more readable description ( the medical references are a little too clinical to form a mental image but will support this ref ). L∴V 00:28, 7 May 2009 (UTC)
If the intention was to describe chorea then its place is signs and symptoms; but references and rewriting are needed. On the other hand I am not completely sure on the comment regarding distribution of damage; since I do not think that the relationship location-symptoms is so straight-forward. Bests.--Garrondo (talk) 07:18, 7 May 2009 (UTC)
I was going beyond my level of knowledge there -- different parts of the striatum are associated with different motor behaviors, so the detailed symptoms pretty much are forced to depend on the distribution of damage; but I don't know the literature well enough to give sources to back that up. I won't object if this is removed. Looie496 (talk) 15:19, 7 May 2009 (UTC)

Bates book

First of all; after reading the epidemiology section of the book I do not think we can improve much the section on epidemiology of the article. Most studies and prevalence figures that appear in the book are area specific so there is no point in naming them. I believe the section is Ok now as it is.

Secondly: The book is cited several times in different sections, and to become a FA we would have to give page numbers. The best option would be to give chapter citations as I have done in epidemiology; instead of only one citation for all the book. Lee; you would have to look for the chapter for every time we use the book and format it into the citation; as I do not have access to it.

Bests. --Garrondo (talk) 13:28, 11 May 2009 (UTC)

...Will do, very busy at the mo, but hopefully will have some time to spare later this week, I need to look into citations of different pages from the same book, it seems a bit messy to have repeated citation entries in the reference section when it's just the page numbers changing , hopefully there's a way to have main info then subreferences for pages used, but it may be wishfull hopefullnes on my part. Good to know the epidemiology section is up to scratch according to the book. L∴V 13:39, 11 May 2009 (UTC)
As far as I know there are two possible ways of doing it: in social science wikipedia articles where a few books are used many times the most common thing is to create a citations section with only the author, title and page, and a second section with the full data on bibliography (See just as an example Structural history of the Roman military; featured in the main page this month). However I believe that for an article such as this one, with only a few books, and being scientific books with most times separate authors for each chapter it is better to cite the chapter with it is pages as part of a bigger collection (the book). Bests. --Garrondo (talk) 07:46, 13 May 2009 (UTC)
Thanks, I looked into short footnotes, but as it stands fine at the moment and I have referenced to chapter-wide - is that enough or do we need to go into exact pages? Another note: when I first started editing I used the Bates book to beef the whole article up, but then realised it needed these 'reference' things. Unfortunately I took the book and dereferenced the information the primary reference the book got it from :( So you see we ended up with a number of primary refs and little refs to the bates/secondary sources. L∴V 10:51, 15 May 2009 (UTC)
This is perfect. Same as we do not cite the exact page in an article we do not need to do it in a book. Regarding the use of the book for creating the whole article: there is no problem with that since we have already fixed it using the lancet article to check and reference any unreferenced or primary referenced statements and right now there are very few primary refs (and most are due to historical interest). I also want to say that you have done a great work in the history section. One improvement might be to add some info on Gorman and Waters descriptions as there is for Lund. Apart from that the section from my point of view is finished.Bests. --Garrondo (talk) 11:19, 15 May 2009 (UTC)
Sounds perfect.--Garrondo (talk) 14:00, 15 May 2009 (UTC)
Thankyou! I'm pretty happy with it, but I think the last two paragraphs aren't complete, missing explicit discovery of the repeat expansion and the last paragraph seems a bit 'rushed' ... 15:19, 15 May 2009 (UTC)

History

As this research became better known and accepted, the misdiagnosis of HD as alcoholism or manic depression reduced, and more appropriate care methods were applied, leading to a reduction in mortality due to starvation or dehydration.

This needs important back-up and has none...At no place we say that it was misdiagnosed with alcoholism (and I doubt it can ever be misdiagnosed with it since they have nothing in common) o manic depression. Additionally I also doubt that a correct diagnosis reduced mortality due to starvation or dehydration. Bests. --Garrondo (talk) 07:37, 15 May 2009 (UTC)

I have finally eliminated it for the moment.--Garrondo (talk) 08:04, 15 May 2009 (UTC)

I believe the misdiagnosis part came from the woodie guthrie article, but as you point out we need a more general ref than one case (if it was generally misdiagnosed that-is). Whilst reading through Bates - history I did notice that one of the earliest papers on treatment was focused on nutritional management, so the starvation/dehydration may have been a major factor but this situation may have improved as healthcare improved irrespective of HD being descibed/diagnosed.L∴V 10:32, 15 May 2009 (UTC)
It seems possible to me that chorea could have been misidentified as delirium tremens. Looie496 (talk) 15:48, 15 May 2009 (UTC)

Very important discovery

Although I'm generally against covering "news" in Wikipedia, it looks to me like the study described here, by Solomon Snyder's group at Johns Hopkins, is strong enough and important enough that it ought to be used in the article very soon. Looie496 (talk) 00:45, 6 June 2009 (UTC)

Amazing, a landmark discovery if they're correct! It does seem to fill out a few holes in our knowledge doesn't it ? The Johns Hopkins press release studies a protein call Rhes, that is found almost exclusively in the same areas that are damaged by HD, and interacts with the mHTT clumps, breaking them up and reportedly causing cell death. It pases my own intuite test (although I suspect there will be modifiers to the process) but I think we need to find/wait for the full study first before fully integrating it, but we could include it in reasearch or mention it as one of the potential interacting proteins. L∴V 10:33, 6 June 2009 (UTC)
Not sure if this is what you meant, but the paper itself is here. Looie496 (talk) 17:45, 6 June 2009 (UTC)
Well its all over the popular press now, I also see Nancy Wexler has commented saying something like it looks like a promising pathway for treatment. So how long do we wait for it to be peer reviewed in the journal I wonder? L∴V 09:54, 8 June 2009 (UTC)
There's a positive commentary in Nature now too, so I've gone ahead and added a couple of sentences to the Cellular changes section, while simplifying the material there a bit. Please check the validity of my edits. Looie496 (talk) 17:46, 11 June 2009 (UTC)

Lead

I think we need to simplify the lead a little bit, as it has to be the most accessible part of the article. Please let me know what you think of this version:

Huntington's disease, also known as Huntington's chorea, sometimes abbreviated as HD, is a neurodegenerative genetic disorder that is the most common genetic cause of abnormal repetitive movements. It is caused by a mutation in the Huntingtin gene, which normally provides the genetic code for the huntingtin protein. The mutation results in a different form of the protein, which gradually damages areas of the brain, although the exact way it does this is unknown. The first physical symptoms are usually noticed in patients between 35 and 44 years of age, but can begin at any age. The rare occasions when the disease begins before the age of 20 are classified as juvenile HD (also known as akinetic-rigid HD or Westphal variant HD), which progresses faster with slightly different symptoms. HD is much less common in people of Asian or African descent than in those of Western European. Genetic testing for HD has been possible since the discovery of the gene that causes the disease. The genetic test can be performed before the onset of symptoms and on embryos, raising heated ethical debates. Genetic counseling has developed to aid individuals address these issues and has become a model for other genetically dominant diseases.

Because it is inherited dominantly, an affected parent has a 50% chance of passing it to each child and the disease runs strongly in families, often affecting several generations. The exact way HD affects an individual varies, even between family members, but its symptoms progress similarly for most individuals. The earliest symptoms are a general lack of coordination and an unsteady gait. As the disease advances, uncoordinated, jerky body movements become more apparent, along with a decline in mental abilities and behavioral and psychiatric problems. Physical abilities are gradually impeded until coordinated movement becomes very difficult, and mental abilities generally decline into dementia. Although the disorder itself is not fatal, complications such as pneumonia, heart disease, and physical injury from falls reduce life expectancy to around twenty years after symptoms begin. There is no cure for HD, and full-time care is often required in the later stages of the disease, but there are emerging treatments to relieve some of its symptoms.

Lay organizations, first founded in the 1960s and increasing in number, have been working to increase public awareness, to provide support for individuals and their families, and to promote research. These organizations where instrumental in finding the gene in 1993. Since that time there have been important discoveries every few years and understanding of the disease is improving. Current research directions include determining the exact mechanism of the disease, improving animal models to expedite research, clinical trials of pharmaceuticals to treat symptoms or slow the progression of the disease, and studying procedures such as stem cell therapy with the goal of repairing damage caused by the disease.

I've also copyedited a bit. Awadewit (talk) 21:54, 30 July 2009 (UTC)

I've changed the first para hope thats OK ϢereSpielChequers 22:57, 30 July 2009 (UTC)

That's better, yes. Awadewit (talk) 22:59, 30 July 2009 (UTC)
Any readability improvement is a boon, the lead has developed organically and was more an accumulation of facts strung together rather than a carefully planned intro. A little copyed myself. My thoughts for important facets are; maybe keep the note about genetic counselling/testing being used as a model since this has an impact that affects other disorders, maybe we should expand the mechanism section slightly ( possibly include the very recent #Very_important_discovery to give the sense of progress in research). One more note - there is talk in Cryptic C62s first comment about leaving out refs for the lead, any thoughts ...?L∴V 11:21, 31 July 2009 (UTC)
Sounds great to me.--Garrondo (talk) 11:57, 31 July 2009 (UTC)
I've added a sentence on the counselling, but I'm not really the best person to expand the mechanism section - perhaps someone else could do that? There is generally no need to reference items in the lead, since the lead is supposed to be a summary of the article, where everything would be sourced. Awadewit (talk) 23:35, 31 July 2009 (UTC)
Thankyou and scratch the specifics of mechanism - which arent necessary in the intro. I am wondering about combining the last two paragraphs now. I think this could be incorporated into the article soon. L∴V 12:59, 1 August 2009 (UTC)
Aargh - got carried away..sorry! Have just split the third paragraph into the other three, added a couple of sentences and reworded others. Maybe a bit too much! Consider this a suggested edit and if it is too much revert to what it was keeping any bits you liked .. L∴V 14:46, 1 August 2009 (UTC)
I think it is fine. Does anyone else have any other improvements to suggest? Awadewit (talk) 18:01, 1 August 2009 (UTC)
Shall we paste this into the article? Awadewit (talk) 14:28, 2 August 2009 (UTC)
I can't see any major objects - can always be edited later. I was leaving the honour to yourself. L∴V 17:11, 2 August 2009 (UTC)
Done. Awadewit (talk) 17:20, 2 August 2009 (UTC)
I just did another copy-edit of the first paragraph, which I think had become a bit disjointed. Looie496 (talk) 18:12, 2 August 2009 (UTC)
I've taken out the dance part - that is not really essential information that needs to be in the lead. If you have any ideas about how to structure the lead to make it flow better, I'm all ears. I realize that the first paragraph in particular has a lot of topics, but I haven't been able to come up with a way to present the material in a more coherent manner. Awadewit (talk) 18:20, 2 August 2009 (UTC)
It seems okay to me as written now. I put in the "dance" part because I believe there is great value in giving the reader a "mental picture", and not one reader in a hundred will know what chorea is without clicking the link; but I won't push it. Looie496 (talk) 19:14, 2 August 2009 (UTC)
Currently 'abnormal repetitive movements' not quite right, how about 'random uncontrolled muscle contractions and postures' for starters ... L∴V 16:30, 4 August 2009 (UTC)

Comments from Cryptic C62

Here are some comments regarding the article's prose:

Resolved issues
  • "It named after the American physician George Huntington who accurately described it in 1872." A few things things: First, suggest adding "was" before "named". Second, in my experience, the names and professions of people are not usually preceded by articles. Instead of "the American physician George Huntington", just use "American physician George Huntington". Third, the use of "accurately described" seems a bit odd here. I think "first described" would make a more logical sentence.
    Have addressed - his description wasn't the first but I think it's covered. started on 2. but eyes and brain bleary, going into sleep mode! L∴V 23:41, 23 July 2009 (UTC)
  • "HD prevalence is up to 7 people in 100,000 (in populations of Western European inheritance), but can be much higher in localized regions." Suggest changing "HD prevalence" to "The prevalence of HD". The use of "up to" is somewhat misleading and confusing here because it is immediately followed by "but can be much higher". Suggest swapping "up to" with "approximately". Also, what is meant by "localized regions"? I'm not sure if it refers to regions with European inheritance or other regions around the world.
    As above the situation isn't as cut and dried without a fuller explanation, but have expanded a little. L∴V 12:20, 24 July 2009 (UTC)
  • "Physical symptoms can begin at any age, although the mean is 35 to 44 years of age." Mean is, in statistical terms, one value, not a range of numbers.
    Done: changed to have same words than later section.--Garrondo (talk) 13:52, 24 July 2009 (UTC)
  • "In 1993, genetic testing was made possible with the discovery of a single causal gene, the first non-sex-linked dominant disease gene to be found." As this is written, it implies that one single gene is used in all genetic tests! Suggest adding "for HD" or "for the disease" after "genetic testing".
    Done. Now is: genetic testing in HD was made possible with the discovery of a single causal gene for the disease--Garrondo (talk) 13:57, 24 July 2009 (UTC)
  • "Consequently, counseling for HD was developed and became a model for other genetically dominant disorders." Genetic counseling, yes? Suggest linking.
I am sorry, but I do not understand what you mean with your comment.--Garrondo (talk) 13:52, 24 July 2009 (UTC)
I think it was just to clarify and wikilink 'genetic counseling' - which is now done. L∴V 14:14, 24 July 2009 (UTC)
  • "The test can be performed before the onset of symptoms, at any age—even pre-birth" The meaning of "the test" isn't entirely clear since the previous sentence dealt with counseling, not testing. Suggest either rearranging this part of the paragraph or replacing "the test" with something a tad more descriptive.
    Simply changed to: The genetic test.--Garrondo (talk) 13:57, 24 July 2009 (UTC)
  • "it is inherited dominantly, so the offspring of an affected person have a 50% risk of suffering it" Somewhat informal. Suggested rewrite: "because it is inherited dominantly, an affected parent has a 50% chance of passing it to each child." or some such. I just try to avoid "so" where "because" will do and avoid "suffering" where possible.
    covered in following point. L∴V 11:02, 25 July 2009 (UTC)
  • "and an individual will often experience several generations of family members suffer from the disease in their lifetime." Somewhat odd. Suggest rewriting the sentence to focus on the family/generations and leaving out the individual/lifetime.
    Have changed to Because it is inherited dominantly, an affected parent has a 50% chance of passing it to each child and the disease runs strongly in families, often affecting several generations. L∴V 11:00, 25 July 2009 (UTC)
  • "but there is a characteristic progression." I'm not really sure what this means. Is "characteristic progression" a standard medical term? Or does it simply mean that the progression of the disease is generally constant across all afflicted persons? If the latter, I suggest rewriting to "but its symptoms progress similarly for most afflicted persons" or something similar.
    Have applied left out 'afflicted' as is implied by context. L∴V 11:00, 25 July 2009 (UTC)
  • "jerky body movements become more apparent, as does a decline in mental abilities and behavioral and psychiatric problems." It seems odd to suggest that mental abilities/psychiatric problems could be "apparent", as this suggests that they are somehow physically manifested. Suggestion: "jerky body movements become more apparent, along with a decline in mental abilities and behavioral and psychiatric problems." Alternatively, consider splitting the mental/psych part off into a separate sentence.
    see below
  • "Physical abilities are gradually impeded." The brevity of this sentence makes it somewhat useless and redundant. Consider listing examples of the affected physical abilities.
    see below
  • "Mental abilities generally decline into dementia, requiring full-time care in the later stages of the disease." I instinctively want to add "often" after the comma. It doesn't seem quite right to imply that all affected persons require full-time care.
    Have made an attempt at combining the above points with Physical abilities are gradually impeded until coordinated movement becomes very difficult, and mental abilities generally decline into [Dementia dementia], often requiring an individual to seek full-time care in the later stages of the disease, but might have problems of its own .. L∴V 11:15, 25 July 2009 (UTC).
  • "Although the disorder itself is not fatal, complications reduce life expectancy to around twenty years after onset of symptoms." What sort of complications? Also, suggest adding "the" before "onset".
    Have added the examples of 'pneumonia, heart disease, physical injury from falls' and end of sentence to 'after symptoms begin'. L∴V 13:16, 26 July 2009 (UTC)
  • "and studying procedures such as stem cell therapy with a view to repairing damage caused by the disease" I'm not sure what "with a view to" means. Perhaps "with the goal of" would be better.
    Done.--Garrondo (talk) 07:09, 27 July 2009 (UTC)
  • "Almost everyone with Huntington's disease eventually exhibits all physical symptoms" The phrase "all physical symptoms" implies that there is some list of physical symptoms that the reader should already be aware of. Or that the cognitive/personality symptoms eventually subside, leaving only physical symptoms.
    Changed to: eventually exhibits similar physical symptoms. Better? --Garrondo (talk) 07:09, 27 July 2009 (UTC)
  • "These are signs that the system in the brain that is responsible for movement is affected." This sentence seems a bit abrupt and, at least to me, somewhat obvious. I suggest either deleting it or merging it with the previous sentence.
    Eliminated.--Garrondo (talk) 07:09, 27 July 2009 (UTC)
  • "Psychomotor functions are increasingly impaired" I suggest switching "are" to "become" both for the sake of consistency and for formality.
    Done.--Garrondo (talk) 07:09, 27 July 2009 (UTC)
  • "Psychomotor functions are increasingly impaired, such that any action that requires muscle control is affected, resulting in physical instability, abnormal facial expression, and difficulties chewing, swallowing and speaking." This is a rather long sentence, and the large number of commas makes it somewhat difficult to follow. Suggest breaking it into two sentences, perhaps after "control is affected".
    Changed to: ...that requires muscle control is affected. Common consequences are physical instability....--Garrondo (talk) 07:09, 27 July 2009 (UTC)
  • Table: The order in which the symptoms are presented in the table are unclear. I've gone ahead and arranged it by the first percentage number.
  • "Possible neuropsychiatric manifestations are anxiety, depression, a reduced display of emotions (blunted affect), egocentrism, aggression, and compulsive behavior, which can cause or worsen addictions, including alcoholism, gambling, and hypersexuality." The use of "possible" at the beginning may imply to some readers that it isn't known which ones are related to HD. Suggested rewording: "Reported neuropsychiatric manifestations include". Also, it is unclear whether it is compulsive behavior alone that causes the addictions or all of the items in the list of manifestations. If it is just the compulsivity, suggest adding "the latter of which".
  • "All humans have the Huntingtin gene, which provides the genetic code to produce the protein huntingtin, abbreviated to HTT." Which is abbreviated to HTT, the gene or the protein? Suggest removing "abbreviated to HTT" and adding "(HTT)" after the relevant phrase.
    Have added the acronyms directly after gene and protein. L∴V 14:59, 29 July 2009 (UTC)
  • "lay organizations have increased in number" What are "lay organizations"? Perhaps a typo?
    changed to support and research, lay s sort of a self-help. non-professional bodie - but many HD organisations have professionals involved. L∴V 14:59, 29 July 2009 (UTC)
    Looking at the lead, this phrase is the same as it was before. --Cryptic C62 · Talk 05:03, 30 July 2009 (UTC)
    Ah I changed the one deeper in the article :(! Have changed the lead section, and I just remembered I was going to write the 'lay organisation' article User:Leevanjackson/layorganisation, maybe I should since 'support' etc doesn't really cover them aptly... L∴V 09:49, 30 July 2009 (UTC)
  • "HTT contains a sequence of three DNA bases—cytosine-adenine-guanine (CAG)—repeated multiple times" Six consecutive terms are wikilinked here. Suggest unlinking cytosine, adenine, and guanine. Also suggest merging DNA bases into one link. Spelling out the three nucleobases might not even be necessary so long as nucleobase is linked to.
  • Done: I have finally left the spelling of the three nucleobases since I think they can be clarifying for those non versed in biology to understand what is the origin of the CAG name; but I have delinked DNA and the three bases.--Garrondo (talk) 13:26, 30 July 2009 (UTC)
  • "This altered form, called mHTT (mutant HTT), increases the decay rate of medium spiny neurons, affecting regions of the brain according to their reliance on them for normal functioning." First, is there something to which "medium spiny neurons" can be linked? Someone who is unfamiliar with neurons may just see that as a barrage of technical terms and not know what to search for. Second, the last clause in this sentence is somewhat confusing. Consider replacing it with examples: "affecting such regions of the brain as..."
  • Have wikilinked and changed to: 'This altered form, called mHTT (mutant HTT), increases the decay rate of certain types of neuron. Regions of the brain have differing amounts and reliance on these type of neurons, and are affected accordingly.' L∴V 16:15, 30 July 2009 (UTC)
  • "with much later onset and slower progression of symptoms, which are less likely to occur in a person's normal lifetime" What does this mean? I interpret it as saying that people usually die of other causes before the symptoms even become apparent.
  • The prose here and the table don't entirely match up. The table mentions full penetrance but not juvenile HD, whereas the text mentions juvenile HD but not full penetrance.
  • Ref 1 (Walker 2007) is used nearly 100 times. This poses a problem for readers who click the [1] but can't figure out which letter to click to navigate back to the text they were reading. It also looks silly. Suggest splitting into separate refs using individual page numbers. This will also make it easier for readers to verify individual claims rather than having to trawl through the entire 10-page article.
    I do not agree: the truth is that it is a short article (as you say; only 10 pages); probably shorter than most articles used as reference. It would be the first time I see splitting such a short article into pages. The only problem is the one you say...going back; and I feel it is not enough to change the reference style.--Garrondo (talk) 13:50, 24 July 2009 (UTC)
    If we do decide to go ahead (gulp) might it be better to use the section titles (as chapters) rather than page numbers? L∴V 14:35, 24 July 2009 (UTC)
    That seems reasonable to me. The other possibility would be to try to delete some instances of Ref 1 and, if necessary, implement others. With nearly 100 distinct sources, surely much of the material presented in Walker 2007 is covered by source you've already used. --Cryptic C62 · Talk 17:44, 24 July 2009 (UTC)
    This would be some task but I'd be happy to do it if it's warranted, am currently focused addressing prose comments as they come in...maybe another opinion required? L∴V 13:16, 26 July 2009 (UTC)
    A quick way to help would be to remove the citations from the lead section. The lead should only contain information which is presented elsewhere in the article, and thus does not need citations. Also, after skimming over the article, I've noticed that nearly every sentence is followed by a citation. In my experience, this isn't necessary, especially when several consecutive sentences are covered by the same source, such as the 3rd paragraph of Signs and symptoms. --Cryptic C62 · Talk 02:26, 27 July 2009 (UTC)
    I would agree to remove citations from lead, but not to remove a citation after every sentence. I know one for paragraph would be enough to become a FAC; but a problem of wikipedia is that it's very easy to insert a sentence in a par not supported by the ref and afterwards it is really hard to verify which ones are supported and which ones are not. This is much harder to do when each sentence has its reference. Therefore I really believe that giving a citation after each sentence improves verifiability of articles which from my point of view is much more important than the stylistic improvement you propose (making it easier to go back from the refs section).--Garrondo (talk) 07:09, 27 July 2009 (UTC)
    <Undent> Alas there is no parameter in Template:Cite journal for a section/chapter title so we could only split by page. I also agree about having the ref per fact sentence - although am more lenient when a few sentences lead on from one another with the same factual base. L∴V 17:05, 30 July 2009 (UTC)
    I think I've gone cross eyed! OK I have reduced the lancet references to specific pages, most double checked as doing so although a couple may be a page out (when the section splits between pages). Next up the lead refs - only one is not used in rest of article (...'first sex-linked'...) which needs to check is in the details. I recommend listing the lancet refs at the end of the lead so that they appear in references in order and most of the lead can be derived from these, covering all bases - or maybe I can look into a way of listing them invisibly...? One more thing thinking of changeing the refnames from 'lancetseminarxxx' to 'lsxxx' to shorten article length and might help readability is that ok? L∴V 19:49, 30 July 2009 (UTC)
    Seems good to me. --Cryptic C62 · Talk 17:04, 31 July 2009 (UTC)
  • "Trinucleotide CAG repeats over 28 are unstable during replication and this instability increases with the number of repeats present." This sentence mentions 28, but the previous section had 27 as the borderline number.
    I have fixed all occurences of repeat numbers to the ones given in lancet, the problem stems from refs sometimes using 'more than', other times 'xx or more' and sometimes something else! L∴V 18:24, 31 July 2009 (UTC)
  • "The brain is greatly affected, with damage initially in the striatum, and then later, as the disease progresses, in other areas as well" This sentence should have a verb after/instead of "initially". How about "appearing" or "originating"?
    Good points! I didn't quite like those line so have changed to: 'The mutated mHTT proteins behavior is not completely understood, but it is toxic to certain types of cells, particularly in the brain. Damage mainly occurs in the striatum, but as the disease progresses, other areas of the brain are also significantly affected.' L∴V 16:36, 1 August 2009 (UTC)
  • "usually starting with symptoms that affect the planning and modulation of movement" Correct me if I'm wrong, but my understanding of "symptom" is that it refers to the actual effect of the disease, not to that which causes those effects. In this case, the deteriorated planning/modulation of movement would not be caused by the symptom, they would be the symptom.
    Once again have altered sentence... 'As the damage accumulates, symptoms associated with the functions of these brain areas appear. Planning and modulating movement are the main functions of the striatum, and difficulties with these are initial symptoms.' L∴V 16:45, 1 August 2009 (UTC)
  • "Proteins it interacts with are involved" Awkward wording. Suggest rearranging to "It interacts with proteins which are involved".
    Thanks, done. L∴V 16:56, 1 August 2009 (UTC)
  • "Its function in animal models is better known" I'm a bit puzzled by the use of "models" in this and the sentence that follows it. I know of two interpretations of "model": the first is a synthetic physical representation of another physical entity, but it seems highly unlikely that scientists would make a model of an animal complete with proteins! The second is a simplified conceptual or visual representation of a complex system, but this is usually used for systems which are either very large or very difficult to accurately study, neither of which seem to apply here.
    Hmmm, will look into, but might need a thinking hat on. They do effectively take the mouse and modify to have human gene/protein characteristics, but the terminology might be suited to stay within research and labs. Perhaps genetically modified animal would be better.L∴V 16:56, 1 August 2009 (UTC)
    How about 'In animals genetically modified to exhibit HD, several functions of HTT have been found.[3] In these animals, HTT is important for ...' I think 'model' is used later in article but it is more in context. L∴V 17:11, 1 August 2009 (UTC)
  • "HTT is important for embryonic development, its absence being related to embryonic death." Improper sentence structure. Possible alternatives: "HTT is important for embryonic development, as its absence is related to embryonic death." or "HTT is important for embryonic development, and its absence is related to embryonic death."
    Thanks - chose the 'as' version as that was the references gist.L∴V 16:56, 1 August 2009 (UTC)
  • "a protein which protects neurons and regulates the neurogenesis of new ones." Neurogenesis refers specifically to the creating of new neurons. As such, "of new ones" is redundant. Suggest replacing "the neurogenesis of new ones" to "neurogenesis".
    Have changed to 'their creation during neurogenesis' to keep readability L∴V 16:56, 1 August 2009 (UTC)
  • Image: I looked at the purple/orange diagram (which you modified) and some of the articles that link to it, and I'm a bit puzzled. Huntington's disease says that the purple and orange make up the striatum, making no distinction between the colors. The file page itself says the purple is the caudate and the orange is the putamen, which together make up the striatum. However, there is also a note on the file page which says that you modified it to highlight the caudate and the thalamus. Putamen says that the purple represents both the caudate and the putamen while the orange is the thalamus. So which one is correct?
    Wow; this is a great mistake in our article and I had not seen it. Caption has changed over time and now it is uncorrect. The putamen description is correct. This image [8] (it is probably copyrighted) may serve to further clarify. I am going to change caption. Thanks a lot.--Garrondo (talk) 09:10, 3 August 2009 (UTC)
    I have changed the caption, but I am not able to change the file description. I'll try later.Bests.--Garrondo (talk) 09:14, 3 August 2009 (UTC)
    Have changed file description. L∴V 21:47, 3 August 2009 (UTC)
  • "Regarding motor function the basal ganglia ordinarily inhibit a large number of circuits that generate specific movements." I don't think the phrase "Regarding motor function" is necessary here. If it is included, it should be followed by a comma.
  • "In HD, damage to the basal ganglia causes behaviors to be released in an erratic and uncontrollable way, or to be terminated before they have been completed." After reading this sentence, I had a eureka moment: "Aha! So that's what causes the jerky movements in HD victims." However, not all readers will make the connection between this discussion of the brain and the noticeable symptoms. I recommend adding a sentence or two to bridge this gap.
    I have reworded and clarified a little, still might need some work, like pos splitting inhibition and reinstatement consequences: 'The basal ganglia ordinarily inhibit a large number of circuits that generate specific movements. To initiate a particular movement, the cerebral cortex sends a signal to the basal ganglia that causes the inhibition to be released. Damage to the basal ganglia can cause the release or reinstatement of the inhibitions to be erratic and uncontrolled, which results in an awkward start to motion or motions to be unintentionally initiated, or a motion to be halted before, or beyond, its intended completion. In HD, the accumulating damage to this area causes the characteristic chorea.' L∴V 22:17, 3 August 2009 (UTC)
  • Caption: "A montage of three images, using a specially modified microscope, of a neuron with inclusion (stained orange) caused by HD, image width 250 µm" I think this caption gives more information than is really necessary. Suggestion: "A neuron with inclusion (stained orange) caused by HD"
    It was changed from a previous version with similar information to the one you propose by the comments from a FAC reviewer who asked for the current details, so I would say that unless anybody else gives their input one way or the other (I do not really have a position) I'll leave it as it is.--Garrondo (talk) 08:59, 3 August 2009 (UTC)
    I suppose we could change the start to 'A microscope image of...' as the other i'montage' and 'modified' is a little superflous? L∴V 22:33, 3 August 2009 (UTC)
    I support the solution that Lee has proposed. --Cryptic C62 · Talk 19:13, 4 August 2009 (UTC)
    Applied. L∴V 23:17, 5 August 2009 (UTC)
  • "Genetic testing can confirm if an individual carries an expanded copy of the gene, even before onset of symptoms, and can also be used for embryonic testing." First, suggest replacing "the gene" with "HTT", as not everyone will have read the Genetics section. Second, what exactly can be used for embryonic testing? As this sentence reads now, it implies that the gene can be used for embryonic testing, which doesn't make any sense.
    changed to : 'Genetic testing is used to confirm a physical diagnosis if there is no family history of HD. Even before onset of symptoms, genetic testing can confirm if an individual or embryo carries an expanded copy of the of the HTT gene that causes the disease. ' just in case they missed that bit too.. L∴V 23:17, 5 August 2009 (UTC)
  • "With the appearance of symptoms HD can be diagnosed clinically." This sentence seems very terse, and I'm not sure what point it is trying to get across. Perhaps it should contain a link to Medical diagnosis? It might also help to reaffirm that these symptoms are unique to HD.
    changed to 'Following the appearance of physical symptoms specific to the disease, medical diagnosis of its onset can be made using a physical assessment.' L∴V 23:17, 5 August 2009 (UTC)
    Hmm, might be better if you flip the two clauses: "Medical diagnosis of HD can be made following the appearance of physical symptoms specific to the disease". --Cryptic C62 · Talk 01:46, 6 August 2009 (UTC)
    'Medical diagnosis of the onset of HD can be ...' Trying to make sure the defnition of 'onset' is clear. L∴V 00:08, 7 August 2009 (UTC)
  • "Genetic counseling is provided" Whereas the previous sentence used "can", this sentence uses "is", which implies that all people with HD receive genetic counseling, which is not true. Suggest rewriting this sentence to reflect the possibility of genetic counseling.
    Have split the sentence too .. 'Genetic counseling is available to provide advice and guidance throughout the testing procedure, including the consideration of the implications of having a confirmed diagnosis. These implications include the impact on an individuals pyschology, career, family planning decisions, and friends and family.'L∴V 23:17, 5 August 2009 (UTC)
    "including the consideration of the implications of having a confirmed diagnosis" I don't think "the consideration of" or "having" are necessary: "including the implications of a confirmed diagnosis" --Cryptic C62 · Talk 01:46, 6 August 2009 (UTC)
    Not sure if it read correctly so have changed to 'testing procedure, and on the implications of a confirmed diagnosis.' L∴V 00:08, 7 August 2009 (UTC)
  • "These implications include the impact on an individual's psychology, career, family planning decisions, and friends and family." Suggest replacing "friends and family" with "interpersonal relations" to avoid using "family" twice.
    Didn't quite cover implications for relatives own diagnosis, have changed to 'relatives and relationships' though?. L∴V 20:58, 9 August 2009 (UTC)
  • "Although the initial motivation of individuals at risk of inheriting HD for having a pre-symptomatic test is strong, upon consideration, only a minority choose to do so." What percentage choose to have a pre-symptomatic test? "a minority" could mean anything from ~0% to 49%.
    Was contemplating 'small minority' but have gone for five percent. L∴V 23:17, 5 August 2009 (UTC)
    Precision ftw! After looking over it again, I think the first chunk of this sentence is a little too wordy. How about: "Despite the benefits of pre-symptomatic testing, only 5% of those at risk of inheriting HD choose to do so."
    Agree, but not sure about the wording as 'benefits', thinking. L∴V 20:58, 9 August 2009 (UTC)
    Ok, used same wording but 'availability' rather than 'benefits'. L∴V 21:45, 9 August 2009 (UTC)
  • "Medical imaging such as computerized tomography (CT) or magnetic resonance imaging (MRI) only show a visible volume reduction in the striatum in advanced stages." It isn't clear what "only" refers to. Do MRIs show a visible volume reduction in the striatum only in advanced stages? Or do MRIs in advanced stages show a visible volume reduction only in the striatum?
    Have simplified, don't think specifying striatum was needed, to 'Medical imaging, such as computerized tomography (CT) and magnetic resonance imaging (MRI), only shows a visible volume reduction in the advanced stages of the disease.' L∴V 21:10, 9 August 2009 (UTC)
    Is there anything to which "volume reduction" can be linked to make this a bit clearer? --Cryptic C62 · Talk 03:56, 11 August 2009 (UTC)
    Have changed to Cerebral atrophy and wikilinked.L∴V 23:26, 11 August 2009 (UTC)
  • "A positive result is not considered a diagnosis, since it may be obtained decades before onset of symptoms." My intuition is that "onset" should be preceded by "the". It seems to read much more naturally. However, "onset" is used without "the" many many times in the article. Is there some specific reason why it is written this way throughout the article?
    I believe it is the result of the references using 'onset' as a concept (since it is the onset of physical symptoms classed as onset of the disease', e.g Age of onset. For the accessibility for the article I see no reason not to add 'the' where possible. L∴V 12:01, 15 August 2009 (UTC)
    I have changed a few, reworded a couple of others, but left a number where it is in reference to 'onset of the disease' itself, may require more work. L∴V 13:32, 15 August 2009 (UTC)
  • "Disclosure and confidentiality are emphasized, as individuals have the right to decide when and how to reveal their results." I don't think this sentence is necessary. It reads more like an HD pamphlet than an encyclopedia article.
    I believe it is an important point, maybe misplaced and misworded .. have moved to ethics section as 'As individuals have the right to decide when and how to reveal their results, many guidelines and testing procedures have strict procedures for disclosure and confidentiality' L∴V 18:17, 15 August 2009 (UTC)
  • "Preimplantation genetic diagnosis can be used after in vitro fertilisation to choose an embryo that does not carry the affected gene is implanted and will therefore not be at risk of HD." Unless I'm misreading this, it doesn't appear that this sentence makes grammatical sense, specifically "is implanted". What is implanted?
    reworded to 'Embryos produced using in vitro fertilisation may be genetically tested for HD using Preimplantation genetic diagnosis. This information can then be used to ensure embryos with affected HTT genes are not implanted, and therefore any offspring will not inherit the disease' L∴V 17:30, 15 August 2009 (UTC)
  • "It is possible to obtain a prenatal diagnosis for an embryo in the womb, which permits the option of abortion to prevent the disease from being inherited." It is unclear what "permits" means here. Does it mean that such a diagnosis has implications on the legality of the abortion? If so, this should specify the jurisdictions in which it is relevant. If not, this should be rewritten to avoid implying such a connection.
    I don't think the abortion part was necessary - maybe could be covered in ethics, so have removed, added fetus to prenatal testing. L∴V 17:30, 15 August 2009 (UTC)
  • "In a person with typical symptoms, and a family history of the disease, diagnosis is usually straightforward." This section should make clearer what a differential diagnosis is. How is it different from a clinical diagnosis?
    seebelow
  • "Of all the genetic disorders that cause chorea, ninety percent are attributable to HD" This implies that there are many many distinct genetic disorders which are collectively referred to as HD. Is this true? As far as I can remember, nothing else in the article implies this.
    seebelow
  • "If genetic testing for HD is negative, the remaining ten percent of causes should be considered." This is an encyclopedia article, not an advice column. Suggest rewriting this sentence to avoid the use of "should".
    seebelow
  • "The causes of most of these HDL diseases are unknown, but those that are have been found" Those that are what? Unless I've misinterpreted this, suggest rewriting to "The causes of most of these HDL diseases are unknown, but those with known causes have been found"
    Ended up rewriting a bit .. 'Although HD accounts for ninety percent of the cases of chorea caused by genetic disorders, and an observational diagnosis for someone with typical symptoms and a family history of the disease is usually correct, a genetic test is required to rule out other disorders. Most of these other disorders are collectively labelled HD-like (HDL). The causes of most of these HDL diseases are unknown, but those with known causes are due to mutations in ...' think it's a little better now... L∴V 17:30, 15 August 2009 (UTC)
  • "There is no cure for HD, but there are treatments available that offer some symptomatic benefit and are palliative in nature." Language needs to be simplified. What does "symptomatic benefit" mean? What is "palliative"?
    changed to 'available to reduce the severity of some of its symptoms'
  • "Tetrabenazine, an orphan drug," This is the only instance of "orphan" in the entire article. I don't think it makes sense to refer to a drug as an orphan without previously referring to the disease as an orphan. Suggest either dropping this clause or stating that HD is an orphan disease somewhere else in the article.
    explained to 'developed specifically to reduce the chorea in HD,'
  • "is useful in the reduction of chorea" Seems a bit informal and promotional. Suggest rewriting to "developed to reduce the effects of chorea" or some such.
see above
  • "Hypokinesia and rigidity can be treated with antiparkinsonian drugs, and myoclonic hyperkinesia with valproic acid." As this is unwritten, it is unclear whether "myoclonic hyperkinesia with valproic acid" is a drug or if myoclonic hyperkinesia is a symptom and valproic acid is the treatment.
    added 'can be treated with' to disambiguate
  • "Because a child of a parent with HD has a 50% chance of inheriting the condition, there is a strong motivation to resolve the uncertainty" Very vague wording at the end. What does it mean to "resolve the uncertainty"?
    how about 'Because there is a 50% chance of inheriting the condition, there is a strong motivation to seek a diagnosis.' L∴V 21:10, 9 August 2009 (UTC)
    "Because there is a 50% chance of inheriting the condition, there is a strong motivation to seek a diagnosis." This is a bit too vague now. If someone skips to the Genetic section and is not familiar with genetic inheritance, they'll be extremely misled by this statement. Also, this can't always be true. Suppose one parent has a homozygous dominant genotype: their child then has a 100% chance of inheriting the disease. Or am I misinterpreting something? --Cryptic C62 · Talk 03:56, 11 August 2009 (UTC)
    I am wondering if the sentence is necessary - Maybe the section should stick to technical details and leave the whys and wherfores to other sections more apt ? L∴V 23:30, 11 August 2009 (UTC)
    Perhaps, but the 50% bit is mentioned throughout the article, so that's still a concern of mine. One parent with a homozygous dominant genotype would be 100%, two parents with heterozygous genotypes would be 75%. --Cryptic C62 · Talk 01:33, 13 August 2009 (UTC)
    True, maybe this should be explained in inheritance section and maybe change other uses to 'strong inheritance' or 'dominantly inherited'? L∴V 12:01, 15 August 2009 (UTC)
    That sounds like a good solution to me. --Cryptic C62 · Talk 02:16, 16 August 2009 (UTC)
    added/modified 'Offspring of an individual who has two affected genes will inherit one of them and therefore definitely inherit the disease. Offspring where both parents have one affected gene have a 75% chance of inheriting HD, including a 25% chance of inheriting two affected genes. Identical twins, who have inherited the same affected gene, typically have differing ages of onset and symptoms.' To inheritance section. L∴V 12:52, 17 August 2009 (UTC)
    Genetic diagnosis now reads 'Because HD is dominant, there is a strong motivation for individuals who are at risk of inheriting it to seek a diagnosis.' need to check other uses of '50%' L∴V 12:52, 17 August 2009 (UTC)
    Ok - the direct uses of 50% remain in the lead and intro paragraphs, but I don't believe it is worth complicating these for the rare cases, which are of course explained in the inheritance section. L∴V 13:14, 17 August 2009 (UTC)
  • "(which reveals a parent is carrying an affected gene and that siblings are at risk of inheriting it)" The meaning of this parenthetical comment isn't very clear, and the meaning that I interpret doesn't seem correct. If a person has a positive result, that doesn't necessarily mean their parent would have a positive result (anticipation phenomenon).
    True, but those cases are rare, have changed to '(which usually means one of the parents also has an affected gene and that the individuals siblings will also be at risk of inheriting the disease)'. I don't like this parentheses bit, but upon reading this section, it all seems a bit bitty, will look back at it once I've addressed other points... L∴V 16:18, 15 August 2009 (UTC)
    I think that makes the parenthetical bit too long. I suggest rearranging the sentence: "Other factors taken into account when testing is being considered include the possibility of discrimination and the implications of a positive result, which usually means one of the parents also has an affected gene and that the individual's siblings will also be at risk of inheriting the disease."
    Done ( with a couple of mods) L∴V 13:23, 17 August 2009 (UTC)
  • "Selective serotonin reuptake inhibitors and mirtazapine for depression, and atypical antipsychotic drugs for psychosis and behavioural problems have been recommended" It's easier to digest a sentence if the verb is closer to the beginning. Suggested rewrite: "Selective serotonin reuptake inhibitors and mirtazapine have been recommended for depression, while atypical antipsychotic drugs are recommended for psychosis and behavioural problems" or some such.
    Done? L∴V 11:54, 16 August 2009 (UTC)
  • "Counseling and guidelines on the use of genetic testing for HD have become models for other genetic disorders" I think this sentence would benefit from the addition of examples. Which genetic disorders?
    Done.--Garrondo (talk) 13:34, 17 August 2009 (UTC)
    Good, but why is breast cancer on the list? According to its article, it has a variety of risk factors. Suggest either excluding breast cancer from this list or changing "genetic disorders" to something less specific. --Cryptic C62 · Talk 01:43, 19 August 2009 (UTC)
    Well... I simply copied it from the ref and it does not give more explanation: I suppose there will be some genetically inherited subgroups of the disease. Any ideas on how to reworded it?.--Garrondo (talk) 08:00, 19 August 2009 (UTC)
    Reworded to '... for other genetic illnesses such as polycystic kidney disease or Alzheimer's disease, and for genes that increase susceptibility for diseases such as breast cancer.' L∴V 23:02, 19 August 2009 (UTC)
    Since few cases of Alzheimer's disease are genetic but at the same time there is a gene that increases susceptibility I am not sure this is correct: I would say familial AD; since it is probably the most similar case to HD.--Garrondo (talk) 07:37, 20 August 2009 (UTC)
    Done my own proposal.--Garrondo (talk) 07:42, 20 August 2009 (UTC)
    I think it would be much simpler if "genetic" were removed from "other genetic illnesses". --Cryptic C62 · Talk 04:44, 24 August 2009 (UTC)
    No way, since references talk about genetic illnesses. I have reworded to: Presymptomatic testing for HD has also influenced testing for other illnesses with genetic variants such as polycystic kidney disease, familiar Alzheimer's disease and breast cancer.[1] Specifically regarding breast cancer from the wikipedia article: No cause is known for 95% of breast cancer cases, while approximately 5% of new breast cancers are attributable to hereditary syndromes.[28] In particular, carriers of the breast cancer susceptibility genes, BRCA1 and BRCA2, are at a 30-40% increased risk for breast and ovarian cancer, depending on in which portion of the protein the mutation occurs.--Garrondo (talk) 13:47, 24 August 2009 (UTC)
  • "Nutrition management is important." This sentence should mention HD. Also, at what stage(s) is nutrition management important?
    have incorporated into weight loss sentence.L∴V 22:32, 24 August 2009 (UTC)
  • "Weight loss and eating difficulties due to dysphagia, as well as difficulty getting food into the mouth due to lack of muscle coordination, are common as the disease advances." I don't it's really necessary to elaborate on the second point. Suggest shortening: "Weight loss and eating difficulties due to dysphagia and other muscle discoordination are common as the disease advances."
    Much better wording, thanks. Have modified by incorporating the nutrition management point into it (seems better context) L∴V 22:32, 24 August 2009 (UTC)
  • In reference to you previous point about increased chances of inheritance in heterzygous case. An anon editor added this info into the lead (end 1st paragraph), I modified into simpler wording as thats two for ... is this new addition and its wording suitable for intro ? L∴V 23:00, 24 August 2009 (UTC)
    Looks good to me. --Cryptic C62 · Talk 00:20, 26 August 2009 (UTC)
  • "The age of onset decreases, and the rate of progression of symptoms increases, with the length of the trinucleotide repeat" Awkward construction. Suggest moving the final clause to the beginning: "A longer trinucleotide repeat decreases the age of onset and increases the rate of progression of symptoms" or some such.
    True, have incorporated and expanded. L∴V 00:58, 27 August 2009 (UTC)
  • "Individuals with greater than approximately 60 CAG repeats often develop juvenile Huntington's disease." It isn't clear to me how this sentence relates to the rest of the paragraph or this section.
    Have rejigged as an expansion of previous point. L∴V 00:58, 27 August 2009 (UTC)
  • "The largest risk is pneumonia, which is the cause of one-third of deaths" Slight ambiguity, as this might mean that pneumonia causes one-third of all deaths. Suggested rewrite: "The largest risk is pneumonia, which is the cause of death of one-third of those with HD" or some such.
    have done. L∴V 00:58, 27 August 2009 (UTC)
  • "As the disease progresses caregiving becomes increasingly important, and should be carefully managed." Reads like a brochure. Perhaps instead of stating the importance of caregiving, this introductory paragraph should briefly explain the different aspects of caregiving.
    Have changed to 'As the disease progresses and a persons ability to tend to their own needs reduces, carefully managed multidisciplinary caregiving becomes increasingly necessary' to attempt to debrochure. I think we need to follow with a section akin to Alzheimer's_disease#Caregiving section? I 've had a few searches for suitable links to 'carer' 'care worker' etc but it is weak area of WP. There is a 20 page section of the Bates book that we could use ... May have to wait a until my business has reduced but I'll get to it asap. L∴V 23:45, 19 August 2009 (UTC)
    I assume you've crossed out too much and/or agree that the section I've popinted out would be invaluable...? L∴V 23:08, 2 September 2009 (UTC)
  • "however more studies on the efficacy of these and other treatments are needed." Not sure what "efficacy" refers to here. Unless there is some ongoing or upcoming research that can be elaborated upon, I suggest scrapping this clause altogether.
    Have moved to intro paragraph as '. For many of these treatments, comprehensive clinical trials to confirm their effectiveness in treating symptoms of HD specifically are incomplete.' There are about 13 in various stages of clinical trial at a quick glance ([9]) some are covered in the research directions section, not sure about non-specific drugs. I think it's important to keep the caveat in but do you think it needs expanding? L∴V 11:54, 16 August 2009 (UTC)
    Here's how I see it: With just one ref, this is really just the speculation and opinion of one researcher. If you were to add multiple refs to make it more definitive, it would deserve to be expanded upon. --Cryptic C62 · Talk 20:58, 16 August 2009 (UTC)
    Sourcing is not a matter of quantity: it is enough to be said by a single high quality review as the lancet one. Regarding expansion: all sections could be expanded; and probably will in the future in secondary articles, but sources do not give more weight to this matter than we do; so per WP:weight and WP:Summary style I believe they are ok right now.--Garrondo (talk) 13:50, 17 August 2009 (UTC)
    "more studies on the efficacy of these and other treatments are needed." This is not a fact. It is an opinion. I am suggesting that you either: expand the sentence to make this distinction clearer; or find other references from different authors to back it up. --Cryptic C62 · Talk 01:43, 19 August 2009 (UTC)
    So how about something like, '... according to 'the Lancet' more studies are needed' suggest tagging onto the end of my rewording as the trials being in various stages and incomplete is verifiable so we get 'For many of these treatments, comprehensive clinical trials to confirm their effectiveness in treating symptoms of HD specifically are incomplete and according to 'the Lancet' more studies are needed.'  ? L∴V 00:09, 20 August 2009 (UTC)
    I still feel that it is better to leave it as it is. It is true that it is an opinion; but an opinion from an expert in a very high quality review; and also a very reasonable one, so for me it is enough to include it in our article. Nevertheless attribution may be a solution, although not the journal but to the author. How about "experts believe that more...". I suppose that other reviews expressing the same thought won't be difficult to find.--Garrondo (talk) 09:03, 20 August 2009 (UTC)
    Yes, I think attribution would work here, though I would avoid making sweeping statements such as "experts believe" until/unless other reviews can be found. --Cryptic C62 · Talk 04:44, 24 August 2009 (UTC)
    The conclusion section from Bates/Harper/Jones book reads 'The experimental therapeutics of HD has a long way to go in developing effective [...] treatments. These therapeutics will only be capable of assessment in the light of longitudal clinical studies of the type described above [ studies to map progression of untreated HD ]. The quantum advances un understanding the aetiology and pathogenesis of HD and the steady, incremental gains being achieved in clinical trials hold promise for [treating HD].' I think this reads as support for the statement. L∴V 22:49, 24 August 2009 (UTC)
    I am unclear if we require more references? L∴V 23:08, 2 September 2009 (UTC)
  • "People who have inherited or are at risk of inheriting HD and their families often benefit from counseling." Is this all that has to be said about HD counseling? It doesn't even specify what "counseling" even refers to in this case. At the very least, this sentence should be moved, as the paragraph it is currently attached to is about drug treatments.
Moved. I'll take a look at the lancet article to see what it says about counseling. If it does not say much more I'll leave it as it is.--Garrondo (talk) 13:40, 17 August 2009 (UTC)
Lancet article does not say much more info. I'll leave it as it is.--Garrondo (talk) 13:50, 17 August 2009 (UTC)
I have a 42 page chapter in the Bates book ... what do we need ? L∴V
I suppose that saying what does "often benefit" exactly mean here would be great; why is it considered benefitial? --Garrondo (talk) 08:58, 20 August 2009 (UTC)
I have expanded the benefits, and includes a preamble for perspective. L∴V 23:08, 2 September 2009 (UTC)
  • "Although there are relatively few studies of rehabilitation for HD" What exactly is a "study of rehabilitation"? Also, suggest replacing "are" with "have been".
    Have expanded to 'Although there have been relatively few studies of exercises and therapies that help rehabilitate cognitive symptoms of HD...' does that help?L∴V 23:16, 2 September 2009 (UTC)
  • "The life expectancy is around 20 years following diagnosis" First, this should mention HD. Second, different victims will receive diagnoses at different stages of the disease. Some victims don't receive a diagnosis at all. It seems to me that life expectancy should be given relative to the point at which symptoms become apparent, not the point at which a diagnosis is made.
    changed to 'Life expectancy in HD is generally around 20 years following symptoms that could be clinically diagnosed as the onset of the disease' bit of a mouthful but hopefully unambiguous L∴V 00:58, 27 August 2009 (UTC)
    Aye, that is a mouthful. Perhaps shorten "symptoms that could be clinically diagnosed as the onset of the disease" to "the onset of visible symptoms" or some such.
    Much more succint, thanks. Done L∴V 20:19, 2 September 2009 (UTC)
  • "Mortality is not caused by Huntington’s disease directly" This implies that humans are generally immortal. I'm fairly certain that this isn't the case ;)
    .. who knows! Corrected to 'Huntington’s disease does not cause mortality directly, but complications caused by its symptoms become increaingly hazardous' not sure about 'hazardous' but best I came up with. L∴V 00:58, 27 August 2009 (UTC)
    Is "mortality" a word that is used in the literature? I would think that "death" would be more appropriate. --Cryptic C62 · Talk 11:49, 30 August 2009 (UTC)
    No, but I felt the need to elaborate a little so now it reads ... 'The pathology of Huntington’s disease is not fatal, but complications caused by the diseases symptoms become increasingly hazardous.' L∴V 20:00, 2 September 2009 (UTC)
  • "The risk of pneumonia increases as the ability to synchronise movements to clear the lungs is compromised and is sometimes caused as a result of aspiration of food or drink." Because this sentence is so long, it is unclear if aspiration causes an inability to synchronise movements or if it causes pneumonia. Suggest splitting off the aspiration bit with an appropriately placed comma, or perhaps cutting this into two sentences.
    Suffered a bit of grammar blindness, have disambiguated a little I think, maybe too long still .... 'As the ability to synchronise movements deteriorates, difficulty clearing the lungs and an increased chance of aspirating food or drink both increase the risk of contracting pneumonia.' L∴V 20:00, 2 September 2009 (UTC)
  • "Survival expectancy is similar in all regions independent of their economic development and the accessibility of treatment." Why?
    Didn't sound right did it? I suspect it came from something to with essential care is only important in the later stages, and is not particularly high-tech ... but could find in the given ref. This should probably have been in epidemiology, anyway. Have removed. L∴V 23:30, 2 September 2009 (UTC)
  • "Suicide is an associated risk, with increased suicide rates of up to 7.3%, and attempted suicides of up to 27%." Does this mean that 7.3% those with HD commit suicide and that 27% of those with HD attempt it? Or does it mean that those with HD are 7.3% more likely to commit and 27% more likely to attempt? I suspect it is the former, in which case I might offer non-HD suicide rates for comparison.
    I couldn't find a good source for suicide rates in the general population, appears to be hidden and only quoted as an annual incidince - apart from being the 11/12th most common cause of death. Expanded with some info from the Oxford Monographs which I thought was informative .. L∴V 22:34, 2 September 2009 (UTC)
    "with 7.3% of deaths of those with HD taking their own lives" Confusing. Suggest shortening to "with 7.3% of those with HD taking their own lives".
    doneL∴V 00:47, 5 September 2009 (UTC)
  • "which have prevalences of up to 700 per 100,000 and were studied to locate the marker for the gene" First, I suggest converting this to a per-million ratio to make it consistent with the rest of the paragraph. Second, it seems odd to mention that these populations were studied to locate the marker. As far as I can tell, this isn't mentioned in the History, Genetics, or Mechanism sections. If it is notable enough to be mentioned, then it should be expanded upon in the appropriate section. Otherwise, I suggest removing it from this sentence to make it more concise.
    Have rationalised to other figures, and rest of sentence was misplaced - it is mentioned in history though - so removed. L∴V 00:53, 5 September 2009 (UTC)
  • "Increased prevalence in some cases occurs according to a local founder effect" Suggest replacing "according" with "due"
    Yep, done L∴V 00:47, 5 September 2009 (UTC)
  • "Earlier statistics use diagnosis based on physical symptoms and a family history of HD," The grammar at the beginning of this clause seems to be a little off. I'm not sure what this phrase is trying to convey.
    Have disambiguated, sentence flow may need some adjustment L∴V 00:47, 5 September 2009 (UTC)
  • "In 1671 Knapp was accused of witchcraft in Groton, New Hampshire, and subject to a torturous trial, but was not condemned." Unless another sentence is added which discusses HD, this sentence seems entirely irrelevant. If it is kept, what exactly does "torturous trial" mean?
    Have rewritten - 'A well-documented case is that of Elizabeth Knapp in 1671. Due to her abnormal posture and outbursts, Knapp was tried, but not condemned, of witchcraft in Groton, New Hampshire. It has since been accepted that Knapp was probably exhibiting symptoms of late onset HD.' leaves out the pov on the trial itself. L∴V 21:08, 8 September 2009 (UTC)
  • "The family that prompted George Huntington's description were able to work while healthy and accepted by their town." Sorry, but I don't understand this sentence at all.
    How about - 'While this persecution may have happened in some communities, others were more accepting, for example, the community of the family studied by George Huntington openly accommodated them' ? L∴V 21:08, 8 September 2009 (UTC)
  • "In 1846 Charles Gorman observed how prevalence seemed to occur in localized regions" Should probably specify a higher prevalence.
    done. L∴V 21:08, 8 September 2009 (UTC)
  • "Both Gorman and Waters were students of Dungison at Jefferson Medical College." It strikes me as odd to have this information presented in a separate sentence. Perhaps it could be combined with the sentence that follows as such: "Independently of Gorman and Waters, both students at Jefferson Medical College, Johan Christian Lund also produced an early description in 1860."
    Done L∴V 21:08, 8 September 2009 (UTC)
  • "a rather secluded area," somewhat unencyclopedia. Perhaps instead of "rather", this clause could end with "in Norway" or "in southern Norway"
    Done L∴V 11:57, 11 September 2009 (UTC)
  • "The first widely recognized description was by George Huntington in 1872." This sentence is confusingly similar to an earlier sentence: "The first definite description of HD was in a letter by Charles Oscar Waters". Suggest rewriting one or both to make it clearer exactly what each person's description is notable for.
    DoneL∴V 11:57, 11 September 2009 (UTC)
  • "Huntington was a third generation physician on Long Island." Somewhat awkward. If you think this information is really relevant, I suggest working it into the previous sentence: "The first widely recognized description was published in 1872 by George Huntington, a third generation physician on Long Island."
    Removed - the important bit is that he recieved knowledge of several generations, that could of happeneed irrespective of being related to previous practitioners, is in his article in more depth anyway. L∴V 11:57, 11 September 2009 (UTC)
  • "even wishing to reassess the family involved a decade later" Did he actually end up reassessing the family? If so, suggest rewriting to make this clearer. If not, I think it's a rather trivial detail to include and I suggest removing it.
    It was important that Osler remained interested, I think the family wished to retain their privacy. I have reworded to show he remained interested and 'tentatively' added a quote by Oslar. L∴V 11:57, 11 September 2009 (UTC)
  • "Osler's interest in HD, combined with his influence in medicine circles, helped to rapidly spread knowledge of the disorder" Helped to spread knowledge, or helped to spread awareness?
    Both, have expanded. L∴V 11:57, 11 September 2009 (UTC)
  • "As Mendelian inheritance was being rediscovered at the turn of the century," Because "Mendelian inheritance" is a strong buzzword, I suspect some readers may skip or skim the previous paragraphs and start reading at this one. For this reason, I suggest specifying which century is being turned here.
specified L∴V 00:36, 18 September 2009 (UTC)
  • "Davenport's interest was roused by his college friend Smith Ely Jelliffe's own interest in HD's strong inheritance pattern" If Davenport's interest existed was inspired by Jelliffe's interest, this implies that Jelliffe's work happened first. However, Davenport's work was discussed first in this paragraph, implying that his work happened first. I suspect that it was Davenport's work that came first, in which case I suggest removing or rewriting the sentence quoted above to avoid the confusion.
Your suspicions were incorrect in this case ;) Have reworded/ordered for chronologicality. In the process came across an aspect of the early research (European based), some notable researchers, and a more definite note about spread of knowledge ( seems chorea was a hot topic at the time). I thought these facts made for a more worldwide perspective so have added to previous paragraph ... L∴V 00:36, 18 September 2009 (UTC)
  • "Research into the disorder continued progressively," I'm not sure what "progressively" means here. Perhaps "steadily" instead? Or, if you're just looking for a way to make this clause seem less choppy, how about "through the 20th century"?
Changed to 'continued steadily through the 20th century, reaching a major breakthrough in 1983' L∴V 22:49, 22 September 2009 (UTC)
  • "and was given a major boost in 1983" To say that research was given a major boost usually implies a major monetary boost. In the context that you've used it, I'd say that "boost" isn't particularly encyclopedic. How about "and reached a major breakthrough in 1983" instead?
see above L∴V 22:49, 22 September 2009 (UTC)
  • "focusing on the populations of isolated Venezuelan villages of Barranquitas and Lagunetas" As this is written, it implies that Barranquitas and Lagunetas are regions or tribes, though I suspect they may be individual villages. In the latter case, I suggest the following rewrite: "focusing on the populations of two isolated Venezuelan villages, Barranquitas and Lagunetas." In the former case, I suggest specifying what exactly Barranquitas and Lagunetas are.
Done L∴V 22:49, 22 September 2009 (UTC)
  • "A transgenic mouse that could be made to exhibit HD was developed in 1996." This is confusing for me. Did the mouse exhibit symptoms of HD or did it not? I really don't think there is any middle ground here, unless the mouse is a remote-controlled robot, which I suspect is not the case.
have generalized to 'modelled in animals' (point below ) L∴V 22:49, 22 September 2009 (UTC)
  • "Modelling the disease in animals enables larger scale testing, and as their metabolism is faster and lifespan shorter than humans" This sentence can't seem to decide whether it is discussing mice specifically or animals in general.
I'm sure that paragraph used to include more animals - I have made more general i.e. 'Modelling the disease in various types of animals like the transgenic mouse, developed in 1996, enabled larger scale experiments...' L∴V 22:49, 22 September 2009 (UTC)
  • "the interactions of HTT, mHTT, and mHTT fragments, potential drug treatments, care methods, and the gene itself" Unless I'm misreading something, I suggest removing the "and" from the middle of this list.
changed to 'the proteins involved with the disease' L∴V 22:49, 22 September 2009 (UTC)
  • "Huntington's disease has tested society's ethics in various ways." Yikes, this immediately struck me as being unencyclopedic, not to mention nonsensical; as a native English speaker, I have never heard of "ethics" being "tested". What exactly is meant by this sentence?
how about 'Huntington's disease, and the application and of the genetic test for the disease in particular, have raised several ethical issues.' Upon a reread this whole section feels a bit awkward, but let's see what can be done .. L∴V 22:55, 27 September 2009 (UTC)
  • "The development of an accurate diagnostic test for Huntington's disease has caused social, legal, and ethical concerns over access and use of a person's results" This sentence doesn't really seem to follow the one before it. I think it would serve better as a lead sentence for a paragraph (or subsection) about the ethics of testing. What else can be said here that doesn't deal specifically with testing issues?
I have moved a few bits around and added a couple more summary sentence into the first paragraph, looking a little better... L∴V 22:18, 30 September 2009 (UTC)
  • "and whether companies should be allowed to use test results." Use them for what?
back after a brief break.. expanded. L∴V 19:15, 7 October 2009 (UTC)
  • "Many guidelines and testing procedures have strict procedures for disclosure and confidentiality to allow individuals to decide when and how to reveal their results" My instinct tells me that "reveal" should be replaced with "review" or "view" or "receive".
'receive' was best but wording was simplidy, so added extra clause: '...and also to whom the results are made available.' L∴V 19:15, 7 October 2009 (UTC)
  • "Financial institutions and businesses are faced with the question of whether to use results when assessing an individual, such as for life insurance or employment." Suggest adding "HD test" before "results" for clarity.
not sure, but by using 'genetic test' have covered the broader question L∴V 19:15, 7 October 2009 (UTC)
  • "Another argument against this type of testing is that a person with the mutation may be free of the disease for many years" I don't understand this argument. How does the late onset of the disease prohibit prenatal testing?
I think this may have got lost in translation - Something to do with minority view that HD shouldn't be considered meriting abortion as the individual may live out a full healthy life. Maybe this could be included in a better eugenics paragraph, but until a better context is found have removed. have added a little of its concept in tesing of minors sentence ... ' as there would be no medical benefit for that individual.'L∴V 19:15, 7 October 2009 (UTC)
  • "with the aim of curing genetic illness by coordinating and supporting research." Shouldn't this say "curing genetic illnesses"?
yes L∴V 20:06, 7 October 2009 (UTC)
  • "At roughly the same time," The same time as what? 1968 or 2009?
specified same time as hdf. L∴V 20:06, 7 October 2009 (UTC)
  • "after his death from HD complications.[86][86]" Repeated ref.
removed one. L∴V 20:06, 7 October 2009 (UTC)
  • "Research into the mechanism has focused" Mechanism of what? I assume HD, but perhaps you have something more specific in mind.
yep - the mechanisms are specified in the rest of sentence. L∴V 00:25, 8 October 2009 (UTC)
  • "Genetically engineered intracellular antibody" The MOS discourages the linking of multiple consecutive terms, and I happen to agree.
me too - yuck stripped to terms necessary for readability, reworded sentence to remove laval and pupal too. L∴V 00:25, 8 October 2009 (UTC)
  • "Researchers have investigated using gene knockdown of mHTT in mice as a potential treatment" The structure of this sentence is unclear.
combined, turned around, rewrote - L∴V 00:25, 8 October 2009 (UTC)
  • "All of these advances are at their first stages and there are important practical difficulties for the use of such techniques in humans." Vague and foreshadowy. I suggest either specifying what these "important practical difficulties" are or leaving this phrase out.
Agree, specific difficulties could be found using the specific research articles, possibly.. I believe we've stated 'in mouse models' and 'preliminary human trials' enough to convey the message of the statement already. L∴V 00:25, 8 October 2009 (UTC)

Current comments

No more to come! --Cryptic C62 · Talk 17:56, 23 July 2009 (UTC)

Are you sure! L∴V 00:25, 8 October 2009 (UTC)
Aye, unless you'd like me to start again from the beginning... Eek! I think that, after nearly 4 months and more than 100 comments, I'm satisfied :) Good work, mate. Talk me if you'd like me to take a look at any of your future projects. --Cryptic C62 · Talk 19:42, 8 October 2009 (UTC)
Are you insane! ... of course I can't stop you starting again, but I think you pointed out anything majorly amiss already! It would be a shame, given your exposure to the article, not to ask for any general comments you may have for enhancement of it. ( I already have anote to expand the care section from amongst your previous comments ). e.g. tone, terminology, prominance of topics covered, that sort of thing. Saying that if you have seen enough for now I wouldn't blame you - it's been a blast and many thanks for your thorough reviewing! L∴V 15:12, 9 October 2009 (UTC)
Thanks Cryptic for your review... I feel it is going to make the article much easier to read once it is finished. Best.--Garrondo (talk) 13:57, 24 July 2009 (UTC)
It appears the combined recommendations and copyeds already applied have been good enough to gain FA status :) You have raised good points thus far, and I'll continue to address them of course. If you carry on at this rate the article will become bullet proof - many thanks! Flu and shock at passing a FA article are slowing me down at the moment but full speed will be resumed shortly ... L∴V 22:03, 5 August 2009 (UTC)
Indeed, I plan to continue reviewing the article. Part of the reason I work on the talk page rather than the FAC is to allow the review to continue regardless of the outcome of the FAC. --Cryptic C62 · Talk 01:46, 6 August 2009 (UTC)

Thanks to the reviewers

I'd just like to say a big THANKYOU to the editors who reviewed this article, who were very understanding of the copyediting needed and made the whole collaboration actually quite pleasant, most of whom also chipped in and applied a little copyediting of their own :) Peace and happiness to you all .. L∴V 00:14, 6 August 2009 (UTC)

Archiving

I have archived all comments that led to FA as they are now obsolete. Since Cryptic C62 comments are quite long it would be a good idea to archive them once the review its finished. Bests.--Garrondo (talk) 10:22, 17 August 2009 (UTC)

Hi Garrondo! There's a few discussions which I think we should leave as recurring e.g. capitalization, italizisation and possibly the links to past GA/FA reviews, basically the bits that future editors can use.... L∴V 11:15, 17 August 2009 (UTC)
True: I did not remember those: Maybe we could copy those again here.--Garrondo (talk) 11:38, 17 August 2009 (UTC)
Done.--Garrondo (talk) 11:46, 17 August 2009 (UTC)

Archive of FA related leadup - and continuing review by Cryptic C62 is now completed.

Archive 1Archive 2Archive 3Archive 4
  1. ^ Cite error: The named reference pmid12849232 was invoked but never defined (see the help page).
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