deletions | additions       diff --git a/Treatment.md b/Treatment.md  index f5f9de1..4118230 100644  --- a/Treatment.md  +++ b/Treatment.md 
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In another study \cite{26091197} 12 children and adolescents, who had tics and were rated as non-responders after 14 weeks of cognitive-behavioral therapy, either received 16 weeks of sertraline treatment or 10 additional sessions of CBT. Internalizing disorders were more common in the non-tic patients and externalizing disorders were more common in the tic patients (50%) than in the non-tic patients (5.3%). The tic patients receiving sertraline showed more improvement as a result of receiving sertraline rather than CBT while the non-tic patients showed similar improvement whether they received sertraline or additional CBT. The authors suggested that the dopaminergic action of sertraline might have helped the OCD patients with tics.  | **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. | 
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This review compared electrophysiological data obtained in nonhuman primate models of TS and Parkinson's disease \cite{26180116}. This paper focuses on identifying possible mechanisms to account for the reason why high-frequency GPi-DBS is effective for treating both a hyper- and a hypokinetic disorder. This article focuses on the possibility that excessive synchrony and pathological low-frequency oscillations (LFO) impairs activation in the motor regions that receive input from the basal ganglia. There is also some evidence synchronous oscillatory activity and excess LFO contribute to TS. DBS effectiveness is considered to occur because population-scale firing rates are maintained allowing proper encoding of desired movement. When used with Parkinson patients, DBS suppresses excess LFO in the GPE in addition to the GPI. GPI-DBS is theorized to suppress the phasic activations in the GPe and the phasic inhibitons in the GPi for TS patients. It is hypothesized that in both medical conditions aberrant output is minimized whiler the population-averaged firing rate is maintained.   | **Title** | **Comment** |  |:----------|:------------|  | \citep{25342253} | Deep TMS add-on for intractable TS | 
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### Other treatment  An open label trial of cranial electrical stimulation treatment was provided to 42 children, who were less than 12 years and had TS \cite{25546850}. The patients applied electrodes to their earlobes so that they could receive the treatment on a daily basis when they went to bed for 24 weeks. Treatment was provided for 60 minutes and they could go to sleep if they wanted. Only one child dropped out before the completion of the study. The mean YGTSS score significantly decreased from 26.3 when they were initially seen to 11.4 after 24 weeks of treatment. fMRI scanning was optional and only 8 subjects completed the scans before and after treatment. Independent component analysis with hierarchical partner matching was used to examine functional connectivity among regions within the cortico-striato-thalamo-cortical circuit followed by Granger causality to examine effective connectivity. After the CES treatment had stronger functional activity and connectivity in the anterior cingulate cortex, caudate and posterior cingulate cortex and weker activity in the supplementary motor area. Although these results are preliminary, an RCT with a larger sample size undergoing scanning before and after treatment (with appropriate controls for possible movement) certainly seems warranted. The strong association between tics and epilepsy was previously discussed \cite{26597416}. The possible role of autonomic dysfunction in both epilepsy and Tourette Syndrome was discussed in detail along with the use of biofeedback of electrodermal activity (EDA) to improve modulation of sympathetic nervous system activity. EDA biofeedback resulted in more than half of the TS subjects having at least a 50% reduction in seizure activity with maintainence over a period of years for the subset that were followed and these results were reportedly replicated in another study. However, an attempt to use a similar EDA biofeedback protocol with TS found that, although, tic activity was reduced during biofeedback periods, this improvement did not generalize to times when the patients were not receiving the biofeedback.