by Jane Icke, University of Nottingham

Credit: University of Nottingham

Two technologies that are based on research by University of Nottingham experts to reduce the severity of tics in people with Tourette syndrome (TS) are closer to patient use after being recommended in draft guidance by NICE.

The two technologies are being developed utilizing research and clinical trial results from University of Nottingham scientists to develop innovative products that are non-invasive and effective in treating the symptoms of TS. This is the first time a NICE committee has recommended digital therapies for this condition.

TS is a neurodevelopmental condition that is usually diagnosed between the ages of 8 and 12. It causes involuntary sounds and movements called tics. Tics are repetitive, stereotyped movements and vocalizations that occur in bouts, typically many times in a single day, and are often preceded by a strong urge-to-tic, referred to as a premonitory urge.

A wrist device that delivers electrical pulses to reduce the amount and severity of tics experienced by individuals with TS is being developed by spin-out Neupulse. The device is being developed based on research conducted by scientists from the University of Nottingham’s School of Psychology and School of Medicine who found that using repetitive trains of electrical stimulation to the median nerve (MNS) at the wrist to entrain rhythmic electrical brain activity—known as brain oscillations—can suppress movements. They found that rhythmic MNS substantially reduces tic frequency and tic intensity, and removes the urge-to-tic, in individuals with TS.

“This NICE recommendation is a significant step forwards in getting the Neupulse wrist device closer to patient use. Our trials of the prototype device showed that people who received active stimulation saw a reduction in tic frequency of more than 25% while they received stimulation. The results showed the positive impact the device could have on people with TS, providing them with control over their tics could be life-changing,” says Professor Stephen Jackson.

The Online Remote Behavioral Intervention for Tics (ORBIT) is a digital tool that is based on research from the School of Medicine that is being developed by NIHR’s MindTech HealthTech Research Center.

ORBIT can be accessed via a web browser and is an online guided self-help intervention which uses videos, animations and interactive scripts to help children and young people aged 9 to 17 years. It is supported by an online therapist (e-coach) across a 10-week program to deliver a form of behavioral therapy called an exposure with response prevention, which involves practicing confronting the thoughts, images, urges, and situations that make a person anxious and provokes their tic.

In a large, randomized control trial published in The Lancet in 2021, ORBIT was shown to be clinically and cost effective, doubling the rate of important clinical improvement in tics, with durable benefits lasting 18 months after the intervention.

“ORBIT represents a huge leap forward in our ability to improve access to evidence-based care for thousands of young people with tic disorders, who currently have little or no access to tic behavioral therapy.

“We are delighted with the NICE recommendation which moves ORBIT digital therapy closer to being routinely available in the NHS and offers hope to many thousands of young people with tic disorders who currently have no access to behavioral therapy for tics,” says Chris Hollis, professor of child and adolescent psychiatry and Digital mental health/director of MindTech.

Each technology would only be offered after clinical assessment with a GP and a diagnosis of tic disorder/Tourette. The first line intervention will remain as psychoeducation, which combines the elements of cognitive-behavior therapy and education, before one of the two technologies could be offered.

“Our committee heard that diagnosis, treatment and support for people with chronic tic disorders and TS can be variable depending on which part of the country they live in. For many, it can take several months to receive a diagnosis, and our patient survey has highlighted that treatment options can be limited.

“Our committee’s recommendation of these two technologies could increase treatment options and could allow more convenient treatment for people wherever they live, be that urban or rural, given the inconsistency in access,” says Mark Chapman, director of HealthTech at NICE.

Neupulse can be used once it has appropriate regulatory approval—it is currently working towards CE and UKCA marking (expected 2026)—and meets the standards within NHS England’s Digital Technology Assessment Criteria (DTAC).

After the consultation, responses will be considered by the committee who may then alter their recommendations before final guidance is published on the website.

A consultation on the draft recommendations has begun and comments can be submitted until Tuesday 17 December 2024.

Journal information:The Lancet

Provided by University of Nottingham

---

Explore further

Clinical trial shows wrist device significantly reduces tics in Tourette syndrome