deletions | additions       diff --git a/Treatment.md b/Treatment.md  index 77df3bd..28e23e2 100644  --- a/Treatment.md  +++ b/Treatment.md 
...
\citet{26002052} reported a carefully designed, thoughtful pilot study of glutamatergic modulators as tic treatment. Twenty-three children with TS completed a double-blind, parallel group study involving 6 weeks of placebo, D-serine (up to 30 mg/kg/day), or riluzole (up to 200 mg/day). Total tic scores from the YGTSS improved by 25-38% in each group, without significant group differences. Although power was limited by the small sample size, this null result argues against eager pursuit of glutamatergic medications for TS at this juncture.   A meta-analysis of 22 randomized, controlled trials (RCTs) involving 2,385 children with ADHD found no causal relationship between stimulants and onset of tics \citep{26299294}. Rather, tics were associated with ADHD itself (5.7% in the psychostimulant groups and 6.5% in the placebo groups). This summary of previous evidence hopefully can further reassure patients and prescribers that stimulants do not cause tics. The evidence for this conclusion is strongest for methylphenidate (19 of the 22 trials), and in a large RCT in children with TS and ADHD, tics _improved_ significantly with methylphenidate \citep{11865128}. In this meta-analysis, results were similar for the 3 trials involving amphetamines, but tic severity did increase in 12 adults with TS  after a single intravenous dose of 0.3mg/kg D-amphetamine \citep{23876376}. Four patients with treatment-refractory TS were studied in an early report of results using vigabatrin, a medication from the GABA-aminotransferase inhibitor class \citep{vigabatrinPR}. 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.