A Review of the Evidence and Current Applications of Portable Translingual Neurostimulation Technology

Neuromodulation. 2021 Dec;24(8):1377-1387. doi: 10.1111/ner.13260. Epub 2020 Sep 3.


Objectives: Translingual neurostimulation (TLNS) with adjunct physical rehabilitation is used to treat balance and gait deficits in several chronic neurological conditions. The purpose of this review is to summarize and appraise the evidence currently available on the portable TLNS device and to assess its potential clinical application.

Materials and methods: In this narrative review, MEDLINE, EMBASE, Web of Science, and Google Scholar were searched for primary research investigating the use of portable TLNS devices on any neurologic condition. Data were extracted, reviewed, and appraised with respect to study design, conduct, and reporting.

Results: Five randomized controlled trials (RCTs), three quasi-experimental trials, and seven case reports/series were found. Most studies demonstrated improvements in balance and gait deficits secondary to traumatic brain injury and multiple sclerosis, but evidence is also present to a lesser degree for stroke and balance disorder patients. In these studies, the feasibility and safety of TLNS have been convincingly demonstrated. Functional magnetic resonance studies have also suggested a plausible neuroplastic therapeutic mechanism. However, the efficacy of TLNS remains unclear due to bias and confounding within studies, and heterogeneity of results between studies.

Conclusions: TLNS is a promising treatment modality for various chronic neurological conditions that are often refractory to conventional therapy. However, TLNS technology remains largely investigational as high-quality RCTs are still required to elucidate efficacy, optimal dosages, necessary treatment durations, and treatment durability. Further research to develop an appropriate control group is needed for scientifically valid comparisons of TLNS.

Keywords: Brain injury; cranial nerve stimulation; high-frequency electrical stimulation; low-frequency electrical stimulation; multiple sclerosis (MS); neurostimulation; rehabilitation; stroke.

Publication types

  • Review

MeSH terms

  • Brain Injuries, Traumatic*
  • Humans
  • Magnetic Resonance Imaging
  • Neuronal Plasticity
  • Stroke*
  • Technology