Translingual Neurostimulation for the Treatment of Chronic Symptoms Due to Mild-to-Moderate Traumatic Brain Injury

Mitchell Tyler; Kim Skinner; Vivek Prabhakaran; Kurt Kaczmarek; Yuri Danilov

doi:10.1016/j.arrct.2019.100026

Translingual Neurostimulation for the Treatment of Chronic Symptoms Due to Mild-to-Moderate Traumatic Brain Injury

Arch Rehabil Res Clin Transl. 2019 Sep 27;1(3-4):100026. doi: 10.1016/j.arrct.2019.100026. eCollection 2019 Dec.

Authors

Mitchell Tyler^{1

2}, Kim Skinner², Vivek Prabhakaran³, Kurt Kaczmarek², Yuri Danilov²

Affiliations

¹ Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, Wisconsin.
² Department of Kinesiology, University of Wisconsin-Madison, Madison, Wisconsin.
³ Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin.

Abstract

Objective: To compare the efficacy of high- and low-frequency noninvasive translingual neurostimulation (TLNS) plus targeted physical therapy (PT) for treating chronic balance and gait deficits due to mild-to-moderate traumatic brain injury (mmTBI).

Design: Participants were randomized 1:1 in a 26-week double-blind phase 1/2 study (NCT02158494) with 3 consecutive treatment stages: in-clinic, at-home, and no treatment. Arms were high-frequency pulse (HFP) and low-frequency pulse (LFP) TLNS.

Setting: TLNS plus PT training was initiated in-clinic and then continued at home.

Participants: Participants (N=44; 18-65y) from across the United States were randomized into the HFP and LFP (each plus PT) arms. Forty-three participants (28 women, 15 men) completed at least 1 stage of the study. Enrollment requirements included an mmTBI ≥1 year prior to screening, balance disorder due to mmTBI, a plateau in recovery with current PT, and a Sensory Organization Test (SOT) score ≥16 points below normal.

Interventions: Participants received TLNS (HFP or LFP) plus PT for a total of 14 weeks (2 in-clinic and 12 at home), twice daily, followed by 12 weeks without treatment.

Main outcome measures: The primary endpoint was change in SOT composite score from baseline to week 14. Secondary variables (eg, Dynamic Gait Index [DGI], 6-minute walk test [6MWT]) were also collected.

Results: Both arms had a significant (P<.0001) improvement in SOT scores from baseline at weeks 2, 5, 14 (primary endpoint), and 26. DGI scores had significant improvement (P<.001-.01) from baseline at the same test points; 6MWT evaluations after 2 weeks were significant. The SOT, DGI, and 6MWT scores did not significantly differ between arms at any test point. There were no treatment-related serious adverse events.

Conclusions: Both the HFP+PT and LFP+PT groups had significantly improved balance scores, and outcomes were sustained for 12 weeks after discontinuing TLNS treatment. Results between arms did not significantly differ from each other. Whether the 2 dosages are equally effective or whether improvements are because of provision of PT cannot be conclusively established at this time.

Keywords: 6MWT, 6-minute walk test; AE, adverse event; ANOVA, analysis of variance; Balance; DGI, Dynamic Gait Index; Facial nerve; Gait; HFP, high-frequency pulse; ITP, in-clinic training program; LFP, low-frequency pulse; Neurostimulation; PSQI, Pittsburgh Sleep Quality Index; PT, physical therapy; PoNS, portable neuromodulation stimulator; Rehabilitation; SOT, Sensory Organization Test; TBI, traumatic brain injury; TLNS, translingual neurostimulation; Trigeminal nerve; mmTBI, mild-to-moderate traumatic brain injury.