Medicine and wellbeing
Setting Tourette’s sufferers free
By sending tiny electric pulses to the wrist, a watch-like device is giving new hope to children and people around the world who live with the agony of unwanted and uncontrollable tics.
When Barbara Morera and fellow researchers from the schools of Psychology and Medicine first witnessed the reactions of participants in a clinical trial of a revolutionary treatment designed to ease the torment of people living with Tourette syndrome (TS), she admits to being amazed – and moved.
The wearable device delivers rhythmic electrical pulses to the wearer’s wrist, with the aim of reducing the verbal and physical tics associated with Tourette’s.
For Charlie, one of the participants, the trial was life-changing. In a video included in a breakthrough research study published in Current Biology (June 2020) by Dr Morera, as the electrical pulses to his wrist increase, his verbal and physical tics subside, and a look of beatific calm and wonderment passes over his face.
Charlie, 21, describes it as a completely shocking experience…”I was silent and still. I felt as if finally, a new treatment may have been found to free myself from my Tourette’s and wanted to cry with happiness.”
All 19 participants in the trial had similar experiences, with their tics and the debilitating urge to tic both significantly reduced.
Dr Morera said the results of the trial delighted everyone in the team led by Professor Stephen Jackson, who adds: “It was stunning to see Charlie’s video for the first time – we don’t have to show the stats on our work, just the video!”
The success of the trial, conducted with the support of the charity Tourette’s Action and NIHR (National Institute for Health Research) Nottingham Biomedical Research Centre, attracted interest around the world and was the springboard for the creation of a University of Nottingham spinout company, Neurotherapeutics Ltd.
Neurotherapeutics is manufacturing the device, which resembles an Apple watch or Fitbit. It will be used for a full clinical trial in November 2021 involving 135 participants from around the UK and again funded by Tourette’s Action, with support from the University of Nottingham.
Dr Morera says the trial has no shortage of volunteers. The team has been inundated with inquiries from the UK, Europe, North America and across the world. People living with the neurodevelopmental disorder and their families say they are prepared to fly to the UK at their own expense to take part in the trial. Others ask if they can buy one of the devices.
"This condition is particularly associated with children and can have a devastating impact on their lives and life chances, while being distressing for parents who see their child suffer every day. It’s amazing and rewarding to be able to potentially help so many people."
For the Nottingham team, such a reaction is humbling and a spur to making further advances. Previously, the most effective treatment for the condition has been deep brain stimulation – planting electrodes into the brain network, or psychological treatments, neither of which are readily available for the majority of sufferers. There is no pharmaceutical treatment for TS, only drugs used to treat other conditions.
Dr Morera, research and development director at Neurotherapeutics Ltd, said: “This condition is particularly associated with children and can have a devastating impact on their lives and life chances, while being distressing for parents who see their child suffer every day. It’s amazing and rewarding to be able to potentially help so many people. I’m lucky to be able to help and be part of this exciting project.”
The device and its novel application of peripheral nerve stimulation also offers exciting possibilities for the treatment of a wide range of brain conditions.
Professor Jackson explains: “About 90% of people living with TS have co-occurring conditions, such as OCD, anxiety disorder and ADHD, and we think that the underlying brain mechanisms for those are very similar, if not the same.”
PhD student Mairi Houlgreave is meanwhile answering fundamental questions, such as what happens in the brain before a tic? She is using new types of analysis for functional MRI, as well as using the world’s first wearable MEG (magnetoencepaholography) brain scanner, which allows people with movement disorders such as Tourette’s to be successfully scanned. Her research with the revolutionary MEG scanner, which itself is being commercialised by another university spinout company, Cerca Magnetics Limited, is being supported by the Medical Research Council. She said: “Our state-of-the-art imaging techniques allow us to take a fine-grained look at what happens in the brain before and during tics, which will give us a better understanding of the processes involved and how best to inhibit them. I’m also helping Barbara to test the peripheral nerve stimulation device with healthy participants, to verify that it's doing what we expected it to.”
The team’s investigation of the role of biomarkers in predicting when people are about to tic offers further exciting developments. Biomarkers could trigger the device to send pulses to the wearer and head off tics in circumstances such as going to school or being in a stressful or unfamiliar social situation.
As a member of the Nottingham Biomedical Research Centre, Dr Morera is studying the potential of peripheral nervous system simulation to tackle other brain conditions, and with Neurotherapeutics will explore applications of the device beyond Tourette’s.
Neurotherapeutics will commercialise the equipment, which, with further funding and development, could be available within two years.
CEO Paul Cable, who brings over 30 years’ experience developing and launching medical devices, said: “This is an exciting time for the new company. Over the next two years we will develop two products: an app to allow individuals with tics to track their symptoms and the wearable wrist device that will on request suppress an individual’s urge to tic. The wearable wrist device will help individuals gain control of their tics and in turn will help them fulfill their ambitions and dreams in life. This is an exciting opportunity to make a real difference to people’s lives.”
How it works
Professor Jackson, a world-leading pioneer of Tourette Syndrome (TS) research, explains: “The device works by modulating the brain networks that we think are involved in generating tics. Barbara’s research showed that when wearers of the device received electric pulses to the wrist’s median nerve, the urge to tic goes away, and their tics reduced massively.
“Our brains have strong rhythms or oscillations, due to the synchronous activity of brain cells within the region, when we are not moving. These desynchronise when we move. So our thinking was: if we actually increase the power and synchrony of those rhythms, it should make it harder to move, and therefore harder for these spontaneous and unwanted movements or tics to arise.
“Barbara’s and Mairi's research shows us that if we give a rhythmic set of peripheral nerve stimulations at a particular frequency, targeting those brain oscillations, we can increase their power and so reduce the likelihood of tics.”