New innovations for spasms and spasticity are on the horizon

 Shaun Barton from MS-UK’s helpline explains the new innovations in the pipeline for treating spasms and spasticity in MS

Our recently revised Choices booklet, Spasms and Spasticity, is chock full of information about these common MS symptoms, how they can be managed and where to find additional support. Inside the booklet is a comprehensive guide to the different treatments which are currently available to people with MS who are looking to manage the impact of spasms and spasticity.

But, what we do not cover in the booklet is information about new innovations which are showing their potential to be effective tools in the management of MS-related spasms and spasticity. This is because it is designed to provide information about the treatments and therapies which are widely available to people affected by MS, particularly via the UK’s public health care system, the NHS.

Regular readers of our New Pathways magazine, website news and blog pages will be aware that we use these platforms to inform the MS community about new developments in the MS world. This includes potential treatment options. Therefore, in this article we take a look at three relatively new therapies which may prove to be significant tools to help people with MS manage spasms and spasticity symptoms.

Mollii suit

This is a whole-body suit that delivers low-frequency transcutaneous electrical nerve stimulation (TENS) to the nervous system. The suit contains over fifty electrodes which are placed around it, allowing for the targeting of specific muscle groups. It is designed to be used to treat spasticity and provide pain relief for people affected by a number of conditions including MS and cerebral palsy.

For people with neurological conditions such as MS, when the neural pathways that connect nerves to muscles are damaged, the electrical signals sent from the nerves are compromised. This causes problems with muscle function, such as spasms and spasticity, and pain, much of which is as a result of the spasticity experienced.

The Mollii Suit uses a method called ‘sub-threshold electrical stimulation’ which, in layman’s terms, ensures that nerve cells contain enough electrical charge, the ‘threshold’, to send their signals to the body’s muscles. This can lead to better, more regular muscle function and relief from the impact of spasticity.

To date, some small studies have shown that the Mollii suit is a feasible way to manage the impact of spasticity, however more robust evidence is required to fully understand its efficacy. This is reflected in a 2017 briefing produced by the National Institute for Health and Care Excellence (NICE) in the UK. Since then, further small studies have returned positive results regarding its effectiveness in managing spasticity and improving motor function.

It may be that NICE will conduct a further review in the near future, taking into account new evidence, which could lead to a more positive outcome in terms of this technology being made available to treat spasms and spasticity via the NHS.

Presently in the UK, the Mollii Suit can be accessed privately, on a purchase or rental basis. A small number of private neuro-rehabilitation practices also offer support if you are interested in finding out more about whether it would be a viable option. A suit costs around £4,100 excluding VAT, and there are options to rent one on a monthly basis. Visit www.remotion.co.uk for more information.

Neubie

In basic terms, the Neubie is a device which delivers neuro muscular electrical stimulation (NMES) to the nerves using a pulsed direct current (DC).

The current is delivered to the nervous system via a series of electrical impulses, which are designed to mimic the electrical pulses that the body produces naturally – these are known as action potentials. Action potentials are the change in electrical potential associated with the passage of an impulse along the membrane of a muscle or nerve cell. When action potentials are compromised, such as by nerve damage caused by MS, this leads to incorrect firing of neurons (nerve cells), leading to problems with muscle spasms, spasticity and associated pain.

The developers of this device, neufit, state that the Neubie’s use of DC current makes it more effective than other NMES devices which use alternating current (AC), not least as it can help to activate denervated muscles, which can occur when a nerve connected to a muscle is damaged. They state that only DC can achieve an electrical pulse length that is sufficient to have this effect.

So far, studies have shown that the Neubie may have potential to help people with MS manage the impact of spasms and spasticity, and that it could in turn promote better motor function.

A small pilot study published in March 2023 involved seven people with MS, each of whom had an expanded disability status scale (EDSS) rating of between 6.0 and 8.0. Each participant was prescribed a comprehensive four-part intervention using a combination of the Neubie device and physical therapy, which was specifically designed to target various aspects of their condition. These aspects included neuropathy, spasticity, strengthening, and functional movements.

The study’s finding showed that the Neubie device was well tolerated, with participants displaying improved strength and a reduction in spasticity at the end of the course of treatment. For two patients, this was particularly impactful, given that they were able to stand without spasticity arising for the first time in more than three years. The study’s authors did indicate that further research is warranted to understand further the efficacy of the Neubie regarding treatment of MS related spasms and spasticity.

The Neubie is not currently available in the UK via the NHS, however it can be accessed privately through certified neufit providers. These can be found on the neufit website.

Noninvasive brain stimulation (NIBS)

These are a group of techniques using slightly different technologies, all of which are designed to stimulate brain activity non-invasively. This means that they can all be administered without the need for surgery. Whilst NIBS are not considered new technologies, it is only in more recent times that they have been considered as a treatment option to help people with MS manage the impact of spasms and spasticity.

There are two main types of NIBS that have shown positive results after having been studied for their effectiveness to treat MS-induced spasms and spasticity.

• Transcranial magnetic stimulation (TMS)

Also known as repetitive transcranial magnetic stimulation (rTMS) this process uses non-invasive magnetic fields to stimulate neurons that appear in certain areas of the brain

Transcranial electrical stimulation (TES)

This is an umbrella term for different low-level electrical stimulation techniques that have been developed. Like with TMS, the aim of this treatment is to stimulate brain neurons and modify brain activity. The two main types which have been used in studies researching the impact on MS-related spasms and spasticity are transcranial direct current stimulation (TDCS) and transcranial alternating current stimulation (TACS).

To date, research has found positive results for both TMS and TES regarding their ability to help people with MS manage the impact of spasms and spasticity. In 2022 we reported on a meta-analysis of 27 previous studies, involving almost 600 MS patients. The analysis found that both TMS and TES were effective tools in the management of fatigue and spasticity for people with MS.

Since then, more evidence has been found that supports these findings but with a slightly different slant. In August 2023 a scientific review of almost 150 previous studies found that MS patients who received TMS treatment experienced a significant reduction in spasticity, with results showing the TDCS approach to be less effective in comparison. These findings tally with a similar-sized review conducted in 2022, which found that TMS treatment was aligned with a reduction in muscle spasticity, while the therapeutic benefits of TDCS were focused towards improved cognitive function and less fatigue.

What all of the NIBS studies to which we have referred have in common is the need for additional, more widespread research. This will help to unfold a better understanding of the efficacy of NIBS therapies for treating spasms and spasticity in people with MS.

In the UK, NIBS variants are accessible via the NHS for conditions such as depression and obsessive compulsive disorder but are yet to be considered as a form of treatment for spasms and spasticity. It will be interesting to see if they become available to treat these common MS symptoms in the near future, should further robust evidence underpin their efficacy.

In summary, it is encouraging to see that time and money is being spent in developing new innovations which may offer further support to the many people with MS who are affected regularly by spasms and spasticity. Here’s hoping that more resources are ploughed into the research of these, and other potential solutions, to underpin their efficacy. If the outcomes continue to be positive, then it may just be a matter of time before more choice is widely available to the MS community.

Note: We strongly suggest that you should consult your medical support team, such as your GP/MS nurse/neurologist, prior to starting any new treatments or therapies.