Multimodal Neuromodulation

While Parkinson’s disease symptoms can vary widely, common indicators include resting tremor, bradykinesia, rigidity, and cognitive impairment. It has been suggested that non-invasive neurostimulation may be beneficial in providing symptomatic relief without the risks associated with surgery. This research project intends to explore multimodal non-invasive neuromodulation as a possible treatment option.

Translingual Neurostimulation (TLNS) and Galvanic Vestibular Stimulation (GVS) 

There has been a growing body of evidence supporting the role of TLNS as a helpful therapeutic tool in neurorehabilitation. Research using the Portable Neuromodulation Stimulator (PoNSTM), a relatively low-cost and portable form of TLNS, has generated a variety of positive results when combined with physical therapy in regards to gait, balance, and strength training, in the rehabilitation of those with various neurological diseases or traumatic brain injuries.

GVS systems have been shown to emulate the frequency characteristics of the vestibular system. Activating deep neural structures, such as the pedunculopontine nucleus (PPN), may affect postural stability. In Parkinson’s disease, GVS has been demonstrated to alter connectivity between the PPN and surrounding structures related to balance, with promising results.

Multimodal Neurostimulation 

Though both GVS and TLNS have growing evidence to support their use, both of these techniques are limited by the large degree of variability in responses. Combined stimulation via GVS and TLNS has yet to be investigated in individuals with Parkinson’s disease, but has reported promising findings in individuals with tinnitus and cervical dystonia. 

Combining Multimodal Neurostimulation Techniques with Neuroimaging 

While there is evidence supporting non-invasive stimulation as an intervention in Parkinson’s disease, there is presently little information about the underlying neurology mechanisms at play. Some studies have used EEG (electroencephalography) with deep brain stimulation or other non-invasive neurostimulation techniques, but EEG has never been used to study TLNS alone, or TLNS and GVS in Parkinson’s disease.

The research team will work in collaboration with subject matter experts and neurorehabilitation professionals at the Pacific Parkinson’s Research Centre (PPRC) and Surrey Neuroplasticity Clinic to develop a therapeutic intervention that uses non-invasive neurostimulation as a treatment for individuals with Parkinson’s. The preliminary clinical study will take place over 12-weeks and involve twice-weekly physical therapy at the clinic under the supervision of research therapists. The results of this study will inform the development of a larger scale trial using advanced neuroimaging to study treatment optimization, safety, and efficacy of multimodal, non-invasive neuromodulation as a therapeutic intervention.