Background: Cranial-nerve non-invasive neuromodulation (CN-NINM)
Summary: Cranial-Nerve Non-Invasive NeuroModulation (CN-NINM) stimulates the brain to self-recover functionality lost to injury or disease. Many neurological diseases involve the brainstem, which regulates numerous functions in the brain and body. Brainstem structures are important for movement, attention, sleep-wakefulness, sensory-motor coordination, and control of unconscious body functions. This is one reason why brainstem damage, for example due to MS, can cause so many kinds of symptoms. CN-NINM improves function of the damaged brain by sending millions of nerve pulses from the tongue to the brainstem, at the same time with special challenge exercises. The tongue pulses help the brain to adapt to the challenges. With time, effort, and CN-NINM stimulation, the parts of the brain surrounding damaged areas self-adjust their function so that overall brain function becomes more normal.
What is neuromodulation (NM)? Neurons are brain cells that process information. They communicate with each other using chemicals called neurotransmitters. Neuromodulation is the process of regulating the level of neurotransmitters in and around neurons. These changes may be targeted to specific brain regions, structures, or functions, or they may be more global in nature. Non-Invasive Neuromodulation (NINM) is any method of neuromodulation applied from outside the body.
What is Cranial Nerve Non-Invasive NeuroModulation (CN-NINM)? CN-NINM uses controlled patterns and sequences of tactile stimuli on cranial nerve endings, located on the head (including in the mouth). CN-NINM may include electrical, mechanical, chemical, and/or thermal stimuli. All are non-invasive because they are applied to the surface of the skin or oral tissues. These tactile stimuli may be combined with other forms of sensory stimuli such as sequenced and patterned sounds, light images, or proprioception (posture and balance).
Are there other forms of NM, NINM, and CN-NINM? Most other forms of neuromodulation are invasive, for example deep brain stimulation (DBS) and vagus nerve stimulation (VNS), which use implanted pacemaker-like electrical devices. Implantation carries surgical risks including infection, allergic reaction, and tissue damage. Many drugs may also be considered chemical methods of neuromodulation. Other forms of NINM include powerful electromagnetic stimulation of the brain’s cortical and subcortical structures (transcranial magnetic stimulation, TMS), or electrodes that pass electric current through the skull (TDCBS), also targeting multiple areas of the brain. We are not aware of other groups working with CN-NINM.
Why is CN-NINM important? Many kinds of physical and mental impairments result from disruptions in information transmission and regulation in the brain, whether due to trauma, loss of blood flow (stroke), or disease. Such disruptions may include physical tissue damage or disruption of the chemical environment surrounding neurons. There is growing theoretical and experimental evidence that many of these conditions might be more effectively treated with neuromodulation, including NINM. Such conditions include motor control impairments affecting balance, posture, gait, speech, and manual dexterity; cognitive disorders of memory, attention, and alertness. Specific diagnoses under investigation include multiple sclerosis, Parkinson’s disease, autism, Alzheimer’s disease, vertigo, depression, and insomnia. We aim to apply CN-NINM to these conditions.
What is the biological basis for CN-NINM? Based on relevant neuroanatomy, we believe that appropriately sequenced and patterned tactile, optical, and auditory stimulation of cranial nerve sensory branches result in activation of the trigeminal nuclei complex and nucleus tractus solitarius and cause radiating therapeutic chemical and neurophysiological changes. These would include both synaptic and non-synaptic information processing in movement control circuitries, including cerebellum and nuclei of spinal motor pathways. Certain brain structures are thus “primed” or “up-regulated” to handle information more efficiently.
What evidence is there that CN-NINM works? To date we have tested over 300 persons with impairments of balance, posture and gait under controlled conditions; the vast majority have shown improvement. Because many of these persons have multiple symptoms, we have also observed fine motor control, eye-movement, tinnitus, sleep, cognitive, and long-term mood improvements in persons with severe vestibular and movement control disorders such as multiple sclerosis and traumatic brain injury. Some of these results are availabl on the TCNL project page.
Is CN-NINM safe? To date we have not observed any adverse effects from CN-NINM intervention. We believe that CN-NINM generally results in better internal homeostatic regulation, or naturally “balanced” brain function. However, our research is still in its early stages and we cannot rule out possible adverse side effects. All CN-NINM research is performed with approval and oversight of the University of Wisconsin-Madison Health Sciences Institutional Review Board to ensure safety and compliance with University, State, and Federal regulations concerning human subjects research.
How is CN-NINM intervention administered? A mild, comfortable electrical stimulus is applied to the surface of the tongue using a flat plastic strip containing a matrix of flat, gold-plated circular disks (electrodes). The materials and electrical stimulus are biologically safe and have not caused side effects. During stimulation, the user simultaneously performs specially-designed balance, posture, gait, cognitive, and relaxation exercises depending on their symptoms. The exercises are safe but challenging, near the limit of the user’s capability, to maximize the beneficial effect of CN-NINM intervention. The intervention is typically administered 2–3 times per day for 30–45 minutes. Intervention typically begins in our laboratory for 1–2 weeks and continues in the user’s home as needed, using a small device called the Portable Neuromodulation Stimulator or PoNS™.
Is CN-NINM available for clinical or personal use? At this time CN-NINM is an experimental technique and cannot be prescribed by your doctor. If you are interested in participating in a research study, please monitor our volunteer subject contact page for announcements concerning calls for human subjects. Please understand that our work is in the early stages and that clinical treatments or even experimental testing on any given condition may be years away. Although believed to be safe, the potential risks of CN-NINM have not been adequately evaluated.If you have a balance disorder, or extremely low vision or blindness, you may wish to contact Wicab, Inc. about their BrainPort™ Balance or Vision devices.
CN-NINM was developed by Tactile Communication & Neurorehabilitation Lab (TCNL), formerly in the University of Wisconsin-Medicine School of Medicine and Public Health, Department of Orthopedics and Rehabilitation. TCNL is now part of the UW Department of Biomedical Engineering.
This information was updated 10/13/2011.