TLNS for Parkinson's disease

Medically reviewed by Evgenii Bugorskii, MD, Founder of RehaLine Group · Scientific supervision: Yuri Danilov, PhD, TCNL, University of Wisconsin–Madison · Updated September 2026

Translingual neurostimulation (TLNS) is a non-invasive method that delivers patterned electrical impulses to the surface of the tongue while the patient performs balance and gait exercises. In Parkinson's disease it is used in our clinics as an adjunct to physiotherapy for postural instability and gait problems. We state this plainly: there are no controlled trials of TLNS in Parkinson's disease. Its use rests on the mechanism of action, on controlled data in other balance and gait disorders, and on our own clinical experience: RehaLine clinics work with this patient group directly and accept patients with the tremor-dominant and the rigid (akinetic-rigid) forms of parkinsonism.

Who this page is for

TLNS is considered for people with Parkinson's disease whose main functional problem is balance and walking: postural instability, small shuffling steps, freezing of gait, difficulty turning, falls. These symptoms respond less well to dopaminergic medication than tremor or rigidity. TLNS does not act on the dopaminergic deficit and does not replace medication or deep brain stimulation; it is added to a structured exercise program to make that program more effective.

How TLNS is expected to help in Parkinson's disease

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, muscle tone and the automatic components of gait. In Parkinson's disease the automatic control of walking is impaired and patients rely on conscious, attention-demanding control instead; brainstem postural circuits and the cerebellum are directly involved in this shift. Functional MRI in balance-impaired subjects shows that tongue stimulation changes activity in the pons and cerebellum for hours after the device is switched off. The working hypothesis is that raising the responsiveness of these circuits during gait and balance training improves what the training achieves. This is a hypothesis supported by mechanism, not a result proven in this disease.

What the evidence shows

Parkinson's disease is not an approved indication for any TLNS device anywhere, including PoNS®. In our clinics it is an individual clinical decision after consultation, with measurement before and after the supervised phase and an agreement that the course continues only if the measurements show progress. The full list of publications is on our Scientific publications page.

Our clinical experience

Parkinsonism is one of the groups our own rehabilitation centers in Moscow and Tashkent work with directly. We accept patients with the tremor-dominant form and with the rigid (akinetic-rigid) form of parkinsonism; the goals set for the course are balance, walking, turning and daily function, and progress is measured with standard scales before and after the supervised phase. We do not claim an effect on the progression of the disease, and medication prescribed by the neurologist continues unchanged.

How a course is organised

A session is 20 minutes of stimulation combined with gait, balance and turning exercises, 2–3 times a day, scheduled in the "on" phase of medication. The first two weeks are supervised in a clinic, where a therapist selects the exercise program and trains the patient and a family member. The following 12 weeks are continued at home, for a total of 14 weeks. The device stays with the patient, and our specialists follow progress remotely. Outcomes are measured with the Berg Balance Scale, Dynamic Gait Index and Sensory Organization Test.

Who is a candidate

• Adults with Parkinson's disease or parkinsonism of the tremor-dominant or rigid (akinetic-rigid) form, with postural instability or gait impairment, on a stable medication regimen, able to stand and walk with or without an aid.
• Able to exercise daily and to hold the electrode in the mouth for 20 minutes; significant swallowing difficulty or excessive salivation is assessed individually.
• 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.
• Patients with a deep brain stimulation system are assessed individually together with the treating neurologist.

Where TLNS for Parkinson's disease 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 a separate commercial TLNS device, cleared by the U.S. FDA for gait deficit in mild-to-moderate MS and chronic stroke and authorised by Health Canada for MS, TBI and stroke, adults only; Parkinson's disease is not among its indications. 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