Other treatment
In a pilot study, Behler et al. administered bilateral cathodal transcranial direct current stimulation (tDCS) over motor cortex in three patients with TS. While one patient displayed a 35% improvement in tic severity, the other two subjects experienced worsening of symptoms. However, all three patients did report a decrease in negative affect, as well as a mild increase in positive affect \citep{30197592}.
Tics, family and society
\citet{Himle_2018} review how tics can affect the family and vice versa. Two large studies have now demonstrated clearly how much TS can hinder school performance. The first is a large study, conducted by the CDC via telephone survey, from the US. The authors found that TS (specifically, when compared to children without TS both with and without other neuropsychiatric conditions) has negative consequences for school performance \citep{29432328}. Subjects with moderate-to-severe TS (n = 97), when compared to those with milder symptoms (n = 203), were significantly more likely to require an individualized education plan (IEP). Furthermore, the prevalence of co-morbid psychiatric illness in TS is quite high; 80% of subjects with TS had at least one co-morbid neuropsychiatric disorder, compared to 18% of subjects without TS. The second study is from the population registry in Sweden, demonstrating academic underachievement in TS/CTD across all educational levels \citep{29813161}. One limitation of this study is that it relies on those who are diagnosed by a physician, who we know are a proper subset of those with tics. One would not be surprised to learn that the factors that lead to care-seeking (like severity of symptoms, or other undiagnosed behavioral problems) may also themselves interfere with education. Commenting on this article, Hartmann and Delorme write, "Ticcing as such impairs attention, and attempts to supress tics at school or work makes things even worse. Teasing and bullying because of tics is a further contributing factor to attention problems. Thus, tics impair academic achievement in their own right, and comorbidities can only partially be blamed for this situation. ... TS and CTD are not harmless neurological conditions but profoundly affect a person’s life trajectory (see also Mataix-Cols' work on suicide in TS \citep{Fernández2017}). Take tics seriously!" \citep*{c2018}.