Reply to a Letter to the Editor Entitled “Comment: The Rush Video‐Based Tic Rating Scale‐Revised: A Practice‐Oriented Revision” Responding to our Paper “the Rush Video‐Based Tic Rating Scale‐Revised: A Practice‐Oriented Revision”

We thank Becker et al for their interest in our recently published revision of the modified rush video‐based tic rating scale (MRVS‐R). ¹ Herein, we respond to the critique and suggestions.

Becker et al suggest to add the explicit instruction to patients not to voluntarily suppress their tics. Such directions were never part of the MRVS ¹ , ² , ³ and we do not favor drawing attention to the subject's tics with any particular focus. According to the original study, ² tic counts increased nearly fourfold when the examiner left the room without any specific instructions compared to the recording with the examiner in the room. From these data and our long‐term experience videotaping patients with tics, we do not see a specific justification to insert new instructions. We would be interested, however, in a study that does use this instruction so that future decisions could be made based on data, as the original manuscript provided.

Becker et al argue that the instruction to “keep eyes open” for accurate blink rate determination may suppress eye tics. For the original scale, the instructions were tested in patient groups, and we were conscious that children especially need to be guided on what they should be doing. The instructions are NOT “force your eyes open,” “open your eyes as widely as possible,” or “do not close your eyes.” Rather the sentence is simple guide to allow a full‐face recording for eye and facial tic assessments.

Contrary to the assertion of Becker et al, the (M)RVS ² , ³ , ⁴ specifies the evaluation of a 1 min segment rather than a 2.5 min segment. Accordingly, we do not suggest to reduce the rating time, but the recording time (from 10 to 5 min). However, to simplify the procedure all tics shall now be rated based on one single 1 min video segment, instead of one for “head tics” and another one for “body and vocal tics.” In the interest of further standardization, we suggest to select a video segment that starts 1 min after the examiner has left the room. Based on our results, these modifications do not result in significant differences.

Becker et al claim that a convergent validity between the MRVS(−R) and the Yale Global Tic Severity Scale‐Total Tic Score is not desirable strikes us as an odd comment of judgment. Having a high correlation shows that indeed we are measuring the same overall entity even with two completely different strategies. Thus, the MRVS‐R captures in 1 min information that echoes an instrument that collapses information from multiple sources over a longer time period and takes several minutes to complete.

Ultimately, the utility of our revision will be answered by its use in clinical care and research efforts. With the increasing international emphasis on precision medicine and individualized care, we strongly favor an objective measure of tics that is practical for patients and raters and recorded by a brief and standardized protocol so that it can be evaluated by multiple raters, and archived for later reference.

Author Roles

(1) Research project: A. Conception, B. Organization, C. Execution; (2) Statistical Analysis: A. Design, B. Execution, C. Review and Critique; (3) Manuscript: A. Writing of the first draft, B. Review and Critique.

R.R.: 1ABC, 2ABC, 3B

E.J.: 1AB, 2AC, 3B

J.E.: 1C,3B

M.H.: 2C, 3B

C.G.G.: 1A, 3B

G.T.S.: 1A, 3B

K.M.V.: 1AB, 2AC, 3AB

Disclosures

Ethical Compliance Statement: The local ethics committee of the Medizinische Hochschule Hannover has approved the study (No. 8339_BO_S_2019). We use the software SoSciSurvey to obtain written informed consent from patients and document it. 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.

Funding Sources and Conflicts of Interest: Nothing to report.

Financial Disclosures of the Previous 12 Months: Rica Riechmann, Ewgeni Jakubovski, Jana Essing, and Martina Haas have no financial disclosure to report. Christopher G. Goetz: Consulting or Advisory Board Membership with honoraria: Consulting honorarium for Genentech. Grants/Research: Funding to Rush University Medical Center from NIH, Department of Defense, and Michael J. Fox Foundation for research conducted by Dr. Goetz. Honoraria: Faculty stipend from the International Parkinson and Movement Disorder Society. Guest professorship honorarium provided by Charlotte County Medical Society. Educational web‐based educational program sponsored by Oruen Ltd London UK. Intellectual Property Rights: none. Ownership interests: none. Royalties: Elsevier Publishers, Wolters Kluwer Publishers, Oxford University Press. Salary: Rush University Medical Center. Glenn T. Stebbins: Consulting and Advisory Board Membership with honoraria: Adamas Pharmaceuticals, Ceregene, Inc., CHDI Management, Inc., Cleveland Clinic Foundation, Neurocrine Biosciences, Inc., Ono Pharma USA, Inc., Pfizer, Inc., Tools‐4‐Patients. Grants and Research: National Institutes of Health, Department of Defense, Columbia University, Dystonia Coalition, CHDI, International Honoraria: International Parkinson and Movement Disorder Society, American Academy of Neurology, Michael J. Fox Foundation for Parkinson's Research, Food and Drug Administration, National Institutes of Health, Alzheimer's Association. Intellectual Property Rights: none. Ownership interests: none. Royalties: none. Expert Testimony: none. Salary: none. Kirsten Müller‐Vahl has received financial or material research support from DFG: GZ MU1527/3–1 and GZ MU 1527/3–2 and Almirall Hermal GmbH. She has received consultant's and other honoraria from Canymed, Emalex, Eurox Group, Sanity Group, Stadapharm GmbH, Swiss alpinapharm, Synendos Therapeutics AG, Tetrapharm, and Triaspharm. She is an advisory/scientific board member for Branchenverband Cannabiswirtschaft e.V. (BvCW), Sanity Group, Synendos Therapeutics AG, SyqeMedical Ltd., and Therapix Biosciences Ltd.. She has received speaker's fees from Almirall, Bundesverband der pharmazeutischen Cannabinoidunternehmen (BPC), Cogitando GmbH, Emalex, Grow, Medizinischer Dienst Westfalen Lippe, Noema, streamedup! GmbH, and Vidal. She has received royalties from Elsevier, Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin, and Kohlhammer. She is an associate editor for “Cannabis and Cannabinoid Research” and an Editorial Board Member of “Medical Cannabis and Cannabinoids” und “MDPI‐Reports” and a Scientific board member for “Zeitschrift für Allgemeinmedizin.