Median nerve stimulation in tic disorders

A long-awaited episode with Professor Stephen Jackson and Dr Barbara Morera from the University of Nottingham and Neurotherapeutics Ltd. 

They have been developing "a safe and effective non-drug treatment that reduces tics and the urge to tic, through gentle stimulation of the median nerve in the wrist". 

We are grateful to them for taking the time to answer very important questions that help us understand the effect of median nerve stimulation on tic suppression. 

Please find below the questions addressed and the key points of our conversation. 

• Why is non-invasive stimulation of interest in the pathophysiological mechanism of tic generation?
• How did the idea of using peripheral stimulation in modulating cortical motor excitability in tics occur?
• When exploring the effect of median nerve stimulation on tic suppression in your study, what was your methodology (in terms of number of participants, inclusion criteria e.g. comorbidities, time and recurrence of stimulation, assessment of efficacy)?
• What did it show? Did the MNS lead to a statistically significant reduction of tics?  
• Is MNS supposed to work only during stimulation?
• You showed that rhythmic but not arrhythmic trains of MNS lead to entrainment of 12 Hz oscillations and are of interest in tic reduction, is that right? How would you interpret this result?
• In your work, tic intensity and tic frequency were studied.

1. What scale did you use?
2. Did you distinguish vocal tics and motor tics?
3. Did the participants have particularly severe forms of TS?

• How did you demonstrate that these results are not only the effects of distraction?
• What is the effect of MNS of volitional movements and cognitive function?
• Who would benefit the most from MNS? / For what use in real life would MNS be useful? Both for children and adults? 
• What do people feel when receiving this stimulation? Is it painful, irritating, annoying, strange?
• Does MNS have a main effect or PU or tics? Are we able to know at this point
• Is there a study planned with a larger sample or another objective? 
• Is there another use of MNS in movement disorders?
• When do you think it will be available on the market? At what price?

Stephen Jackson is Professor of Cognitive Neuroscience at the University of Nottingham and Director of the University’s Centre for Neuromodulation, Neurotechnology, and Neurotherapeutics. He is a co-founder of Neurotherapeutics Ltd, a university medical device spin-out established in 2021 to develop a wearable for of non-invasive brain stimulation (the Neupulse device) for the treatment of tic disorders. His current research focuses on developing non-invasive brain stimulation treatments for a range of brain disorders and mental health conditions.

Dr Barbara Morera is a neuroscientist who has been working with Prof. Stephen Jackson on the development of a non-invasive treatment for Tourette Syndrome and Chronic Tic Disorder for the last 8 years. Co-founder of the company Neurotherapeutics, a spin out company from the University of Nottingham, founded with the aim to make this treatment available for those who would like to control their tics.