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Pioneering Tourette technology inspires Parkinson’s tremor study

A study funded by Parkinson’s UK is exploring if technology that eases the tics associated with Tourette syndrome could also help reduce tremor in people living with Parkinson’s. Early career researchers Caitlin Smith and Mairi Houlgreave explain. 

The Parkinson’s UK study follows on from our work with a team led by our PhD supervisor Professor Stephen Jackson, who created and developed a watch-like device that helps suppress unwanted, uncontrollable tics in people living with Tourette’s.  

It works by delivering rhythmic electrical pulses to the median nerve in the wrist, which clinical trials have shown reduces the amount and severity of tics in people with Tourette syndrome. The technology’s potential to transform thousands of lives attracted huge interest and the device has been commercialised and further developed by a º£½ÇºÚÁÏ spin-out company, Neupulse. The award-winning hit film I Swear, which depicts how Tourette’s campaigner John Davidson MBE took part in trials for the device, shone a further spotlight on this breakthrough. 

Could this technology be applied to other neurological conditions? 

Such global attention also prompted the question – could this amazing technology be applied to other neurological conditions? Professor Jackson was contacted by Parkinson’s UK, and we’re now half-way-through a two-year study exploring if this approach could be used to reduce tremor, which affects 75% of people with Parkinson’s Disease (PD).  

With the support of the East Midlands Parkinson’s Research Interest Group (PEMRIG) and Parkinson’s UK, we’re now 75% recruited. We’re aiming for 60 participants who experience resting hand or arm tremor. Half are randomly selected to receive the active stimulation we believe may work, and the remaining 30 use a sham device which offers stimulation to different parameters so that the placebo is not immediately obvious. We’re hugely grateful to our participants. They are incredibly generous with their time, making multiple visits here and sharing detailed information about their symptoms.  

We’re using 10 Hz electrical stimulation (10 pulses a second) to test its effects on tremor, while our colleague and study lead Kat Gialopsou is testing whether varied stimulation frequencies (5, 10, or 20 Hz) work better for different people, and combining stimulation with EEG to understand why. 

Each participant completes questionnaires and movement tasks, and wears an accelerometer (an electromechanical sensor) at home so we can capture how their tremor naturally varies throughout the day and across medication cycles. The accelerometer data is analysed by Yordan Raykov in Mathematics, while our collaborator in Computer Science, Alex Turner, is using machine‑learning methods to help identify tremor changes from video recordings of study participants. All this gives us rich, multilayered data, with objective evidence supporting highly valuable insights from our participants’ lived experience. 

Although it is too early to draw conclusions, many participants tell us they feel calmer when the stimulation is applied. Some describe subtle but noticeable reductions in tremor. Unlike Tourette’s, where tic changes can be dramatic and immediate, changes in Parkinson’s tremor can be smaller and more nuanced, but still meaningful.

"As early career researchers, we're proud to contribute to the university's world-leading reputation for brain health innovations, and it is so rewarding to help rapidly delivery discoveries that change lives.

Dr Mairi Houlgreave and Dr Caitlin Smith

Personalisation may be key for Parkinson’s  

Personalisation may be key, with devices calibrated to frequencies that work best for the wearer. In future, a personalised “at‑home” device, similar to the pathway used for Tourette’s, could be possible. 

This is the first study of its kind in the world, and we’ve found our participants are very open to median nerve stimulation as an approach that offers a degree of autonomy and control.  In a similar way for people living with Tourette's, neuromodulation techniques offer non-invasive, non-drug treatments for people with PD. A wearable, personal device that’s activated as the individual requires also offers a higher degree of autonomy in their lives, and the potential to control tremor during day-to-day activities offers hope to people living with Parkinson’s.

Although our current trial focuses on Parkinson’s tremor, we’re already exploring other conditions. We’ve piloted work with ataxia, and we’re writing up findings from studies targeting OCD and anxiety. Caitlin is also investigating combined forms of stimulation to aid people with Tourette’s who don’t respond to the standard protocol. Early piloting for essential tremor (a nuerological movement disorder) is under way as well.

Looking ahead, we’ve submitted a grant proposal to explore focused ultrasound stimulation as a non‑invasive form of “deep brain stimulation without surgery” for Parkinson’s.  

A faster pathway to impact 

We were PhD (Mairi) and undergraduate (Caitlin) students here when the first Tourette’s proof‑of‑concept studies were happening. It’s exciting that the translation pathway is much faster than it was a decade ago, as the wrist‑worn device is already in development through the university spin‑out Neupulse. We are now part of the Centre for Neurotechnology, Neuromodulation and Neurotherapeutics (N3), which brings together scientists, engineers, clinicians and people with lived experience of brain health conditions to develop devices and technology to help diagnose and treat a range of conditions. 

As early‑career researchers, we’re proud to contribute to the university’s world-leading reputation for brain health innovations, and it is so rewarding to help rapidly deliver discoveries that are changing lives.