Reply: Comorbid Obsessive Compulsive Disorder in Tourette's Syndrome: Questioning its Impact
Bibliographic record
Abstract
We are grateful for the insightful comments3 on our study5 by Ms. Hanafi and Prof. Lavoie regarding the potential impact of comorbid obsessive-compulsive disorder (OCD). While the active and sham stimulation arms did not have statistically significant differences, we acknowledge the higher presence of OCD as a comorbidity in the active stimulation group. Despite lack of difference in baseline Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores and inclusion criteria requiring stability in comorbidities, we agree that there may be an influence of milder OCD symptoms. The question of the intersection between premonitory urge and OCD has been a topic of interest in the literature. The Premonitory Urge for Tics Scale (PUTS) is a nine-item measure which incorporates various phenomenological descriptors of urges (feeling itchiness, pressure, tension, not “just right,” not complete, or an energy in the body) and question on frequency, relief after tics, and overall tic suppression ability.3 While correlations between PUTS and OCD severity have been identified by some,4 other studies have failed to find differences in PUTS scores between participants with or without OCD1. Interestingly, however, there may exist item-level differences (for example higher report of feeling tense or “wound up” in those with OCD).2 Evaluating urge outside of the PUTS, one study identified higher urge intensity, but not frequency, associated with OCD.1 Given the small sample size, our study was not adequately powered to detect impact of the intervention on comorbidities including OCD. The detection of changes in the Yale Global Tic Severity Scale (YGTSS) and Premonitory Urge for Tics Scale (PUTS), which are informed by patient experience, rather than video-based tic counts, supports the notion that transcranial direct current stimulation (tDCS) is influencing the overall experience of tics beyond just frequency. Larger studies are therefore required to interrogate exactly which individuals—with unique comorbidity profiles—stand to benefit from tDCS. Funding Sources and Conflict of Interest: No specific funding was received for this work. The authors declare that there are no conflicts of interest relevant to this work. Financial Disclosures for the Previous 12 Months: YM has no additional disclosures to report. DM has received consultancies fees from Roche, and honoraria as speaker from Abbvie, Merz Pharmaceuticals, the Dystonia Medical Research Foundation Canada, the International Parkinson's Movement Disorders Society, and Canadian Movement Disorders Society. He receives honoraria as scientific advisor for the Ministry of University and Research of Italy. He receives royalties from Springer-Verlag and Oxford University Press. He has received research grants from the Weston Family Foundation, the New Frontiers for Research Fund, the Neuroscience, Rehabilitation and Vision Strategic Clinical Network of the Alberta Health Services, the National Institutes of Health (Dystonia Coalition), the Canadian Institutes of Health Research, the Parkinson Foundation, the Azrieli Foundation and the Calgary Parkinson's Research Initiative (CaPRI). He is a site PI for a clinical trial for UCB and for an observational study supported by MRM Health NV and Nimble Science. DM is chair of the Research Committee of the Board of the charity Parkinson's Association of Alberta. Ethical Compliance Statement: Institutional review board approval was not necessary for this study. Informed patient consent was not necessary for this work. We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this work is consistent with those guidelines.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.012 |
| Meta-epidemiology (narrow) | 0.002 | 0.002 |
| Meta-epidemiology (broad) | 0.003 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.013 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; both teacher heads agree on what is shown here.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".