Comparison of efficacy of deep brain stimulation, repeat transcranial magnetic stimulation, and behavioral therapy in Tourette syndrome: A systematic review and Bayesian Network Meta-Analysis

Efficacy of deep brain stimulation for Tourette syndrome and its comorbidities: A meta-analysis

Tourette Syndrome (TS) is a neurodevelopmental disorder characterized by multiple motor and vocal tics, often accompanied by comorbid disorders. Optional treatments for patients with TS include behavioral therapy, pharmacotherapy, and neurostimulation techniques. Deep brain stimulation (DBS) has been considered a therapeutic approach for refractory TS and its comorbid symptoms. However, systematic comparison is necessary to understand the therapeutic effect of DBS among patients with TS with various comorbid symptoms, demographic characteristics, or stimulation targets. Consequently, our research aimed to assess the clinical efficacy of DBS in alleviating the symptoms of TS and its comorbidities. A systematic literature search was conducted across five databases: PubMed, Web of Science, MEDLINE, Embase, and PsycINFO. The primary outcome was the mean change in the global score of the Yale Global Tic Severity Scale (YGTSS), which assesses the severity of tics. The secondary outcomes included mean improvement of comorbid symptoms, such as obsessive-compulsive behaviors (OCB), depression symptoms and anxiety symptoms. In total, 51 studies with 673 participants were included in this meta-analysis. Overall, the DBS led to a significant improvement in tic symptoms (p ​< ​0.001), as well as the comorbid obsessive-compulsive, depression, and anxiety symptoms with effect sizes of 1.88, 0.88, 1.04, and 0.76 accordingly. In the subgroup analysis, we found that striatum stimulation led to a more significant improvement in OCB in patients with TS compared to that observed with thalamic stimulation (p ​= ​0.017). The relationship between sex, age, and target with the improvement of tics, depression, and anxiety was not statistically significant (p ​= ​0.923, 0.438, 0.591 for different male proportions; p ​= ​0.463, 0.425, 0.105 for different age groups; p ​= ​0.619, 0.113, 0.053 for different targets). In conclusion, DBS is an efficient treatment option for TS, as well as the comorbid OCB, depression symptoms, and anxiety symptoms. It is important to highlight that stimulating the striatum is more effective in managing obsessive-compulsive symptoms compared to stimulating the thalamus.

Quantitative risk assessment of college campus considering risk interactions

Because of the more emerging risks and stronger risk interactions, the risk of college campuses as well as students and staff received more and more attention. Current works on campus risk mostly focus on single-category factors, and few of them considered risk interactions. Therefore, an integrated model for assessing comprehensive risks on the campus is proposed to put forward risk reduction strategies. First, a comprehensive risk identification of the college campus is conducted by integrating the modified egg model and the fault tree. Then, DEMATEL (Decision-Making Trial and Evaluation Laboratory) is applied to quantify the complex risk interactions and determine the influential causes for further modelling. Finally, the Bayesian network is established for cause diagnosis, consequence prediction, and risk reduction. The identified most sensitive cause is alcohol use. In the case of the four sensitive causes simultaneously occurring, the probability of high campus risk will increase from 21.9% of the original to 39.4%. Moreover, an efficiency analysis of different risk reduction strategies is performed to determine the most efficient risk reduction strategy. The results indicate that the proposed methodology may of great significance for the risk reduction of the college campus in the changing age.