deletions | additions       diff --git a/Treatment.md b/Treatment.md  index fdaceb3..c6c2828 100644  --- a/Treatment.md  +++ b/Treatment.md 
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A small uncontrolled open trial of mindfulness-based stress reduction was provided to 18 individuals who were at least 16 years old \citep{25149879}. Treatment consisted of 8 weekly 2-hour group classes and one four hour retreat. Participants were encouraged taught a tic-specific meditation exercise that involved noticing any urges to tic while maintaining a focus on one's breathing rather than trying to change or eliminate the urge to tic. Only one subject dropped out. Mean tic severity decreased by 20% and 10 subjects were rated as "much improved" or "very much improved" and thus considered treatment responders and these gains were maintained at a one month follow-up.  An open label trial of psychotherapy using a cognitive psychophysiological model of tic behavior was conducted with 102 adults with 49 TS sbujects subjects  and 36 subjects with chronic tic disorder completing treatment. The treatment consisted of 10 weeks of individual psychotherapy involved a variety of tasks including increasing awareness of tics, muscle discrimination, decreasing muscle tension and an overactivte overactive  style of action, identifying low and high risk activities in terms of tic probability, highlighting the differences in behaviors, thoughts and feelings; decreasing perfectionistic beliefs linked to tension and relapse prevention. These psychotherapy tasks were chosen because of research suggesting that some TS subjects have perfectionist beliefs when they plan actions and this leads to an impulsive overactive style resulting in frustration, tension and tics. Large effect sizes were sen for both control groups compared to the waiting list control. 65% of the chronic tic disorder group and 74% of the TS group had reductions of more than 35% on the Tourette Syndrome Global Scale. At the end of treatment 78 of 85 completers were rated as mild or below regardless of the starting severity and the other 7 were considered to have moderate symptoms. Large effect sizes were seen whether they were imple simple  or complex and similar results were seen for tic locations (i.e., eyes, face, head, neck and shoulder, trunk and abdomen, phonic). This group (Morand-Beaulieu et al., "Cognitive-behavioral therapy induces sensorimotor and specific electocortical changes") Morand-Beaulieu _et al._ \citet{26022060}  examined the effects of this psychotherapy approach on event-related potentials and lateralized readiness potentials (LRPs). 20 EEGS EEGs  were recorded for 20  TS subjects and 20 control subjects matched for age, sex and Raven Progressive Matrices score, while performing a stimulus-response compatibility inhibition task. During the NoGo condition, the TS group exhibited a delayed and overactivated frontal late positive component. The authors interpreted this result as evidence that this frontal activation may be an adaptive mechanism that allows patients to perform behaviorally similarly to the control subjects. TS subjects exhibited delayed stimulus-locked lateralized readiness potential onset latency. TS subjects also displayed larger response-locked LRP peak amplitudes which are associated with the execution of the motor program for the correct response. The authors suggest that the larger amplitudes may reflect overactivation of the pre-motor and motor cortex in TS patients. The larger sLRP amplitude was not normalized after psychotherapy. In contrast the sLRP onset and the rLRP peak were normalized after psychotherapy. | **Title** | **Comment** |  |:----------|:------------|  | \citep{25616186} | This review discusses the possible relevance of neurofeedback for the treatment of Tourette syndrome and suggests that it may be most useful to treat TS children and adults who also have ADHD. |  ### Medication