Psychological treatments for tic disorders blah blah summary sentence more studies
Medication
Swedish treatment registries were searched to identify patterns of medication prescribing for almost 7000 patients with TS/CTD from 2005–2013 \citep{29870273}. Among other interesting findings, ADHD drugs, antidepressants, and hypnotics/sedatives were all prescribed more often than antipsychotics.
A first direct comparison of pharmacotherapy with behavioral therapy in children and adolescents with TS / CTD \cite{Rizzo2018}. Both approaches were effective in reducing tics and improving quality of life; however, only pharmacotherapy was effective in reducing OC symptoms.
The D1 receptor antagonist ecopipam was compared to placebo in a double-blind, crossover, randomized controlled trial (RCT) in children and adolescents with TS \citep{chipkin2017}\citep{chipkin2018}. YGTSS total tic score (TTS) declined significantly more with the active drug.
Neurosurgery
Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome: The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry
\citep{Martinez_Ramirez_2018}. This report summarizes information on 185 Tourette patients from 10 countries. Mean improvement in total YGTSS score was 40% at 6 months after
vs. before surgery, and 45% at 12 months. The difference between stimulation sites (CM-Pf, anterior GPi, posterior GPi) was not statistically significant. About a third of patients had side effects, mostly related to stimulation not surgery. A large, collaborative group is beginning a study using this database to investigate the optimal site for DBS via a 3D analysis (
link).
DBS in children remains controversial. Coulombe et al. review available data on DBS in "children" (ages 12-21) \citep{30497215}, and \citet{Smeets2018} discuss ethical considerations regarding DBS in TS patients under the age of 18.