John Terry, co-founder and managing director of Neuronostics, speaks to Med-Tech Innovation News after the company behind brain biomarkers for better detection and monitoring of epilepsy.
Rob Lacey
John Terry from Neuronostics delivers his pitch at Med-Tech Innovation Expo. Photo: Rob Lacey
First, congratulations on winning the Pitch competition. How did you feel when you were declared the winner?
Wow, it was a pretty amazing feeling. With 10 other start-ups, all working on great ideas and tech, the field was tough. When the panel chair was giving feedback on what constituted a good pitch, I was mentally ticking off the aspects we’d covered. So come the end I was thinking we were in with half a shout, but it was still amazing for Neuronostics to be announced as the winner. And whilst I’m the front of house, so to speak, it’s really a team effort and a great reflection of the hard work everyone is putting in!
For those who weren't in attendance, tell us about Neuronostics?
We’re on a mission to revolutionise diagnosis and prognosis of neurological conditions. Spun out of the University of Exeter in 2018, we’re currently developing a cloud-based platform to support clinical decision making in epilepsy. Right now, we’re a team of 10 with scientific, technical, commercial, and clinical expertise based in the heart of Bristol at the Engine Shed. We’re part of the SETsquared accelerator, which is a fantastic community that supports emerging companies with a focus on tech.
What does your innovation do that others don't in the area of epilepsy?
At present, if you want to confirm a case of epilepsy you really need to see a seizure, or a signature of a seizure, in a clinical test called an EEG. This test measures the large-scale electrical activity of the brain, which can become disrupted and result in a seizure. However, most people with epilepsy most of the time don’t have seizures and so their electrical activity appears apparently normal. This makes diagnosis very challenging. In contrast, we have developed an approach that enables us to create a personalised computer model of the brain that is informed by these apparently normal EEG recordings. We use this model to understand how easy it is for seizures to emerge, and this ease informs a risk score that we call BioEP (short for Biomarker of Epilepsy). We provide a report to the treating neurologist, who can use the risk score alongside other information they have collected to determine the most appropriate next steps for the person with suspected epilepsy.
By analogy, imagine going to the mechanic suspecting there is something wrong with your car and the mechanic asks you to drive down the road so they can observe what happens. If you fail to brake effectively and crash, only then does the mechanic realise there’s a problem with your tyres. This is effectively how epilepsy diagnosis works at present. For cars we have markers of tyre or brake wear that tells us when we need to replace them to reduce the risk of accidents. Until now, we haven’t had robust markers of future seizure risk. Our innovation – BioEP – provides this.
Can you tell us what kind of work has gone into the development of this biomarker?
Rob Lacey
Martin Hunt (L) from NIHR with John Terry (R) from Neuronostics
For the first few years, we were focused on fundamental research. By this I mean creating mathematical models that could describe the transition between apparently healthy brain states and pathological brain states (such as seizures). At first these models described the brain activity within a single region of the brain, but over time we extended them to describe an interacting network of brain regions. In this description the emergence of seizures can be due to alterations in the brain network or the brain dynamics within a region or regions, or even a combination of both.
From these early theoretical studies, we then sought evidence that these mechanisms could exist in the human brain. To do this, we have worked really closely with clinicians and people with epilepsy to develop a carefully controlled database of human EEG recordings. From these recordings we found evidence that the mechanisms we proposed theoretically were present in many people with epilepsy. This exciting finding ultimately led to the development of BioEP.
At the heart of your development appears to be a seizure risk score, how did you develop something that can quantify the risk of such events?
Building from our research, we developed a suite of patented algorithms that could extract information about brain networks from clinical EEG recordings that are collected routinely as part of the diagnostic journey for someone with suspected epilepsy. We use these recordings to create a patient-specific representation of the brain. Simulating the model under a variety of different conditions gives you an indication of how easily the specific brain network can enable transitions into seizure like brain states. This likelihood informs the risk score.
What kind of support have you received in recent years?
We’ve been really fortunate to have received significant financial and business development support. We’ve received over £1.5 million in grant funding from Innovate UK and NIHR, as well as smaller grants from the West of England Business Innovation Fund and the Epilepsy Foundation. Last year we also closed an oversubscribed pre-seed round, raising £300,000 from a group of nine angel investors. However, beyond the financial support we’ve also really benefited from belonging to communities like SETsquared, as well as being a part of the Creative Destruction Laboratory. We’ve just graduated from the scheme, and this provided us with access to a range of mentors with global expertise in the medtech space.
What next for Neuronostics?
We’ve just launched our next funding round, which will enable us to complete prospective studies of the BioEP technology, as well as to develop new markers for other clinical indications such as autism, dementia, and traumatic brain injury. These are all conditions that commonly co-exist with epilepsy.
Anything else that you'd like to tell us?
We’d love to hear from people who can contribute to our mission to revolutionise diagnosis and prognosis of neurological conditions. Whether you are a person with a neurological condition, a clinician interested in using our technology or demonstrating its efficacy, an industry partner with whom we can collaborate or an investor looking to support us on our journey feel free to reach out on info@neuronostics.com.
