Talk:Management of Tourette syndrome/Archive 1

GA review: comments

• A lot of hard work has been put into this article. Good job!
• This article appears to have been written by a domain expert. I would suggest going through and re-reading it carefully for terms that have become quite familiar to you, but may not be familiar to the intelligent layman (comorbidity, dopamine, serotonin, "cognitive blunting," placebo etc.). If the term can be neatly paraphrased (as perhaps in, "they often take treatment priority," "treatment-refractory," "monotherapy" and "modality," and certainly in "ameliorate" and "exacerbate"), then the paraphrase may be preferable. Paraphrases within a quotation should be enclosed in square brackets, of course. If a term or phrase cannot be rephrased (as is frequently the case in this article), then a wikilink would be a good idea. Even "insomnia" and "cannabis," which are in fairly widespread use, deserve a wikilink.
• If there is no article to wikilink to, please consider putting that on your "to do" list ;-).
• Also consider poking around a bit to see if links to articles such as Social anxiety may be applicable and helpful. Your "See Also" (I prefer "Further Reading") section is empty. Incorrect, See also (preferred to Further reading) contains an entire template. Sandy (Talk) 01:44, 20 November 2006 (UTC)
• Lead section: Suggest re-writing the opening sentence to place the non-negative clause first. I'm not editing it for fear of making unintended substantive changes, but suggest something like, "Treatment of Tourette syndrome has the goal of managing symptoms rather than eliminating them, since there is no cure and no universally effective medication." Also, since education of "the patient, family, and surrounding community" is a key part of treatment, suggest putting a paraphrase of that sentence into the lead as well. That's a judgment call; it depends upon how important presenting that point to the audience is. The lead should be a quick look (written in clear and interesting prose) at whatever main points you wish to present.
• --Ling.Nut 14:56, 8 November 2006 (UTC)

• Thanks for your comments, Ling.Nut. I am traveling, did not submit these article to GA, did not feel they were ready, and do not have time to complete them now. This series of articles, nominated by someone else for GA, are daughter articles for the recently promoted FA on Tourette syndrome, and they aren't yet polished. I can work on these items next week. You are correct in the items which have not yet been completed here except for one area — See also is not at all empty: it has an entire template which links it to every article about Tourette syndrome on Wikipedia. See also is preferable to Further reading, as it shows the extent to which relevant content has been wikified, which is always preferable to external content. Thanks for the review, and I will let you know when the article is completed. Sandy (Talk) 16:18, 8 November 2006 (UTC)

Failed GA Nomination of October 29, 2006

This article has failed a the good article nomination of October 29, 2006. While interesting and comprensive, the language of the article remains far too technical to be easily comprehended by the average reader. On November 8, Ling.Nut made some excellent suggestions on how to improve this article, but they still haven't been addressed. After taking another look at the article and polishing it up, please feel free to resubmit it to WP:GAC. Best of luck. Neil916 (Talk) 05:59, 18 November 2006 (UTC)

Repeat message (most unfortunate that another author put up four articles for GA at once, all written by me, without inquiring if these articles were ready or if I had time to finish them.) Thanks for the input, Neil916, but there's no need to give it time. As I've explained elsewhere, I did not nominate the article for GA, someone put all the TS daughter articles up for review just as I was traveling and did not have time to finish them, I am the only author, and I don't have time for this polishing/finishing right now. My preference would be to remove them all from GA, and strike all GA templates from the page: I'm not a fan of the entire GA process anyway, and would not have submitted these articles:-) When I have time to polish and finish the article, I will ask for review from the medical project and other copyeditors I know, and not from GA. I'm sorry you had to go to the trouble; thanks again for the input. I will finish the article when I have time, and then submit it to the Medicine Project for peer review. Sandy (Talk) 14:21, 18 November 2006 (UTC)

Contemporary Assessment and Pharmacotherapy of TS article

Regarding this edit, deleting material sourced to Scahill L, Erenberg G, Berlin CM Jr, Budman C, Coffey BJ, Jankovic J, Kiessling L, King RA, Kurlan R, Lang A, Mink J, Murphy T, Zinner S, Walkup J; Tourette Syndrome Association Medical Advisory Board: Practice Committee. Contemporary assessment and pharmacotherapy of Tourette syndrome. NeuroRx. 2006 Apr;3(2):192–206. PMID 16554257

Page 5

In order to guide clinical practice, the medications used in TS are classified according to their level of empirical support. The following criteria from the International Psychopharmacology Algorithm Project were selected:

CATEGORY A reflects treatments with Good supportive evidence for short-term safety and efficacy derived from at least two randomized placebo-controlled trials with positive results.

CATEGORY B corresponds to treatments with Fair supportive data as evidenced by at least one positive placebo-controlled study; and

CATEGORY C reflects treatments with Minimal supportive evidence such as open-label studies and acumulated clinical experience (Jobson and Potter, 1995).

From Page 7
Table 3
Antipsychotic drugs used in the treatment of tics: empirical support and dosing guidelines

• Haloperidol (Haldol) - Empirical support A
• Pimozide (Orap) - Empirical support A
• Risperidone (Risperdal) - Empirical support A
• Fluphenazine (Prolixin) - Empirical support B
• Tiapride - Empirical support B
• Ziprasidone - Empirical support B
• Olanzapine - Empirical support C
• Sulpiride - Empirical support C

Table 4
Non-antipsychotic drugs ...

• Clonidine - Empirical support B
• Guanfacine - Empirical support B
• Pergolide - Empirial support B
• etc ...

Where is the problem and what is the suggested wording change? SandyGeorgia (Talk) 23:22, 5 February 2007 (UTC)

Image needs replacement

Hello all...

An image used in the article, specifically Image:Adderallrx.jpg, has a little bit of a licensing issue. The image was uploaded back when the rules around image uploading were less restrictive. It is presumed that the uploader was willing to license the picture under the GFDL license but was not clear in that regard. As such, the image, while not at risk of deletion, is likely not clearly licensed to allow for free use in any future use of this article. If anyone has an image that can replace this, or can go take one and upload it, it would be best.

You have your mission, take your camera and start clicking.--Jordan 1972 (talk) 00:59, 29 September 2008 (UTC)

Corbett study

I removed the following text:

Corbett et al. correlate elevated cortisol levels in children with Tourettes syndrome. Although the link between allergen exposure, histamine release, cortisol release, and subsequent Tourette syndrome symptoms has not been proven, the Corbett article does provide the link between cortisol and Tourette syndrome. The "allergen to histamine release to cortisol release" path is a well-known phenomena, but it has not been shown that this is the primary cause of cortisol release in Tourette syndrome patients. Stress has been shown to impact ticcing and is associated with cortisol release (Corbett et al., 2008). Removal of histamine-producing triggers would lower histamines that caused elevated base levels of cortisol and thus reduce Tourette syndrome symptoms. While unproven, allergen control in an attempt to lower blood cortisol levels would be logically supported by the Corbett et al. (2008) findings.

because it relies on a primary source and a small sample. See WP:RECENTISM, WP:MEDRS and WP:V. To my knowledge, there is no secondary review support for this text as yet. Further, although I haven't read the full study, it appears that the text introduced some original research. PMID 18487023 SandyGeorgia (Talk) 19:42, 13 October 2008 (UTC)

To say "Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome." is misleading. The sentence is probably correct, because "proven" is such a strong word.

A previous study connecting tourettes to allergies is: J Formos Med Assoc. 1999 Jul;98(7):492-5 by Ho CS, Shen EY, Shyur SD, and Chiu NC (http://www.ncbi.nlm.nih.gov/pubmed/10462998). "In our clinical practice, we often encounter signs and symptoms of allergy, such as rhinitis and asthma, in patients with Tourette's syndrome (TS). Some of the allergic manifestations are similar to the oral tics or motor tics found in TS patients. To clarify the association between TS and allergy, we evaluated 72 consecutive patients with TS from 1 September 1996 through 31 August 1997. The diagnosis of TS was based on the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria. Sixty-five boys and 7 girls, 4 to 17 years old (9.4 +/- 3.1 yr) were evaluated using the Multiple Allergens Simultaneous Tests (MAST) for the detection of total and specific immunoglobulin. Forty-five patients had positive results, of whom 41 (56.9%) had clinical evidence of allergy. The prevalence of allergy in the local population as reported by The International Study of Asthma and Allergy in Childhood Taiwan Group (1994) was 44.3% (33.5% with allergic rhinitis and 10.8% with asthma). These subjects served as controls. Comparing the number of patients with clinical evidence of allergy in the MAST positive group (56.9%) of TS patients with the control group (44.3%), the difference was significant++ (p < 0.05). The prevalence of allergy in TS patients in our study was significantly higher than in the general population. TS had an association with allergy." —Preceding unsigned comment added by Rapatters (talk • contribs) 22:12, 13 October 2008 (UTC)

Please read WP:V regarding the use of primary sources in Wiki articles. The statement you call "misleading" is sourced to multiple secondary reviews, and can be sourced to even more secondary reviews. It's also accurate. SandyGeorgia (Talk) 22:32, 13 October 2008 (UTC)

I concur that the sentence which is claimed to be misleading is fully supported by the sources, both of which are among the best kind of sources for use on Wikipedia. In contrast, the removed text fails WP:PRIMARY, which forbids editors from interpreting primary research sources and coming their own conclusions. Colin°^Talk 17:45, 15 October 2008 (UTC)

Marinol text

After a mediation, text was added to this article (actually, the main TS article and later moved to here) two and a half years ago, that used primary sources to discuss the treatment of tics with Marinol or cannabis. At the time, there was no mention in secondary, peer-reviewed sources as required by WP:MEDRS, and in fact, I don't know if MEDRS existed at the time of the mediation (I was a brand new editor). The Singer review paper does have a brief mention:

Multiple non-dopaminergic therapies have been proposed for the treatment of tic disorders. Several clinical trials have suggested a beneficial response of TS to delta-9-tetrahydrocannabinol, the main psychoactive ingredient of cannabis.155,156 Nicotine has various potential mechanisms of action in the CNS157 and there are reports indicating improved tic control when nicotine gum or a skin patch is used in conjunction with a neuroleptic drug.158 PMID 15721825

* 155 Muller-Vahl KR, Schneider U, Prevedel H, et al. Delta 9-tetrahydrocannabinol (THC) is effective in the treatment of tics in Tourette syndrome: a 6-week randomized trial. J Clin Psychiatry 2003; 64: 459–65.
* 156 Muller-Vahl KR, Schneider U, Koblenz A, et al. Treatment of Tourette’s syndrome with delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry 2002; 35: 57–61.

That is the extent of the text. I removed the text that was previously sourced only to primary studies and shortened the section, adding back the sources indicated in the Singer review;[1] it additional secondary review material can be found, more text can be added. SandyGeorgia (Talk) 03:41, 27 October 2008 (UTC)

Kathartic, please discuss your edits on talk. Yes, a lot has changed since the mediation I had with you when I was a brand new editor, almost three years ago. I am now aware of the place of primary sources on Wiki, and that text should not have been added even then, as it was WP:RECENTISM and against WP:MEDRS. Now that we do have secondary sources discussing the primary studies, we can use them. SandyGeorgia (Talk) 04:02, 27 October 2008 (UTC)

Can you please tell me exactly what the secondary source said about the Marinol research? Kathartic (talk) —Preceding undated comment was added at 04:05, 27 October 2008 (UTC).

The entire text is quoted above; other editors with better access to more journals may be able to find more secondary reviews that mention Marinol. SandyGeorgia (Talk) 04:10, 27 October 2008 (UTC)

The RECENTISM link is just an essay, not official wikipedia policy. As far as the secondary source is concerned, are you sure this is the only secondary source with this information? —Preceding unsigned comment added by Kathartic (talk • contribs) 04:12, 27 October 2008 (UTC) ]]

I've been watching for mention for three years, and haven't seen any. I'm reviewing all of my sources now, but I don't have an automated means of doing that: I have to thumb through four file drawers. According to scholar.google.com, Singer seems to be the only review that mentions these studies. Other editors, with better access to journals and automated search tools, may be able to find something more, or something sooner than I can, but I haven't come across anything. SandyGeorgia (Talk) 04:17, 27 October 2008 (UTC)

I also found a blurb in Robertson (which I have to type by hand because I don't have an online copy, pardon any typos):

In the author's clinical experience several patients have reported a reduction in symptoms with the recreational use of marijuana. It has also been documented however, that cannabis has no effect on tics and increases the individuals inner tension (Meuldijk and Colon, 1992). A recent study evaluated the effect of marijuana smoking in 47 TS patients; of the 13 patients taking marijuana, 11 (85%) reported a marked tic reduction (Muller-Vahl et al., 1997). PMID 10686169 p. 447

She doesn't mention the Marinol studies at all. There is no entry in the index of the Advances in Neurology book (looking under cannabis, Marinol, or delta-, and I find no mention in any of the most comprehensive sources I have. SandyGeorgia (Talk) 04:27, 27 October 2008 (UTC)

Ah, by looking under THC, I found something in the A/N book:

Since the seminal observation of Seignot that haloperidol reduces the tic symptoms in TS, it is clear that agents which block dopamine (D2) receptors can have a beneficial effect. Other agents demonstrated to be of benefit include delta-9 tetrahydrocannabinol (24, 25), pergolide, clonidine, mecamylamine, and tetrabenazine, among others. Although these reports indicate a beneficial effect in tic disorders, the issue remains to determine for whom these agents are effective in a context outside of a clinical trial setting. PMID 16536366 p. 193

* 24. Muller-Vahl, 2003
* 25. Muller-Vahl, 2002

So there doesn't appear to be much we can say beyond what is already said, and the primary study conclusions we had included before are not mentioned in secondary reviews. SandyGeorgia (Talk)

Well it didn't take me very long to find other secondary articles that cite the primary research, such as: "Endogenous cannabinoid signaling and psychomotor disorders" [2] Or "Emerging drugs in Tourette syndrome" [3] Kathartic (talk)

The first is PMID 10785542 and the second is PMID 15934872; can you quote the full text please? I do not have those articles, and we shouldn't cite from abstracts only. SandyGeorgia (Talk) 05:30, 27 October 2008 (UTC)

Here's another source that cites the primary research papers "Involvement of the Endocannabinoid System in Motor Disorders" [4] This one is partically intersting because it it's abstract says "New data strengthen the idea of a prominent role for the endocannabinoid signalling system in the modulation of a wide variety of neurobiological functions. Among these, one of the most important is the control of movement. Cannabinoid CB1 receptors are abundantly concentrated in the basal ganglia and their activation by plant-derived or synthetic cannabinoids, as well as by their endogenous ligands, modulates the activity of various neurotransmitters thus producing an hypokinetic action." As you know TS is a basel ganglia movement disorder, and it is facinating that CB1 receptors are abundantly concentrated there... something I did not realize. The abstract goes on to say "This fact, together with the occurrence of marked alterations in CB1 receptors in the basal ganglia of patients affected by several motor disorders, an event that has been corroborated in animal models, has encouraged the research on the therapeutic potential of cannabinoid-based compounds to alleviate symptoms in these disorders. In addition, cannabinoids are also neuroprotective..." I won't quote the entire abstract here bc I want to stay within the "fair use" guidlines under copywrite law, but you can read it for yourself. It looks there is going to be more research in treating basel ganglia disorders, like TS, and that we will have more information to add about it, if not now, in the future... Kathartic (talk) —Preceding undated comment was added at 05:21, 27 October 2008 (UTC).

That doesn't appear to be indexed on PubMed, so I'm not sure what it is, but we can't cite to abstracts only. SandyGeorgia (Talk) 05:34, 27 October 2008 (UTC)

I meant to say "It looks there is going to be more research in treating basel ganglia disorders, like TS, using synthetic THC and perhaps other synthetic cannibanols, and that we will have more information to add this, if not now, in the future..." Also, a source does not need to be indexed on pubmed to be cited in Wikipedia. However I didn't say I would cite it, I'm just discussing that possibily... Also, what about the other two secondary souces I mentioned earlier? You said nothing about those...Kathartic (talk) 05:44, 27 October 2008 (UTC)

Yes I did ... look up :-) Unless someone has access to these papers, the abstracts are of little use. SandyGeorgia (Talk) 05:46, 27 October 2008 (UTC)

Sorry, didn't notice... well I might have access to the papers... but unfortunately, I don't have as much time as you do to edit wikipedia, and I defiantly don't have much time to do research just for the purpose of editing wikipedia. But do have some time and I will put it on my "to do" list. :-) Kathartic (talk) 05:51, 27 October 2008 (UTC)

Some more-recent marinol sources

• Treatment of Tourette syndrome currently cites Müller-Vahl et al. 2002 (PMID 11951146), an older primary study. It shouldn't be doing that; it should just cite reviews.
• This seems to be work done by one group, not replicated elsewhere, suggesting that we should summarize it a bit more cautiously than we do.
• I checked for some other secondary sources on this subject, and found the following material from more-recent reviews which I suggest be used to rewrite the summary of this topic.

• "Cannabis-based medicines are also promising treatments for particular symptoms of Tourette’s syndrome and glaucoma...." —Murray et al. 2007 (PMID 17925811)
• "... in Tourette syndrome, both studies (by the same authors) have shown a decrease in tic frequency first in a single dose study, and then over a 6-week treatment period as well as an improvement in obsessive-compulsive behaviour, and in the 6-week study; the dose of THC used was relatively low at up to 10 mg daily.[Müller-Vahl et al. 2002 (PMID 11951146), Müller-Vahl et al. 2003 (PMID 12716250)] ... A review of the results of the published studies leads this reviewer to conclude that there is a general paucity of compelling evidence of efficacy for the synthetic cannabinoids perhaps with the exception of Tourette syndrome, where more work is needed." —Wright 2007 (PMID 17952657)
• "Patients with Gilles de la Tourette’s syndrome — a compulsive tic disorder of proposed striatal etiology — experienced a reduction in the severity of behavioral tics when they were treated with plant-derived cannabinoids; this includes data obtained from patients who self-medicate with cannabis.[Hemming & Yellowlees 1993 (doi:10.1177/026988119300700411); Consroe 1998 (PMID 9974182); Müller-Vahl et al. 1998 (PMID 9879795), 1999 (PMID 10080574), 2002 (PMID 11951146); Müller-Vahl 2003 (PMID 14521482)] ... We feel that this body of research has established an excellent rationale for the development of novel pharmacotherapies.... These approaches hold promise not only for the alleviation of specific symptoms of multiple disorders (e.g.,... tics in Tourette’s syndrome,...) but they also could provide a remarkable array of benefits in terms of delaying or arresting the progression of these neurodegenerative diseases, due to the neuroprotectant or neuroregenerative properties described for certain cannabinoids. However, most of the studies which have examined the therapeutic potential of these compounds in basal ganglia disorders have been conducted in animal or cellular models, whereas the number of clinical trials is still too limited." —Gerdeman & Fernández-Ruiz 2008 (doi:10.1007/978-0-387-74349-3_21)

• In summary, recent reliable reviews seem to be saying that there's some promise here but "more work is needed", particularly for the synthetic cannabinoids. Hope this helps.

Eubulides (talk) 06:39, 27 October 2008 (UTC)

• Thank you for those sources, Eubulides: I don't think I'll be able to get to this for a few days, in case you find time to rewrite that one sentence before I do. SandyGeorgia (Talk) 13:39, 27 October 2008 (UTC)

New comment

• This article is a horrendous piece of pharmaceutical industry propaganda. In the "Experimental Treatments" section marijuana is not even mentioned. It is only mentioned to dismiss it in the beginning of the article. This article might as well be an ad for Ritalin. Tros (talk) 16:30, 31 March 2009 (UTC)Tros

If you have reliable sources for treatment with Marijuana, pls provide them. To my knowledge, there is nothing that has been left out, although I am working to get a new review paper on emerging treatments. SandyGeorgia (Talk) 20:17, 31 March 2009 (UTC)

"Unfounded Fears"

This is original research and therefore isn't citable, but... I have Tourette's and ADHD. I was given Ritalin and it very much did worsen the tics; the thing is, while stimulants lessen the attention problems, they still are stimulants, therefore increasing adrenaline, therefore worsening tics. Even if that logic was flawed, I can still tell the difference between when I'm on medication or not; if I'm on Ritalin or Concerta, I tic a lot more. If I'm not, I don't. Not unfounded in the least. 98.252.40.34 (talk) 16:56, 29 May 2011 (UTC)

I'm sorry, but Wikipedia articles rely on reliable medical sources rather than anecdote, and stimulants have been repeatedly demonstrated useful in treating ADHD in the presence of tics. SandyGeorgia (Talk) 17:00, 29 May 2011 (UTC)

Deep Brain Stimulation

That section at the very bottom is massively out of date, I'll try and come back here once I've finished this project. Also can anyone tell me how to leave a signoff? — Preceding unsigned comment added by Speedigecko (talk • contribs) 05:20, July 27, 2012‎

Although the 2006 data was old, the conclusions have not changed. I have updated the paragraph to include three newer secondary reviews with this edit. SandyGeorgia (Talk) 18:24, 5 July 2013 (UTC)

Neurofeedback

These edits by two IPs resolving to Brisbane, Australia have been removed twice.[5] [6] The text is ungrammatical, and unsupported by reliable sources. Also, WP:3RR applies to an individual, not an account, so if the same person is behind both IPs, editwarring should be avoided.

The article states the following, backed by secondary reviews compliant with MEDRS (Zinner 2004 and Swerdlow 2005):

Complementary and alternative medicine approaches, such as dietary modification, allergy testing and allergen control, and neurofeedback, have popular appeal, but no role has been proven for any of these in the treatment of Tourette syndrome.

The following more recent reviews confirm that the text in the article is still correct: PMID 21445725 and PMID 21387811. Please do not continue to add this text unless a secondary review compliant with WP:MEDRS is provided. SandyGeorgia (Talk) 15:48, 5 July 2013 (UTC)

Moved the following unsigned IP post from User talk:SandyGeorgia:

neurofeedback for tourettes theta downtraining

There are other sources i will attempt to find but theta downtraining of the anterior cingulate appears to be a big advance in the removal of tics in quite a few studies now coming out.

http://www.youtube.com/watch?v=q1asyhngz8o

http://www.brainclinics.com/dynamic/media/1/documents/Articles/PhD_Martijn_Arns_Final.pdf

http://eeg-feedback.cz/Joural_of_Neurotherapy.pdf

http://lib.bioinfo.pl/paper:16970874

http://optimalep.com/wp-content/uploads/2012/04/ComprehensiveNeurofeedbackBibliography.pdf

http://www.hbimed.com/fileadmin/user_upload/images_and_pdfs/research/ERP_endophenotypes_Book_on_neurofeedback_and_neuromodulation_2011.PDF

Consider sources and see if any of them meet the requirements to include theta downtraining in the alternative treatment of tourettes medical requirements as one could argue that the dopamine inhibitor drugs at best are ineffective — Preceding unsigned comment added by 123.50.151.44 (talk • contribs) 09:41, July 6, 2013‎

IP 123: you have added text for the third time on neurofeedback, after the notice above and an explanation of WP:3RR and Wikipedia's medical sourcing requirements was posted to your talk page.

1. Please review WP:3RR and do not reinstate text without gaining consensus. Again, please note that 3RR is not a license to revert contested text three times, and that it pertains to an individual, not an IP address or account.
2. Please read WP:MEDRS; if you can locate a secondary review (most likely listed at PubMed) that mentions success with neurofeedback for TS, we can discuss it. I have most of the recent reviews and am aware of no secondary review of TS that mentions success with neurofeedback.
3. Please review WP:NOTNEWS; publishing unreviewed recent research is unencylcopedic.
4. Please review WP:OR; "one could argue" isn't how Wikipedia articles are written.

Perhaps it is time to request protection of the article? SandyGeorgia (Talk) 11:49, 6 July 2013 (UTC)

School Phobia??!!

School phobia is mentioned as a possible side effect for novel antipsychotics, such as Risperdal and Zyprexa. As far as I know, this is a mistake. Medicines like these typically reduce anxiety. They are more likely to be used as a treatment for school phobia. There is no citation to support the school phobia assertion. I'm tempted to remove it myself, but I am not a registered wikipedia editor. Probably better for someone else to fix it. 69.108.163.203 (talk) 22:24, 16 December 2013 (UTC)

yes, there is a citation (see the end of the paragraph), and yes, it is accurate-- school phobia is a reported adverse effect. SandyGeorgia (Talk) 23:16, 16 December 2013 (UTC)

Alpha2 agonists are first line in treating tics

α2 adrenergic agonists like Clonidine and Guanfacine are considered first line in treating tics. At present, those drugs are buried deep in the third paragraph in Treatment Priority. This article is entirely correct; they are weaker than antipsychotics. However, due to their lighter side-effects they are the first line therapy for tics - that fact is rather important, and is not reflected in this article. I've seen that fact in several textbooks, but here's a good online source: http://emedicine.medscape.com/article/289457-medication#4

I also feel it worth mentioning that, in general, treating behavioral problems and/or concomitant ADHD is usually higher priority than the tics. Mutecebu (talk) 23:43, 2 October 2014 (UTC)

Semi-protected edit request on 17 January 2016

Propranolol is also prescribed for tic disorders.  (I should know, I have it, and this medication gives me great relief).

(I feel like most of the articles written about tic disorders are written by those whom do not have the problem, but in their arrogance speak their mind anyway. I have had these problems for 25 years. They wax and wain. I cannot always control the tics. I have ADULT onset, and have never done drugs, etc. They change from time to time, but are usually fairly complicated. You have never heard of anyone with some of my tics, lol. ).

fyi: http://scholarship.claremont.edu/cgi/viewcontent.cgi?article=1320&context=cmc_theses

68.226.162.229 (talk) 23:00, 17 January 2016 (UTC)

68.226.162.229 (talk) 23:00, 17 January 2016 (UTC)

Not done: please provide reliable sources that support the change you want to be made. The source you provided does not say that Propranolol is prescribed for tic disorders, it doesn't even say that it's been tested. It merely suggests a mechanism by which it may help Cannolis (talk) 02:01, 18 January 2016 (UTC)

Revert article vandalism

In the second paragraph of the heading "Treatment of ADHD in the presence of tic disorders", "proven efficacy" links to https://en.wikipedia.org/wiki/Zombie. This appears to be vandalism and should probably be reverted.

 Done. Thanks for spotting this vandalism that lasted four years. Adrian J. Hunter^{(talk•contribs)} 01:40, 25 January 2016 (UTC)

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Revert

Beginning on 29 December 2016, there were a number of changes that led to an edit war. I came to the talk page here to find not one single talk post made in the entire period. I started through the edits and found:

• 12/29 19:03 Lack of inline citations does not equal original research, and tics rarely need treatment, while ADHD treatment is a priority.
• 19.05 problems apparent
• 19.07 organized by proof of efficacy, but not opposed to changing this
• 19.08 no, because treatment priority includes tics, which are not a comorbid
• 19.09 there is one review in PubMed on diet in Tourette's, and it is dated (1992). pls provide source for expansion
• 19.18 disagree on both counts, but could discuss separating typical and atypical
• 19.25 could discuss separating each comorbid, but if we are to do that, it will be with MOS-correct headings. We have an article on OCD, which discusses OCD treatment (the situation with ADHD is different because of past incorrect advice on stimulants in the presence of tics)
• 19.27 no explanation
• 19.28 Stubby sections
• 19.29 someone reverted the lot, and then the editor continued,[7], reverted again, and again (edit war) with no discussion on talk.

At that point, I stopped trying to find helpful edits and restored the article.[8] If there was something worth saving in there, it should have been discussed on talk, particularly with edit warring and unsubstantiated tags. Although there was no talk page discussion of any of these edits, I archived the talk page (see archive).

I plan to continue through the diffs to see if I missed something that might be restored. SandyGeorgia (Talk) 19:44, 23 March 2018 (UTC)