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\citet{25882028} discuss various obstacles to carrying out randomized, blinded studies of DBS with appropriate controls.   | **Title** | **Comment** |  |:----------|:------------|  |TMS \citep{25342253} | Deep TMS add-on for intractable TS |  ### Other treatment  Previous studies have aimed repetitive transcranial magnetic stimulation (rTMS) at supplementary motor area (SMA) for treatment of TS. However, rTMS most effectively stimulates superficial regions of cortex. A new coil for rTMS in humans allows stimulation of deeper areas, and an Israeli group reports application of this coil to 12 patients with treatment-refractory TS. Although the patients as a whole did not improve significantly, a _post hoc_ analysis showed benefit in the 6 patients who also had OCD \citep{25342253}. The treatment was well tolerated. A double blind, sham-controlled study in this subgroup will be needed to confirm efficacy.  An open label trial of cranial electrical stimulation (CES) treatment was provided to 42 children with TS who were less than 12 years old \citep{25546850}. The patients applied electrodes to their earlobes when they went to bed so that they could receive the treatment on a daily basis 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 this subsample had stronger functional activity and connectivity in the anterior cingulate cortex, caudate and posterior cingulate cortex and weker activity in the supplementary motor area. These results must be viewed as preliminary, since an RCT is required to rule out spontaneous improvement.  A study reporting a surprisingly strong association between tics and epilepsy \citep{26597416} was discussed above. \citet{26074752} summarize evidence suggesting that autonomic dysfunction may have a role in both epilepsy and Tourette Syndrome. This articles also summarizes attempts to use electrodermal activity (EDA) biofeedback to treat both conditions and describes the challenges that are presented by TS in using this type of intervention. EDA biofeedback, which consisted of 12 sessions over 4 weeks, produced at least a 50% reduction in seizures in more than half of the epileptic subjects and also produced changes in Contingent Negative Variation, which is modulated by changes in peripheral autonomic activity. Based on seizure diaries that were kept by a subset of the patients, these improvements were maintained over a period of years. These results were replicated in a 2014 study by another research group. In contrast, when a similar EDA biofeedback protocol was used with TS subjects \cite{24674962}, TS patients in the active and sham biofeedback groups were not able to reduce their sympathetic activity. Despite this, both the active-biofeedback and sham-control groups had significant decreases in tic frequency and obsessive-compulsive disorder symptoms, plus improvements in quality of life related to OCD symptoms. A 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 \citep{25616186}.