deletions | additions       diff --git a/Treatment.md b/Treatment.md  index d5d5911..d32caa0 100644  --- a/Treatment.md  +++ b/Treatment.md 
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### Psychological interventions  Group habit reversal training with a control group; small; both groups had improvements Behavior therapy is now an accepted first-line treatment for tic disorders. Still, some practitioners retain misconceptions about its safety. A report on 228 participants  in Quality randomized controlled trials (RCTs)  of Life; greatest improvements in motor Comprehensive Behavioral Intervention for Tics (CBIT) helps to confute those concerns \cite{26763495}. Specifically, CBIT participants were no more likely to have new tics, have adverse events, increase  tic severity medications or have an exacerbation  in the HRT group; important point is that group format works \cite{27037483} psychiatric symptoms relative to patients who received supportive therapy.  Examined 228 CBIT Wider implementation of behavior therapies for tics is held back in part due to cost  andsupportive therapy participants; CBIT participants were not any more likely  to have new tics, have adverse events, increase a limited number of trained practitioners. Group (rather than individual) therapy is one option that could address these obstacles. A small study provided initial testing of this possibility using a treatment and a control group. Both groups had improvements in quality of life, and the greatest improvements in motor  tic medications or have an exacerbation severity occurred  in psychiatric symptoms relative the HRT group \cite{27037483}. The most important conclusion from this pilot study was that the group format was acceptable and appears not  to patients who received supportive therapy \cite{26763495}. Important for those who still fear CBIT will worsen tics. impair efficacy.  | **Title** | **Comment** |  |:----------|:------------| 
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### Neurosurgery  Surgery remains an option for a few patients with TS, yet several important questions remain \cite{27548235}.  The Milan, Italy, center provided a progress report on their large sample of TS patients treated with DBS, deep brain stimulation (DBS),  mostly in the ventromedial thalamus \cite{26348012}. In 11 of 48 patients (23%), the device was removed after "inflammatory complications" or poor compliance with follow-up. In the remaining 37 patients, 29 had a more than 50% reduction in YGTSS scores (clinician-rated tic severity and impairment). In a separate publication, they argued that the patient's symptoms beyond tics should be considered when a DBS target is selected \cite{26739445}. Hartmann argued contrariwise that our current state of knowledge better supports a narrower focus on tic reduction in choosing a DBS target \cite{hartmann:2016:opinion}. The TS group from Maastricht, The Netherlands, reported positive unblinded follow-up results in 5 patients with refractory TS treated with DBS in the anterior globus pallidus pars interna (GPi) \cite{26811866}, and a Chinese group reported unblinded 1-year follow-up of GPi DBS in 24 patients with TS, with improvement, on average, in both tics and OCD symptoms (50% reduction in mean YGTSS total tic score and 27% reduction in mean Y-BOCS score) \cite{27098785}. Interestingly, this latter report includes one patient whose tics continued improved after the DBS electrode was removed (p. 1025), (p. 1025),  consistent either with spontaneous improvement over time or with a micropallidotomy lesion effect. Given the current lack of consensus on DBSmethods  in TS, gathering data on all DBS patient outcomes a mouse model suggests that self-injurious behaviors, probably over-represented  in TS is crucial, and a recent collaborative report described the establishment patients referred for surgery, may be amenable to DBS  of the International Deep Brain Stimulation Registry and Database for Gilles de la Tourette syndrome \cite{27199634}. subthalamic nucleus \cite{26606849}.  |**Title** | **Comment** |  |:----------|:------------|  | \cite{26963088} | A single-case long-term DBS follow-up report |  | \cite{27548235} | A review Given the current lack  of consensus on DBS methods in TS, gathering data on all  DBS patient outcomes  in TS | is crucial, and a recent collaborative report described the establishment of the International Deep Brain Stimulation Registry and Database for Gilles de la Tourette syndrome \cite{27199634}.  ### Other treatment  Many patients have reported to their doctor that playing music reduces their tic symptoms. \cite{Brown:2016:thesis} addressed this formally, reporting on a survey of 183 musicians diagnosed with TS. On a scale of 1 (drastic symptom worsening) to 5 (drastic symptom improvement), subjects reported a mean of 4.45 for the effect of engaging in a musical activity (performance, not passive listening). This result strongly supports the patient anecdotes and suggests the possibility that formal music therapy should be tested in a randomized controlled trial for benefit on TS symptoms.