deletions | additions       diff --git a/Treatment.md b/Treatment.md  index 5569901..98bcf82 100644  --- a/Treatment.md  +++ b/Treatment.md 
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The issue of temporary DBS treatment was raised by a case study (Zeka, 2015). The patient started having simple motor tics at the age of 7 followed by vocal and complex motor tics two years later. The patient also had ADHD and learning difficulties. Thalamic DBS surgery was provided when he developed continuous motor and vocal tics that resulted in him leaving school at the age of 17. A year after surgery his YGTSS score had decreased by 58%. 3 years after the surgery the tic severity increased and the IPG was replaced resulting in improved tic severity again. When the patient was 23 it was noticed that the IPG was not operational and there had not been any increase in the patient's symptoms. After the device was left off for 2 years and the patient remained stable clinically, the decision was made to remove the device and the patient was still stable 8 months later.  An open label trial of cranial electrical stimulation treatment was provided to 42 children, who were less than 12 years and had TS {Qiao et al}. 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 \citep{25342253} | Deep TMS add-on  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. intractable TS  |**Title** | **Comment** |  |:----------|:------------| 
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|:----------|:------------|An open label trial of cranial electrical stimulation treatment was provided to 42 children, who were less than 12 years and had TS {Qiao et al}. 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.|  |  |\citep{25342253} | Deep TMS add-on for intractable TS  |  |