Percutaneous spinal stimulation to enhance gait and alleviate functional impairments in multiple sclerosis: A pilot study

Objective: To evaluate the feasibility and potential efficacy of percutaneous spinal stimulation (epidural stimulation, ES) combined with task-specific training to reduce spasticity and improve gait and balance in individuals with progressive multiple sclerosis (MS). Methods: Two men with progressive MS (EDSS 6.5) underwent ES lead implantation targeting the lower spinal cord, followed by one month of rehabilitation involving 12 ES-assisted training sessions. Assessments included instrumented gait analysis, Modified Ashworth Scale (MAS), pendulum test, and static balance testing performed at baseline, and at end of study with ES-Off and ES-On conditions. Results: Participant 1, with spastic hemiparetic gait, demonstrated improved lower extremity joint kinematics and muscle activation during gait, reduced knee extensor spasticity, and enhanced functional movement patterns with ES-On. Participant 2, with significant paraparesis and minimal spasticity, showed limited gait changes but experienced marked improvements in static balance, particularly under eyes-closed conditions. No adverse events were reported. Conclusion: This pilot study suggests that ES paired with task-specific training may enhance gait and balance in individuals with progressive MS. Responses varied based on impairment profiles, underscoring the importance of individualized ES parameter tuning. These findings warrant further investigation of ES as a therapeutic option for motor impairments in MS.