TLNS for multiple sclerosis
Translingual neurostimulation (TLNS) is a non-invasive method that delivers patterned electrical impulses to the surface of the tongue while the patient performs gait and balance exercises. In multiple sclerosis it is used as an adjunct to physiotherapy for walking and balance deficits. The evidence in MS is mixed: two early controlled pilots were positive, while a sham-controlled trial published in 2026 did not find an added benefit at the dose used. This page presents both sides. RehaLine clinics have their own experience with this patient group: we accept patients with multiple sclerosis with an EDSS score of up to 6.0 for rehabilitation.
Who this page is for
TLNS is considered for adults with multiple sclerosis whose main functional problem is walking and balance: slow or unsteady gait, difficulty on uneven ground, fatigue after short distances, fear of falling. It is applied in a stable phase of the disease, alongside the disease-modifying treatment prescribed by the neurologist. TLNS does not act on the immune process or lesion load; its target is the motor and balance function that remains trainable.
How TLNS helps in multiple sclerosis
The tongue is innervated by the trigeminal and facial nerves, whose fibres terminate in the trigeminal and solitary nuclei of the brainstem. These nuclei are densely interconnected with the cerebellum, the vestibular nuclei and the reticular formation, the structures that regulate posture, balance and the automatic components of gait. In MS, demyelination is scattered across brain, brainstem, cerebellum and spinal cord, so walking depends on how well the remaining pathways compensate. Functional MRI shows that tongue stimulation changes activity in the pons and cerebellum for hours after the device is switched off; the exercises performed in this window are what the nervous system learns, and TLNS is applied only in combination with them. In MS patients, Leonard et al. (2017) found greater neuroplastic changes on MRI with real stimulation plus intensive rehabilitation than with sham.
What the evidence shows
| Study | Design | Result |
|---|---|---|
| Tyler et al., 2014, Journal of NeuroEngineering and Rehabilitation | Randomized double-blind controlled pilot, 20 people with chronic MS, 14 weeks | Positive: active stimulation plus exercise improved gait and balance significantly more than sham stimulation with the same exercise. PMID 24885412 |
| Leonard et al., 2017, Multiple Sclerosis Journal ETC | Controlled pilot with multimodal MRI | Positive: greater working-memory gains and neuroplastic changes on imaging with real stimulation than with sham. PMID 28607750 |
| Donkers et al., 2026, Archives of Physical Medicine and Rehabilitation | Sham-controlled randomized trial, 44 people with MS (NeuroMSTraLS protocol, Ploughman et al., 2023) | Negative: physical therapy improved gait and balance in both groups, but adding TLNS at the dose used did not confer extra benefit over sham. PMID 42150723 |
| Safety across studies | No serious device-related adverse events; the typical side effect is mild tingling or transient soreness of the tongue. | |
How we read this: the 2014 pilot was small, and the larger 2026 trial did not reproduce its result at the dose tested. Reviews (Diep et al., 2021, PMID 32881193; Boughen et al., 2022) describe TLNS in MS as promising but requiring larger trials. In practice, we do not promise a specific size of effect in MS; we run a supervised trial phase, measure with standard scales, and recommend continuing only when the measurements show progress. The full list is on our Scientific publications page.
Our clinical experience
Multiple sclerosis is one of the groups our own rehabilitation centers in Moscow and Tashkent work with directly, not only through the published literature. We accept patients with an EDSS score of up to 6.0 inclusive — that is, people who can still walk, unaided or with a cane or crutch — because this is the group in which balance and gait training has the most to gain; patients who no longer walk (EDSS above 6.0) are not candidates for this program. Each patient is assessed with standard scales before the supervised phase and again after it, and the decision to continue is based on those measurements.
How a course is organised
A session is 20 minutes of stimulation combined with gait and balance exercises, 2–3 times a day. The first two weeks are supervised in a clinic, where a therapist selects the exercise program and trains the patient. The following 12 weeks are continued at home, for a total of 14 weeks, the duration used in the MS trials. The device stays with the patient, and our specialists follow progress remotely. Outcomes are measured with the Dynamic Gait Index, Sensory Organization Test and Berg Balance Scale; the supervised phase is the decision point for continuing.
Who is a candidate
- Adults with multiple sclerosis in a stable phase, with an EDSS score of up to 6.0, a gait or balance deficit and the ability to stand and walk with or without an aid.
- Able to exercise daily and to hold the electrode in the mouth for 20 minutes; fatigue and heat sensitivity are taken into account when scheduling sessions.
- Not used during pregnancy, with known sensitivity to nickel, gold or copper, with active or suspected malignancy, with open wounds or bleeding in the mouth, or with absent sensation of the tongue.
- Not started during a relapse or within the recovery period after one; disease-modifying therapy continues unchanged.
Where TLNS for MS is available
The RehaLine TLNS device is registered in Russia, Mexico (COFEPRIS), Uzbekistan and New Zealand; registration is in progress in Brazil, Vietnam and the Philippines. Courses are run in our own rehabilitation centers in Moscow and Tashkent and by partner clinics. The device is not cleared by the U.S. FDA and is not offered in the United States. Clinics that want to add TLNS to their services can read about our partnership program.
PoNS® is the device used in the MS trials above. It is cleared by the U.S. FDA for gait deficit in mild-to-moderate MS in adults aged 22 and over and for chronic stroke, and authorised by Health Canada for MS, TBI and stroke; list price $28,270 per the manufacturer's FAQ. RehaLine's system covers more indications, including a pediatric program, the device stays with the patient, and a course costs several times less. PoNS® and PoNS Therapy® are trademarks of their respective owner; 4STIM is not affiliated with Bioness Medical, Helius Medical Technologies or their partners.
Frequently asked questions
If the 2026 trial was negative, why offer TLNS in MS at all?
Because the earlier controlled pilots were positive, imaging shows a real physiological effect, and the 2026 result applies to the dose tested. Patients are told the evidence is mixed, and the decision to continue beyond the supervised phase is based on their own measured progress.
Does TLNS affect the course of MS or replace medication?
No. TLNS acts on balance and gait function, not on the immune process. Disease-modifying therapy prescribed by the neurologist continues unchanged.
Can it be used in progressive MS?
The trials included people with chronic MS of different types. Candidates are assessed on the EDSS score (up to 6.0), walking ability and the capacity to exercise daily, not on the MS subtype alone.
How do we start?
Send the MS type, EDSS score if known, current walking ability and current treatment to our Telegram assistant; a specialist will review the case and arrange an online consultation. General information is on the TLNS therapy page.