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### Medication  Efforts to maximize the value of pharmacological treatment continues. continue.  One of our colleagues highly recommended the following review of current medication treatment practice in Germany: \citep{24888751}. These researchers examined psychotropic prescriptions issued in Germany between 2006-2011 for children and adolescents who had been diagnosed with a tic disorder. There was only a slight increase in the number of prescriptions overall issued in 2011 compared to 2006. The mostly frequently prescribed medications were ADHD medications. Antipsychotics were the next most frequently prescribed; second-generation antipsychotics were more frequently prescribed over this time period, with a relative increase in risperidone prescriptions specifically. Patients with a TS diagnosis were more likely to receive psychotropic medication than were children with other tic diagnoses. A meta-analysis of 22 studies involving 2,385 children found no causal relationship between stimulants and tic onset although tics were associated with ADHD itself (5.7% in the psychostimulant groups and 6.5% in the placebo groups) \cite{26299294}. This summary of previous evidence hopefully can further reassure patients and prescribers that methylphenidate products do not cause tics (the evidence is less clear for amphetamine products).  Four patients with treatment-refractory TS were studied in [this early report](http://www.webcitation.org/query?url=http%3A%2F%2Fir.catalystpharma.com%2Freleasedetail.cfm%3FReleaseID%3D919254&date=2016-05-09) of results using medication from the GABA-aminotransferase inhibitor class. One patient had a clinically significant reduction in tics while two others had tic reduction of approximately 25% but did not report subjective clinical improvement. ### Neurosurgery