When the movie “First Steps”came out in 1985 medical experts scoffed at its message — that electrical stimulation was a viable option for helping people to walk again after traumatic spinal cord injuries.
Today experts are successfully providing functional electrical stimulation for spinal cord patients.
And just recently extended its use to the world of MS.
How stimulation treatment works
Functional electrical stimulation (FES) is a treatment that uses small electrical charges to improve mobility for someone who has difficulties with walking caused by damage to the brain or spinal cord.
FES stimulates the nerves in the leg, causing the muscles to contract and produce a movement that can aid in walking. Currently with MS, the most common use of FES is as a treatment for foot drop.
Dr. Stephen Selkirk, a neurologist at the Louis Stokes Cleveland VA Medical Center, told Healthline that FES may not work for everyone.
He said in order for FES to work it is important that nerve fibers between the spinal cord and the muscles are not damaged.
There are cases where the damage is too extensive for treatment to work. While this is true in traumatic spinal cord injuries, it may not be an issue for people with MS.
Adapting device for MS treatment
After seeing success with FES for people with traumatic spinal cord injuries, Selkirk suggested using it for people with MS.
So, in partnership with the Advanced Platform Technology (APT) Center, a new device was created specifically for these people.
This new device is the size of a hockey puck and is inserted into the abdomen cavity, similar to baclofen pumps used to treat muscle spasticity in people with MS.
Selkirk specializes in spinal cord injuries and works with people who have MS and amyotrophic lateral sclerosis (ALS) who can no longer walk.
In his work at Veterans Affairs (VA), Selkirk sees some 300 people with MS, 100 of whom can no longer walk.
“There has been a long battle to find funding,” said Selkirk, adding that different grant applications were submitted 11 times but never approved.
But then APT approved it and found success, yet there is concern about the market size of people with MS who could benefit from these devices.
Approximately 2.5 million people worldwide have MS, and of those some 30 percent have difficulties with walking and can end up using a wheelchair.
What devices are available
Currently, there are several FES devices available to people with MS, according to the National Multiple Sclerosis Society website.
At a price tag of around $5,000, the WalkAide from Innovative Neurotronics, the NESS L300 from Bioness, and the Odstock Dropped Foot Stimulator from Odstock Medical Limited in the United Kingdom, are available over the counter.
These devices only work with the ankle and knee and not the entire leg, which make them good for foot drop, but not as successful for those needing more help walking.
Doctors also prescribe Ampyra, a prescription drug designed to help with walking, but it is only effective in about 30 percent of those who’ve taken it.
The new, implanted FES works by bypassing the demyelinated axons and allowing the “box” to communicate directly with the nerves, telling them to send a signal to a muscle.
Electrodes are implanted under the skin at the sites of the affected muscles and can easily be adjusted according to progression.
However, the peer reviews don’t see it this way. “They see a fixed system,” making it difficult to get funding for further studies.
Selkirk debunked a couple of other concerns.
It is generally OK for people with MS to undergo the surgery necessary for the implantation, he said.
The other concern is in MRI compatibility. Earlier devices did not work with this technology, but a new MRI compatible device is currently being tested.
What the future holds
The next step is to prove MRI compatibility in the next iteration of the device, then implant it in the next group of people.
Selkirk has plenty of volunteers — people with MS willing to try just about anything to find an improved quality of life.
While the device being tested right now requires someone to turn it on and control it, the goal is to have the brain communicate this information to the device directly.
Selkirk is currently working with Braingate to create a brain-computer interface.
“This is the future. An implanted system where you bypass the broken part with technology that is integrated, and all you need to do is think ‘move my left leg’ and it will happen,” he said.
“Key thing to consider is perspective.” Selkirk said. “In the private sector doctors see various levels of MS. I only see advanced MS patients.”
He knows what is important to people with MS, such as quality of life.
Even just the ability to stand up, to transfer to the commode or wheelchair is improvement in quality of life.
To be independent and spontaneous along with the physical benefits such as alleviating pressure wounds and sores could benefit many.
Editor’s Note: Caroline Craven is a patient expert living with MS. Her award winning blog is GirlwithMS.com, and she can be found @thegirlwithms.