Two technologies that are based on research by University of Nottingham experts to reduce the severity of tics in people with Tourette's are closer to patient use after being recommended in draft guidance by NICE.
The two technologies are being developed utilising research and clinical trial results from University of Nottingham scientists to develop innovative products that are non-invasise and effective in treating the symptoms of Tourette's. This is the first time a NICE committee has recommended digital therapies for these conditions.
Tourette Syndrome (TS) is a neurodevelopmental condition that is usually diagnosed between the ages of eight and 12. It causes involuntary sounds and movements called tics. Tics are repetitive, stereotyped movements and vocalisations 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 (PU).
A wrist device that delivers electrical pulses to reduce the amount and severity of tics experienced by individuals with Tourette's 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 remove 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 Tourette's, providing them with control over their tics could be life-changing.
The Online Remote Behavioural 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 Centre. 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 programme to deliver a form of behavioural therapy called an exposure with response-prevention, which involves practicing confronting the thoughts, images, urges, and situations that makes a person anxious and provokes their tic. In a large randomised control trial published in the Lancet, 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 intervetion.
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 behavioural 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 behavioural therapy for tics.
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 behavioural therapy for tics".
Each technology would only be offered after clinical assessment with a GP and a diagnosis of tic disorder/Tourettes. The first line intervention will remain as psychoeducation, which combines the elements of cognitive-behaviour therapy and education, before offering one of the two technologies could be offered.
Our committee heard that diagnosis, treatment and support for people with chronic tic disorders and Tourette syndrome 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.
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 our website.
A consultation on the draft recommendations has begun and comments can be submitted until Tuesday 17 December 2024.
