SCS Likely Effective Therapy Among Persons Living With MS

An analysis from Italy of 7 studies that investigated spinal cord stimulation (SCS) among persons living with multiple sclerosis (MS) found the treatment to be effective at improving motor disorders, urinary dysfunction, and neuropathic pain—the 3 principal functional limitations among these individuals, according to the study authors.

The team of investigators from Fondazione Policlinico Universitario Agostino Gemelli and Università Cattolica del Sacro Cuore published their findings in Minimally Invasive Surgery. They used the terms multiple sclerosis, spinal cord stimulation, and dorsal column stimulation for their literature search of PubMed, Scopus, and Embase.

“The aim of our study was to systematically review the literature to evaluate the effectiveness of SCS in MS patients,” the authors wrote, explaining that SCS use in the context of treating MS is typically examined as a subset within a larger study comprising “different causes of pain, motor disorder, and other functional limitations.

Their study cohort comprised 455 persons with MS (mean [SD] age, 44.25 [0.75] years). Most (n = 373) were enrolled in a stimulation trial, with the remaining 82 undergoing de novo implantation (or, without the trial). Of those in the stimulation trial, most (76.4%) subsequently were enrolled for permanent stimulation. The overall mean follow-up was 44.4 (25.0) months.

Overall, significant and long-lasting improvements were seen in a majority of patients for the 3 measures evaluated:

• 55.80% of the 346 participants with motor disorders saw symptom improvement
• 67.13% of the 134 participants with urinary dysfunction saw symptom improvement
• 82.35% of the 34 participants with neuropathic pain saw symptom improvement

SCS was also proven more effective at treating urinary dysfunction (P = .0144) and neuropathic pain (P = .0030) vs motor disorders, and among the de novo cohort, neuropathic pain was the only measure with a maintained significant improvement.

“These significant differences were confirmed in the subgroup of patients submitted to the SCS trial and then to the definitive implant,” the authors wrote.

For this study specifically, the author defined patient improvement as any gain in a functional measure “regardless of the evaluation scale used.”

Noting that the symptoms they evaluated—in addition to others common with MS, such as visual impairment, sensory impairment, and fatigue—can stop responding to treatment and that SCS is a minimally invasive procedure, they highlighted the treatment’s nondestructive and reversible properties. In addition, recent advancements in the neuromodulation procedure, such as in implant technique and greater SCS device compatibility with MRI systems, have enabled less system malfunctioning and wound infection and better disease follow-up, respectively.

“Thus, in our opinion, SCS may represent a valid option for MS patients whose symptoms are not controlled by medications,” the authors concluded. “Moreover, a better selection of cases and the implementation of a stimulation trial before the definitive implantation may help in increasing the number of patients responding to this treatment, as we demonstrated in this systematic review.”

Reference

Rapisarda A, Ioannoni E, Izzo A, D’Ercole M, Montano N. Is there a place for spinal cord stimulation in the management of patients with multiple sclerosis? a systematic review of the literature. Minim Invasive Surg. Published online April 19, 2021. doi:10.1155/2021/9969010