**4.2 Deep brain stimulation surgery**

Deep brain stimulation surgery (DBS) is an approach used to treat other movement disorders including tremor and may be effective for selected patients with severe, disabling and medication-refractory tics. Have been open-label reports of tic reduction following transcranial magnetic stimulation (TMS) of the supplementary motor area39 40. To date, most reported cases involve bilateral targeting of the centro-median parafascicular and ventralis oralis complex or central nuclei of the thalamus41, the globus pallidus internus42 and nucleus accumbens/anterior limb of the internal capsule43.

Although sustained benefit has been reported to at least 17 months and most patients continue to require some medication for tics44, more careful investigation of their efficacy, safety, and tolerability of DBS for the treatment of tics is needed.
