Noninvasive Spinal Cord Stimulation Plus Therapy Shows Promise for Improving Function in MS

New findings from a pilot randomized crossover study suggest that noninvasive cervical spinal cord stimulation may have the potential to augment rehabilitation strategies for people with multiple sclerosis (MS). Presented at the Consortium of Multiple Sclerosis Centers (CMSC) Annual Meeting, held May 27-29 in Charlotte, North Carolina, the study evaluated a cervical stimulation approach delivered through surface electrodes alongside exercise therapy aimed at improving hand and arm function.

Investigators Sarah Simmons, MD, PhD, assistant professor in the Department of Rehabilitation Medicine at the University of Washington, and Fatma Inanici, MD, PhD, research assistant professor in the same department, presented the findings during a session focused on emerging rehabilitation interventions for MS. To gain further insight into the study and its potential implications for clinical practice, NeurologyLive^® sat down with both researchers following their presentation.

In the interview, Simmons and Inanici discussed the study's design, the observed improvements in upper-extremity strength and function among participants who received spinal cord stimulation plus therapy, and the broader implications for individuals with progressive MS and greater disability. The pair also highlighted key limitations of the pilot study, future research priorities, and the potential for more accessible home-based treatment approaches.

NeurologyLive: Can you provide an overview of your randomized crossover trial and its design?

Sarah Simmons, MD, PhD: We just completed a pilot randomized, open-label, crossover trial looking to see if people with multiple sclerosis could benefit from spinal cord stimulation. Specifically, we looked to see if spinal cord stimulation combined with occupational therapy or hand and arm exercises would lead to improved function of the hands and arms compared with just therapy alone.

The spinal cord stimulation that we used was noninvasive. It was applied over the cervical vertebra using sticker electrodes. It was a small study with 4 participants who received 6 weeks of spinal cord stimulation plus therapy and 6 weeks of therapy alone, separated by a 6‑week washout period. Participants were randomized to which intervention they got first.

What were the main findings from this pilot study?

Fatma Inanici, MD, PhD: The findings from this small pilot study showed that spinal cord stimulation combined with exercise therapy improves function and strength better than exercise therapy alone. So, spinal cord stimulation augments the outcomes of the conventional rehabilitation approach.

How do you interpret the clinical significance of these results for people with MS?

Inanici: Exercise therapy is the mainstay of treatment in people with spinal cord injury, but the outcomes are less than satisfactory right now, especially for hand and arm function and upper extremity function. We need to improve the outcomes of exercise therapy alone. Combining it with spinal cord stimulation makes the exercise therapy outcomes much better, which is something we need in people with multiple sclerosis.

Simmons: Especially for people who have progressive MS or a higher level of disability, their hand and arm function can be really affected, and that really impacts quality of life and their ability to do things independently on a day‑to‑day basis. Anything that we can use to help them regain hand and arm function can be really impactful.

I think this is the first step toward getting this type of intervention out to patients. It is just a small pilot study, but it is the first step toward moving toward eventual FDA approval to get these devices into therapy clinics, because a lot of larger studies start from a small pilot study. It is definitely a step in the right direction.

What were the key limitations or unanswered questions that emerged from this pilot trial?

Simmons: The biggest limitation is that this was just 4 participants. It is really a small study. We were encouraged that each participant received both interventions, so they acted as their own internal control and comparator. That strengthened what we felt were the outcomes of the study, but this needs to be repeated and verified with larger numbers.

Inanici: I also think we need to test sham stimulation compared with active stimulation to better understand how the active stimulation is helping the participants and to rule out the placebo effect.

Simmons: We also need to understand more about which types of people with MS will benefit—meaning, is it people who have impaired sensation, impaired strength, or other features? We need to figure out who will benefit most.

How might these findings influence future clinical practice if they are confirmed in larger studies?

Simmons: Right now, this type of noninvasive spinal cord stimulation is already FDA approved for people who have traumatic spinal cord injury, so that is really exciting. It means that, potentially, if these findings are confirmed in larger studies, it can move quickly toward broadening the FDA approval to people with multiple sclerosis.

Inanici: With the safety profile and ease of use of noninvasive spinal cord stimulation, it is really easy to translate into clinics. We tested upper extremity function—whether spinal cord stimulation can improve upper extremity function—but there is also potential with noninvasive spinal cord stimulation to improve locomotor function and bladder and bowel functions as well. There are lots of ongoing studies in other neurological disorders.

What did you learn about treatment burden for participants, and how is that shaping your future plans?

Simmons: Something that came out during this trial is that the burden on our participants was pretty high. They had to come into the clinic 3 times a week to receive their therapy. They came 3 times a week for an hour each time for 6 weeks during each intervention period, and that is pretty burdensome, especially for someone who has impaired hand and arm function and might not be able to get themselves to the clinic independently.

They told us that they would love to have more of a home‑based protocol, where they could use the spinal cord stimulator at home while doing exercises at home. We are really trying to listen to that and develop a protocol so that this could hopefully be easier to use and less of a burden from having to come into clinic so often.

Any final thoughts you would like to share with clinicians?

Simmons: I think this is a promising first step, but we need larger, controlled trials to really define the role of noninvasive spinal cord stimulation in MS rehabilitation and to understand which patients are most likely to benefit, in a way that is feasible and not too burdensome for them.

Transcript edited for clarity. Click here for more CMSC 2026 coverage.