ES in Multiple Sclerosis References

Abbate A.D., Cook A.W., and Atallah M. (1977) Effect of electrical stimulation of the thoracic spinal cord on the function of the bladder in multiple sclerosis. J. Urol. 117, 285-288.
Abstract: We treated 40 patients who had multiple sclerosis and bladder symptoms with thoracic spinal cord electrical stimulation. Bladder and sphincter dysfunction was evaluated by cystometry and electromyography. Subjective improvement was noted in 77.5 per cent of the patients and documented improvement was found on cystometry and electromyography in 42.5 per cent. By electrical stimulation of the spinal cord we have demonstrated varying degrees of restoration of voluntary and reflex control of the bladder and sphincter

Barker A.T., Freeston I.L., Jalinous R., and Jarratt J.A. (1987) Magnetic stimulation of the human brain and peripheral nervous system: an introduction and the results of an initial clinical evaluation. Neurosurgery 20, 100-109.
Abstract: This report describes a novel method of stimulating the motor cortex and deep peripheral nerves in humans. The technique, developed in the Department of Medical Physics of Sheffield University, uses a large pulse of magnetic field to induce currents within the body and is painless. The basic principles of magnetic stimulation are described, and the technique is compared with conventional electrical stimulation. Safety aspects are discussed with reference to established clinical electrical and magnetic procedures. The results of the first clinical study using magnetic stimulation are described and show clear central motor pathway slowing in multiple sclerosis patients

Berardelli A., Inghilleri M., Cruccu G., Fornarelli M., Accornero N., and Manfredi M. (1988) Stimulation of motor tracts in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 51, 677-683.
Abstract: Percutaneous electrical stimulation of the motor cortex was used to evaluate corticospinal conduction to upper-limb motoneurons in 29 patients with multiple sclerosis. Central motor conduction abnormalities were correlated with clinical signs and somatosensory evoked potentials. Muscle responses to cortical stimulation were altered in 20 patients. The most common abnormality was increased central motor conduction time; in two cases the responses to cortical stimulation were absent. Abnormalities were also present in patients with no clinical evidence of corticomotoneuron deficit. Alterations of muscle responses and of somatosensory evoked potentials were usually correlated, but may appear independently. Both testing methods are useful in the study of patients with multiple sclerosis

Berg V., Bergmann S., Hovdal H., Hunstad N., Johnsen H.J., Levin L., and Sjaastad O. (1982) The value of dorsal column stimulation in multiple sclerosis. Scand. J. Rehabil. Med. 14, 183-191.
Abstract: Ten patients with definite and one with probable MS, all markedly inflicted, but with a varying degree of motor and bladder dysfunction were subjected to spinal cord stimulation in a controlled study. None of the patients exhibited appreciable fluctuation in symptoms in the pre-study period. Bladder symptoms were most markedly influenced by electrical stimulation. The reduction in hesitancy and urgency was of great importance to the patients. In 9 of 10 patients reduction in voiding frequency took place, the all over reduction being 8%. Maximum extension torque increased by 9% and flexion torque by 29% during the stimulation when compared to the first placebo period. In selected MS patients, i.e. patients with bladder dysfunction and with a certain muscular reserve, electrical spinal cord stimulation may have an indication

Campos R.J., Dimitrijevic M.M., Faganel J., and Sharkey P.C. (1981) Clinical evaluation of the effect of spinal cord stimulation on motor performance in patients with upper motor neuron lesions. Appl. Neurophysiol. 44, 141-151.
Abstract: The effect of chronic electrical stimulation of the spinal cord was evaluated in a group of 24 patients with multiple sclerosis, spinal cord injury, and degenerative disorders of the central nervous system. The systems for stimulation had been implanted from 12 to 30 months prior to completion of evaluation. At the time of completion of evaluation, 23 of the 24 patients still had implanted systems, although 6 of them had not used spinal cord stimulation because of no noticeable effect. In 3 patients stimulation had been disconnected because of technical failure of the system. In 1 patient the system had been removed 8 weeks after implantation because of inflammation in the under- skin receiver pocket. The effects on motor performance of the remaining 14 patients who had continuously active systems were improved bladder control, diminished spasticity, improved movement coordination, and increased endurance

Cook A.W., Taylor J.K., and Nidzgorski F. (1979) Functional stimulation of the spinal cord in multiple sclerosis. J. Med. Eng Technol. 3, 18-23.
Abstract: The authors describe the effect of electrical stimulation of the spinal cord in multiple sclerosis. After considering the nature of multiple sclerosis, the authors describe the background, character, mode and method of delivering electrical fields to the spinal cord. The results of this form of treatment and the implications of these observations in terms of physiologic mechanisms are discussed

Cook A.W. (1976) Electrical stimulation in multiple sclerosis. Hosp. Pract. 11, 51-58.
Abstract: When electrodes were implanted in the spinal cord of a patient with MS-- for dorsal column stimulation to relieve intractable pain--she regained considerable movement in her legs. Subsequently such stimulation has been employed in more than 70 other patients, and many have regained voluntary control over their arms, legs, and sphincters. The procedure is detailed and its implications are explored

      Cook A.W. (1974) Letter: Electrical stimulation of the spinal cord. Lancet 1, 869-870.

DeLisa J.A., Hammond M.C., Mikulic M.A., Miller R.M. (1985) Multiple Sclerosis: Part 1. Common physical disabilities and rehabilitation. AFP 32:157-163.

Duquette P., Duquette J., and Bouvier G. (1980) [Electrical stimulation of the spinal cord in multiple sclerosis]. Union Med. Can. 109, 890-894.

Fredriksen T.A., Bergmann S., Hesselberg J.P., Stolt-Nielsen A., Ringkjob R., and Sjaastad O. (1986) Electrical stimulation in multiple sclerosis. Comparison of transcutaneous electrical stimulation and epidural spinal cord stimulation. Appl. Neurophysiol. 49, 4-24.
Abstract: Forty-nine multiple sclerosis patients with bladder symptoms and/or walking disability were subjected to a therapeutic trial with electrical spinal cord stimulation and transcutaneous electrical stimulation, a second aim being to compare these two treatments. A clear subjective improvement in bladder symptoms was achieved in the majority of the cases, and this was substantiated by objective parameters. In a proportion of cases a more moderate improvement seems to have been achieved in a variety of symptoms. Transcutaneous electrical stimulation seems to be a useful selection procedure for later electrical spinal cord stimulation

Gross R.E. and Lozano A.M. (2000) Advances in neurostimulation for movement disorders. Neurol. Res. 22, 247-258.
Abstract: In just 12 years since its introduction, deep brain stimulation (DBS) has become well established as a safe and effective therapy in the treatment of medically refractory movement disorders. Ventralis intermedius (Vim) DBS has virtually replaced thalamotomy in the routine clinical treatment of essential tremor, affording relief to thousands of patients who previously would not have undergone surgery, and there is increasing usage of Vim DBS in other tremors of intention (e.g., multiple sclerosis). Subthalamic nucleus (STN) and globus pallidus internus (GPi) DBS have revolutionized the treatment of advanced stage Parkinson's disease, improving all cardinal disease features and increasing 'on' time without dyskinesias. Finally, DBS of various sub- cortical structures is being developed and tested in other less prevalent movement disorders such as dystonia. Future developments in this rapidly advancing area will no doubt include widening indications for this relatively safe surgical procedure, elucidation of the mechanisms of action of electrical stimulation, and technological advancements improving effectiveness and convenience

Haher J.N., Haher T.R., Devlin V.J., Schwartz J. (1983) The release of flexion contractures as a prerequisite for the treatment of pressure sores in multiple sclerosis: a report of 10 cases. Ann Plast Surg 11:246-249.

Hess C.W., Mills K.R., Murray N.M., and Schriefer T.N. (1987) Magnetic brain stimulation: central motor conduction studies in multiple sclerosis. Ann. Neurol. 22, 744-752.
Abstract: Central motor conduction (CMC) was evaluated in 32 normal subjects and 83 patients with multiple sclerosis, and the findings were correlated with clinical signs and evoked potential data. CMC time was obtained from the latency difference in responses from the abductor muscle of the little finger to magnetic stimulation of the motor cortex and electrical stimulation at the C-7/T-1 interspace. Mean CMC time in normal subjects was 6.2 msec (SD 0.86 msec), and amplitudes of responses to cortical stimuli were at least 18% of those obtained with stimuli at the wrist. CMC was abnormal in 60 patients with multiple sclerosis (72%); this correlated well with brisk finger flexor jerks (p less than 0.005). CMC was abnormal in 79% of patients with weakness of the abductor muscle of the little finger and in 54% with a normal muscle. Neurological examination was normal in 7 arms with abnormal CMC. Visual evoked potentials were abnormal in 67%, somatosensory evoked potentials in 59%, and brainstem auditory evoked potentials in 39% of those tested. For each procedure more subjects had abnormal CMC and normal evoked potentials than the reverse. The technique is of value for demonstrating and documenting central motor pathway lesions in multiple sclerosis, especially when physical signs are equivocal

Javidan M., Elek J., and Prochazka A. (1992) Attenuation of pathological tremors by functional electrical stimulation. II: Clinical evaluation. Ann. Biomed. Eng 20, 225-236.
Abstract: In this study we evaluated a technique for tremor suppression with functional electrical stimulation (FES), the technical details of which were described in the previous paper. Three groups of patients were investigated: those with essential tremor, parkinsonian tremor, and cerebellar tremor associated with multiple sclerosis. In each group, tremor was attenuated by significant amounts (essential tremor: 73%; parkinsonian tremor: 62%; cerebellar tremor: 38%). These attenuations were in good accord with predictions based on the dynamic analyses and filter designs derived in the previous paper. With filters "tuned" to the lower mean tremor frequency encountered in the cerebellar patients, more attenuation was possible in this group as well. We identified some practical limitations in the clinical application of the technique in its present form. The most important was that in daily use, only one antagonist pair of muscles can realistically be controlled. At first sight, this restricts the usefulness of the system to patients with single-joint tremors. However, the concomitant use of mechanical orthoses may broaden the scope of application

Lenman A.J., Tulley F.M., Vrbova G., Dimitrijevic M.R., and Towle J.A. (1989) Muscle fatigue in some neurological disorders. Muscle Nerve 12, 938-942.
Abstract: Fatigue of tibialis anterior (TA) was induced by repetitive electrical stimulation. Using this test, patients with upper motor neuron muscle weakness owing to multiple sclerosis (MS) and injuries to the spinal cord showed greater fatigability of their TA muscles, suggesting that the muscle fiber population changed toward that typical of fatigable motor units. During repetitive stimulation, in addition to the decrement in tension there was an increase in half-relaxation time of tetanic contractions at 40 Hz in both subjects and patients. The increase in half relaxation during repeated activity was greater in patients with MS and spinal cord injury than in healthy subjects, suggesting that the long-term inactivity affected the efficiency of the Ca2+ uptake mechanism of their muscle fibers. Thus long-term inactivity of patients with upper motoneuron dysfunction leads to increased fatigability of their muscles and exaggerates the slowing of muscle relaxation after prolonged exercise

Mathers S.E., Ingram D.A., and Swash M. (1990) Electrophysiology of motor pathways for sphincter control in multiple sclerosis. J. Neurol. Neurosurg. Psychiatry 53, 955-960.
Abstract: The central and peripheral motor pathways serving striated sphincter muscle function were studied using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation and sphincter electromyography in 23 patients with multiple sclerosis (MS), and sphincter disturbance, including incontinence of urine or faeces, urinary voiding dysfunction, or constipation. The central motor conduction time was significantly increased in the MS group compared to controls (p less than 0.05). Damage to both the upper and lower motor neuron pathways can contribute to sphincter disturbance in MS. The latter may be due to coexisting pathology or to involvement of the conus medullaris by MS

Montgomery E.B., Jr. (1999) Deep brain stimulation reduces symptoms of Parkinson disease. Cleve. Clin. J. Med. 66, 9-11.
Abstract: Surgical ablation or continuous electrical stimulation of specific areas deep in the brain may help patients with Parkinson disease or other movement disorders for whom medications have failed or who experience dose-limiting side effects from medications

Perry J., Gronley J.K., Lunsford T. (1981) Rocker Shoe as Walking Aid in Multiple Sclerosis. Arch Phys Med Rehabil 62:59-65.

Primus G. and Kramer G. (1996) Maximal external electrical stimulation for treatment of neurogenic or non-neurogenic urgency and/or urge incontinence. Neurourol. Urodyn. 15, 187-194.
Abstract: Maximal electrical stimulation by intravaginal or intra-anal electrodes was used for treatment of 75 patients with complaints of urgency and/or urge incontinence. The patient group consisted of 51 women and 24 men. A neurogenic background was present in 30 of the women who had a diagnosis of multiple sclerosis, in the other 45 patients the pathology was idiopathic in nature. After 3 weeks of maximal electrical stimulation treatment, composed of 15 sessions of 20 minutes duration, 59% of the patients had urodynamic and subjective improvement and an additional 40% only subjective improvement. One patient found no benefit after this treatment. The effect lasted for at least 2 years in 64% of the idiopathic group. In the multiple sclerosis group relapse occurred within about 2 months. Re-treatment of the failures was successful again immediately; the multiple sclerosis patients do need daily home stimulation treatments

Primus G.  (1992) Maximal electrical stimulation in neurogenic detrusor hyperactivity: experiences in multiple sclerosis. Eur. J. Med. 1, 80-82.
Abstract: OBJECTIVES: We report our experiences with maximal tolerable electrical stimulation in neurogenic bladder dysfunction due to multiple sclerosis. METHODS: 27 female patients were treated with an intravaginal electrode carrier and an external pulse generator. The devices were individually adjustable with respect to electrode positioning and stimulation parameters. The frequency was 20 Hz. The threshold for sensation of the electrical stimulus was determined by slowly increasing the current and care was taken to stimulate with maximal tolerable stimuli. Urodynamic evaluation was done before and after cessation of treatment. RESULTS: During stimulation, 85% of the patients were free of symptoms. Three months after cessation of treatment only 18% remained free of symptoms, but the symptoms were not as pronounced as before treatment. CONCLUSION: Electrical stimulation using intravaginal electrodes represents a practical technical choice to treat motor urge incontinence in multiple sclerosis patients, although chronic stimulation is needed to retain improvement

Ruud Bosch J.L. and Groen J. (1996) Treatment of refractory urge urinary incontinence with sacral spinal nerve stimulation in multiple sclerosis patients. Lancet 348, 717-719.
Abstract: BACKGROUND: Urge urinary incontinence in multiple sclerosis patients is usually due to detrusor hyperreflexia. Patients who do not respond to conservative measures such as anticholinergics, with or without clean intermittent catheterisation, are difficult to manage. METHODS: We applied electrical stimulation to the S3 sacral spinal nerves with the aim of activating afferent somatic nerve fibres. Stimulation of these fibres can inhibit the micturition reflex. An S3 electrode coupled to a subcutaneously placed pulse generator was implanted in four women who had shown a good response during temporary stimulation via a percutaneously placed wire electrode. All patients were followed for at least 2 years. FINDINGS: The number of leakage episodes decreased from a mean of 4 to 0.3 per 24 h. Two patients were completely dry. The hyperreflexia disappeared in one, improved in two, and got worse in one patient. The urodynamic result in the last patient may be explained by clinical progression of the multiple sclerosis. INTERPRETATION: Chronic stimulation of the S3 sacral spinal nerve by an implantable neuroprosthesis is a promising treatment option for selected multiple sclerosis patients with refractory urge incontinence.

Schriefer T.N., Hess C.W., Mills K.R., and Murray N.M. (1989) Central motor conduction studies in motor neurone disease using magnetic brain stimulation. Electroencephalogr. Clin. Neurophysiol.  74, 431-437.
Abstract: Central motor conduction (CMC) to abductor digiti minimi (ADM) was evaluated in 22 patients with motor neurone disease (MND) using magnetic stimulation of the motor cortex and electrical stimulation at the C7/T1 interspace. CMC was abnormal in 14 patients; prolonged CMC time and absence of response to brain stimulation were more frequent abnormalities than low amplitude responses without prolonged CMC time. The technique can reveal subclinical upper motor neurone involvement and document central motor pathway dysfunction in MND. The patterns of abnormality are not specific to MND; all may occur in other neurological disorders including multiple sclerosis

      Siegfried J. and Lippitz B. (1994) Chronic electrical stimulation of the VL-VPL complex and of the pallidum in the treatment of movement disorders: personal experience since 1982. Stereotact. Funct. Neurosurg. 62, 71-75.
Abstract: Since 1982, we have been able to control involuntary movements associated with deaf-ferentation by means of chronic electrical stimulation of the thalamic sensory nucleus through implanted programmable neuropacemakers. Since 1987, we have been using the same system with electrodes chronically implanted in the VL for treating selected cases of tremor due to Parkinson's disease, multiple sclerosis and in cases of essential tremor. In our series of 60 patients, suppression of tremor was achieved in almost all cases; however, due to dysarthria in 30% of the cases (cases after previous thalamotomy in the other side or with bilateral stimulation), the amplitude of stimulation was corrected and thus some tremor was still observed. The rigidity of parkinsonism was in all cases improved. One case of hemiballism was perfectly controlled with the same technique. Finally, 3 cases of Parkinson's disease with severe hypokinesia, speech and gait disturbances, and on-off phenomenon have been globally improved by a bilateral chronic stimulation of the pallidum

Siegfried J., Lazorthes Y., and Broggi G. (1981) Electrical spinal cord stimulation for spastic movement disorders. Appl. Neurophysiol. 44, 77-92.
Abstract: Clinical results of electrical stimulation of the spinal cord at three different clinics are reported for 53 patients suffering from different spastic movement disorders out of a series of 164 cases tested transitorily. Two-thirds of the cases were multiple sclerosis patients. The difficulty of objective assessment is emphasized. Motor function was principally evaluated and surprisingly showed a marked improvement 1-5 years after the implantation of an electrical device. Other criteria are analyzed and compared with literature. Dorsal cord stimulation seems to be a valuable method for improving the quality of life in a limited percentage of cases of neurological motor disorders

Siegfried J. (1980) Treatment of spasticity by dorsal cord stimulation. Int. Rehabil. Med. 2, 31-34.
Abstract: Two types of operations can be proposed today in the neurosurgical treatment of spasticity; the destruction of a brain target, a medullary pathway or a nerve root, and electrical stimulation of nervous structures. Striking improvements in voluntary motor control and sensory appreciation were first reported by Cook and Weinstein (1) in 1973, after implantation of a dorsal cord stimulator for intractable back pain in a case of muiltiple scleroris. The favourable effect on spasticity was confirmed later by other groups. Our own experience, with 26 cases tested for a few days with floating electrodes and 11 cases operated on and followed up for more than 3 years, shows that the best results are obtained in cases of medullary spasticity, without complete section of the cord, occurring mainly in multiple sclerosis. Cerebral spasticity did not respond as well. The objective data, measurement of stretch and H-reflexes, support the clinical results. The physiological mechanisms of dorsal cord stimulation on spasticity have not yet been elucidated

Smeltzer S.C., Skurnick J.H., Troiano R., Cook S.D., Duran W., Laviates M.H. (1992) Respiratory function in multiple sclerosis. Utility of clinical assessment of respiratory muscle function. Chest 101:479-484.

Swain I.D., Burridge J.H., Johnson C.A., Mann G.E., Taylor P.N., Wright P.A. (2000) The efficacy of Functional Electrical Stimulation in improving walking ability for people with multiple sclerosis. Proc 5th Annual Conf of the IFESS Society, Aalborg, Denmark, pp 55-58.

Tani S., Shimizu H., Ishijima B., and Hanakago R. (1984) [Our experiences of PISCES (percutaneously inserted spinal cord electrical stimulation) in SMON and other neurologic disorders]. No To Shinkei 36, 383-388.
Abstract: Percutaneously inserted spinal cord electrical stimulation (PISCES) was carried out in eleven intractable pain cases and in one spastic paraplegic case. The causes of intractable pain constitute subacute myelo-optic neuropathy (SMON) 6 cases, cerebrovascular disease 2 cases, multiple sclerosis (MS) 1 case, Charcot-Marie-Tooth (CMT) 1 case and transverse myelitis (TM) 1 case. The cause of spastic paraplegia was due to the ossification of posterior longitudinal ligament (OPLL). A trial stimulation was performed about two weeks before planning a permanent implantation of PISCES system. For the trial stimulation, epidural electrodes were percutaneously inserted with a guide of fluoroscopy in a X-ray room. The conditions of stimulation were adjusted to give an optimal electric dysesthesia. We employed pulse width 0.1-1.0 msec, pulse rate 1-120 Hz and pulse amplitude 0-10 Volt. If an excellent effect was obtained by trial study, we proceeded to the chronic implantation of PISCES system which were composed of epidural electrodes, a subcutaneous receiver and a surface antenna. The procedure of implantation was carried out in an operating room under local anesthesia. In our series, seven subjects (58%) experienced a rewarding effect by the trial stimulation and three underwent the permanent implantation of PISCES. We summarized the clinical courses of these three cases which were OPLL, CMT and SMON. Compared with the other methods for pain relief, PISCES is most characteristic in its safety and simplicity. To date, PISCES has been applied to various disorders; such as ataxia, spasticity, intractable pain, neurogenic bladder and peripheral vascular disease. But its efficacy has not been established in all these disorders.(ABSTRACT TRUNCATED AT 250 WORDS)

Taylor P.N., Burridge J.H., Dunkerley A.L., Wood D.E., Norton J.A., Singleton C., and Swain I.D. (1999) Clinical use of the Odstock dropped foot stimulator: its effect on the speed and effort of walking. Arch. Phys. Med. Rehabil. 80, 1577-1583.
Abstract: OBJECTIVE: To assess the clinical effectiveness of the Odstock dropped foot stimulator by analysis of its effect on physiological cost index (PCI) and speed of walking. This functional electrical stimulation (FES) device stimulates the common peroneal nerve during the swing phase of gait. DESIGN: A retrospective study of patients who had used the device for 4 1/2 months. SUBJECTS: One hundred fifty-one patients with a dropped foot resulting from an upper motor neuron lesion. SETTING: A medical physics and biomedical engineering department of a district general hospital specializing in the clinical application of FES and a neurophysiotherapy department at a separate hospital. MAIN OUTCOME MEASURES: Changes in walking speed and effort of walking, as measured by PCI over a 10-meter course. RESULTS: There was a 92.7% compliance with treatment. Stroke patients showed a mean increase in walking speed of 27% (p<.01) and reduction in PCI of 31% (p`.01) with stimulation, and changes of 14% (p<.01) and 19% (p<.01), respectively, while not using the stimulator. Multiple sclerosis patients gained similar orthotic benefit but no "carry-over." CONCLUSIONS: The measured differences in walking with and without stimulation were statistically significant in the stroke and multiple sclerosis groups. In this study use of the stimulator improved walking. Those with stroke demonstrated a short-term "carry-over" effect

      Taylor P.N., Burridge J.H., Dunkerley A.L., Lamb A., Wood D.E., Norton J.A., and Swain I.D. (1999) Patients' perceptions of the Odstock Dropped Foot Stimulator (ODFS). Clin. Rehabil. 13, 439-446.
Abstract: OBJECTIVE: To determine the perceived benefit, pattern and problems of use of the Odstock Dropped Foot Stimulator (ODFS) and the users' opinion of the service provided. DESIGN: Questionnaire sent in a single mailshot to current and past users of the ODFS. Returns were sent anonymously. SETTING: Outpatient-based clinical service. SUBJECTS: One hundred and sixty-eight current and 123 past users with diagnoses of stroke (CVA), multiple sclerosis (MS), incomplete spinal cord injury (SCI), traumatic brain injury (TBI) and cerebral palsy (CP). INTERVENTION: Functional electrical stimulation (FES) to correct dropped foot in subjects with an upper motor neuron lesion, using the ODFS. MAIN OUTCOME MEASURES: Purpose-designed questionnaire. RESULTS: Return rate 64% current users (mean duration of use 19.5 months) and 43% past users (mean duration of use 10.7 months). Principal reason cited for using equipment was a reduction in the effort of walking. Principal reasons identified for discontinuing were an improvement in mobility, electrode positioning difficulties and deteriorating mobility. There were some problems with reliability of equipment. Level of service provided was thought to be good. CONCLUSION: The ODFS was perceived by the users to be of considerable benefit. A comprehensive clinical follow-up service is essential to achieve the maximum continuing benefit from FES-based orthoses

      Vahtera T., Haaranen M., Viramo-Koskela A.L., and Ruutiainen J. (1997) Pelvic floor rehabilitation is effective in patients with multiple sclerosis. Clin. Rehabil. 11, 211-219.
Abstract: OBJECTIVE: To determine the effect of pelvic floor muscle exercises combined with electrical stimulation of pelvic floor on lower urinary tract dysfunction in multiple sclerosis (MS) patients with near normal (# 100 ml) postvoid residual volumes. DESIGN: Open, controlled, randomized study in two parallel groups. SETTING: Rehabilitation centre for MS patients. SUBJECTS: Fifty women and 30 men with definite MS and current symptoms of lower urinary tract dysfunction. OUTCOME: The muscle activity of the pelvic floor muscles was tested using surface EMG. Subjective urinary symptoms were assessed using a questionnaire. INTERVENTIONS: Pelvic floor muscles were stimulated using electrical stimulation at six sessions. During and after the final session the patients were taught to exercise their pelvic floor muscles and advised to continue these exercises regularly for at least six months. The control group was not treated. RESULTS: The maximal contraction power and endurance of the pelvic floor muscles increased after six sessions of electrical stimulation with interferential currents. Symptoms of urinary urgency, frequency and incontinence were significantly less frequent in the treated group than in the untreated subjects. Male patients appeared to respond better to the treatment than female patients. Compliance with the pelvic floor exercises was over 60% at the end of a follow-up for six months. Most drop-outs were due to the disappearance of urinary tract symptoms or to severe relapses in MS. CONCLUSIONS: The present study indicates that pelvic floor muscle exercises combined with electrical stimulation of the pelvic floor constitute an effective treatment for lower urinary tract dysfunction at least in male patients with MS

      Vodovnik L., Rebersek S., Stefanovska A., Zidar J., Acimovic R., and Gros N. (1988) Electrical stimulation for control of paralysis and therapy of abnormal movements. Scand. J. Rehabil. Med. Suppl 17, 91-97.
Abstract: After a short review of the functional aspects of electrical stimulation in rehabilitating paralysed patients, the article describes its effects on spasticity. Three different studies are briefly described. In the first one paraplegic patients' knee extensors and flexors were stimulated with four channel stimulator. In the second one two channel stimulation was applied to the ankle joint flexors and extensors in hemiplegic patients, while in the third, the effects of spinal cord stimulation were studied in multiple sclerosis patients. Although the parameters and sites of stimulation were different in each study, the effects were similar. In approximately 50% of paraplegic and hemiplegic patients stimulation caused decrease of reflex activity which lasted more than half an hour. In M.S. patients measurements were performed only in intervals of day and therefore short term effects were not documented. Two days after interruption of continuous spinal cord stimulation the reflex activity significantly increased in the majority of patients. In addition to this increase the volitional force decreased considerably

      Winter A. (1976) The use of transcutaneous electrical stimulation (TNS) in the treatment of multiple sclerosis. J. Neurosurg. Nurs. 8, 125-131.

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