Hospital neurology and neurophysiology services are increasingly overwhelmed. With a growing and ageing population, the incidence of neurological conditions is increasing. Compounded by the COVID-19 pandemic, there are now over 10,000 people in the UK waiting more than a year for an appointment with a neurologist.
N-CODE is addressing these challenges through the development of new technologies that enable diagnosis and management in the community rather than the hospital environment. This could mean though community diagnostic hubs, high-street healthcare professionals, GP surgeries, mobile units or even to the home environment.
Digital solutions built around neural interfacing, signal processing, machine learning and mathematical modelling as enabling technologies offer significant potential for addressing many challenges currently faced by people with neurological conditions and those responsible for their care.
For example, they will lead to novel biomarkers for diagnosis, prognosis and monitoring of neurological, neuropsychiatric or neurodevelopmental conditions, as well as markers that inform new therapies for (neuro)rehabilitation and clinical management. Working in close cooperation with partners who are developing new technologies for measuring brain, eye, spinal, and peripheral nerve activity using wearable technology and minimally invasive devices, as well as hand-held scanners and transportable machines, will accelerate the transformation to community-based care.
To achieve this, we have built a network of partners with backgrounds spanning academia, industry, hospitals and GP surgeries, charities and policy makers. Crucially we ensure that people with lived experience of neurological conditions are at the heart of our network. Their experience informs debate and shapes our research priorities, ensuring feasibility and acceptability of emerging technologies.
Case studies from our N-CODE investigators
Professor John Terry (in partnership with Neuronostics Ltd) has developed biomarkers that are predictive of the likelihood of an individual having epilepsy. These biomarkers utilise mathematical models that are personalised using routinely acquired clinical data (EEG) and so provide a prediction of the likelihood of future seizures that is specific to the individual, instead of a population average.
Professor Rohit Shankar MBE (in partnership with SUDEP Action) has led the development of the seizure safety checklist, which was translated into the EpSMon smartphone app. The app can predict an elevation in the likelihood of sudden death from epilepsy, enabling people with epilepsy to participate in taking preventative lifestyle changes. The app has won 8 national awards and features in the NHS RightCare Toolkit for epilepsy and is now available to over 50% of GP practices via EMIS patient record systems.
Professor Dario Farina has developed and translated wearable interfaces that provide access to individual neural cells in the spinal cord from wrist- or arm-mounted sensors. This predictive technology is providing personalised diagnosis and treatment of both essential and Parkisonian tremor.
Professor Alexandra Sinclair has pursued a participatory approach (in partnership with the James Lind Alliance) that has established headache and raised brain pressure (idiopathic intracranial hypertension (IIH)) as a top priority for patients. She has driven changes in patient care though personalised patient approaches supported by delivering clinical trial evidence disseminated in international treatment guidelines. For example, predicting and tracking ocular disease using innovation in ophthalmic monitoring and identifying markers to predict increased risk of cardiovascular disease in IIH.
Professor Christopher James has developed infrastructure for automated analysis of data collected using off the shelf devices, home medical devices, smartwatch and phone apps. These predictive techniques enable personalised behaviour change solutions and so have facilitated a participatory relationship between patients and clinicians.
Meet the Team
Professor John Terry
Professor Alexandra Sinclair
Professor Dario Farina
Professor Rohit Shankar MBE
Professor Christopher James
Dr Rebecca Ward
Dr Caroline Gillet
The N-CODE Steering Group provides strategic direction, priority setting, funding decision making and advocacy in order to ensure that N-CODE delivers against its objectives. It is independently chaired by Professor Stafford Lightman FRS, University of Bristol and co-founder of URHYTHM.
The Steering Group is made up of the core investigator and management team alongside members from our partner organisations, lay representation and an observer from the EPSRC. The current membership is:
On Monday 10th October, N-CODE held an online launch event to present the network to the partners. The host, Professor John Terry, N-CODE Principal Investigator, provided the partners with further insight into the vision for N-CODE, introduced the network’s current team and discussed opportunities for involvement, funding, mentorship and training. The event also provided space for discussion between attendees on what activities N-CODE can offer to support their research & development, what skills and expertise are needed and what areas of research should be prioritised.
Our project partners are at the heart of the network and involving stakeholders from across healthcare, academia, industry, charities, policy makers and people with lived experience of neurological conditions means that we can co-create synergistic research to maximise the likelihood of impact on people’s lives.
We are always looking for new partners to join us. Our current list of project partners is:
Equality, Diversity & Inclusion
Our approach is inclusive and multi-disciplinary with a clear focus on Equality, Diversity and Inclusion (EDI). N-CODE knows that diverse teams deliver high quality research outcomes. Furthermore, Equality, Diversity and Inclusion approaches lead to happy and healthy research teams. N-CODE wants to encourage, support and respect ideas from everyone and ensure our inclusive activities are representative of our network’s community.