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Greek To Me August 1999 Frequently, patients urgently seeking information from the medical literature are put off by the big strange words. But it really isn't all that difficult. Doctors seem to favor those words, even when an English synonym is available, for a variety of reasons: Conciseness, precision (many common English words have become too ambiguous), and tradition. Up to about the mid- 1700s, formal schooling was a privilege of the well-to-do, and because of its rarity, textbooks generally were printed in Latin or Greek, to be independent of the many local languages such as French, German, Italian, Swedish, Danish, etc. Modern doctors often maintain the tradition when a new word is needed, so that it will carry a hint of meaning to readers of many nationalities. And with a little digging in the dictionary, such words can be broken into parts and understood even by non-medical readers. For example, the name of the ubiquitous PD drug Sinemet is a combination of the Latin "sine" (=not, without) and the Greek "emet" (=sickness, as in English "emetic" or "emesis"). That's easy, but what about a word like "rhabdomyolysis" as mentioned in the official description of tolcapone (Tasmar)? Well, "rhabdo" is Greek for rod, or rod-like; "myo" is Greek for muscle; and "lysis" is Greek for disintegration or dissolution. The term refers to sudden and severe destruction of skeletal (as opposed to heart, gut, etc.) muscle, thought by the Tasmar writers to be related to neuroleptic malignant syndrome, since it appeared with other symptoms in several trial subjects who abruptly stopped taking Tasmar, and killed at least one of them. And one of the signs of rhabdomyolysis (and neuroleptic malignant syndrome) is the elevation of myoglobulin, a protein component of muscle tissue, in the blood or urine. What's myoglobulin, you ask? Well, "myo" = muscle, again, and "globulin" refers to the little microscopic globules formed by any of several proteins that are insoluble in water. Myoglobulin is released when the muscle tissue containing it is destroyed. See how easy it is? And, see how valuable it can be to decipher those big words? When you have done this for a while, you see the same root forms recurring in other words, which you can take apart in the same way. Doctors aren't generally interested in or renowned for skill in linguistics, so sometimes the system doesn't work. "Neuroleptic" is a case in point. It is of course a combination of the Greek "neuro" (= nerve, nervous system) and "lept-" (= sieze, grab hold of); but the term seems to be reserved only for drugs that _improve_ the user's mental state, i.e., antipsychotic drugs. What about drugs having a different use, but which may _degrade_ the user's mental state, i.e., cause psychotic symptoms? Some examples are levodopa, and numerous others commonly used to treat PD. Well, those aren't strictly "neuroleptics" and the word creators haven't provided a good substitute term. This is unfortunate, because both classes of drugs share the important feature that on rare occasion, abrupt withdrawal of either one may cause a life-threatening syndrome that includes multiple autonomic failure. Authors in the PDR and elsewhere tend to blur the distinction by calling syndromes "like", but not identical to, neuroleptic malignant syndrome. Not a very good situation. Cheers, Joe J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013