Multiple sclerosis(MS) is demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged . In some cases we use FES ( functional electrical stimulation) to cure lack of walking in leg .But Is there any solution in order to improve the conductivity of neuron in absence of insulating covers and after that use a system like FES in other cases for example Visionary system ?
Multiple Sclerosis and Deep Brain Stimulation
How Does Deep Brain Stimulation Help Multiple Sclerosis?
The main purpose of deep brain stimulation for people with multiple sclerosis is to control a severe tremor related to the disease. In the case of multiple sclerosis, other problems such as loss of vision, sensation, or strength are not helped by deep brain stimulation.
Can Deep Brain Stimulation Cure Multiple Sclerosis?
No. Electrical stimulation does not cure multiple sclerosis nor prevent the disease from getting worse; it helps to relieve the symptom of tremor related to MS.
Is Deep Brain Stimulation Considered Experimental?
Deep brain stimulation is not experimental. The FDA has approved DBS to treat Parkinson's disease, essential tremor, and dystonia. Dystonia is a type of movement disorder characterized by abnormal postures and twisting motions.
The FDA has not specifically approved deep brain stimulation of the thalamus to treat multiple sclerosis. However, this does not mean that the treatment is experimental or that it would not be covered byinsurance. There are many examples of treatments that are used every day but have not been approved by the FDA for a specific medical condition.
Who Should Consider Deep Brain Stimulation?
There are many important issues to be addressed when considering deep brain stimulation. These issues should be discussed with a movement disorders expert or a specially trained neurologist.
Before considering surgery, you should try medication first. Surgery should not be undertaken if drugs are able to control your symptoms. However, surgery should be considered if you do not achieve satisfactory control through medications. If you are unsure if DBS is right for you, consult a movement disorders expert or a neurologist who has experience with movement disorders.
Where Should Deep Brain Stimulation Be Performed?
Deep brain stimulation should be performed in a center where there is a team of experts to care for you. This means neurologists and neurosurgeons who have extensive experience and specialized training in doing these types of surgeries. Always ask a physician how many of a specific procedure he has performed.
http://www.webmd.com/multiple-sclerosis/guide/deep-brain-stimulation?page=2#2
Functional electrical stimulation (FES)
Functional electrical stimulation (FES) is a treatment that applies small electrical charges to the leg to improve mobility in people who have difficulties with walking arising from damage in their brain or spinal cord. In MS it is mostly used as a treatment for foot drop.
What is FES?
Functional electrical stimulation (FES) uses small electrical signals to stimulate the nerves in the leg, causing the muscles to contract and produce a movement that can help walking. In MS, the most common use of FES is as a treatment for foot drop where disruptions in the nerve pathways between the legs and brain which means the front of your foot cannot be lifted to the correct angle whenwalking.
An FES device consists of a control box, about the size of a pack of cards, which is either worn on your leg or around your waist. Connected to this control box is a sensor worn in your shoe (heel switch) which detects pressure changes as the foot starts to move, then electrodes attached to the skin below the knee apply the electrical signals to the leg. If you have foot drop, these signals can, for some people, help lift the foot to the correct angle for taking a step and prevent it dragging on the ground.
There is also a version of FES available that uses a nerve stimulator that is surgically implanted. However the versions that are worn are much more commonly used, and wired as well as wireless versions are now available.
As well as being a treatment for foot drop FES can also be used in rehabilitation, complementing physiotherapy techniques, often to assist with movements in muscles that have become weak. This allows you to build up strength and range of movement. This may also help with reducing spasticity and sometimes in reducing swelling, depending on the cause.
Who can use FES?
If you have difficulty with walking due to foot drop, you may benefit from FES. However, as FES stimulates the existing nerves in the legs, it is important that your nerve fibres between the spinal cord and the muscles are not damaged. To be suitable for the treatment, you need to be able to walk, even if only for a few metres with a stick or crutch.
Typically you will have an initial assessment that lasts for about an hour to see if you are suitable for treatment and if you respond to the FES stimulation. If you do respond then you can start the treatment process. A health professional will set up the device with you and teach you how to use it. At first you may find it difficult and time consuming to put the device on and position the pads correctly, but this becomes easier with practice.
FES treatment can continue for as long as it is appropriate, as FES is safe to use in the long-term and some people have used FES for many years.
Although FES can be used to make the most of your walking ability, it does not improve the signal your nerves send without the stimulator and it does not protect your nerve pathways from further deterioration. This may mean there will come a point when FES is no longer effective for you.
Even though people are carefully assessed before treatment, some find they get no benefit from FES or they find it difficult to use the stimulator effectively. Some people have difficulty placing the electrodes precisely, especially if they experience numbness in their fingers, for example. Others do not like to sensation of the stimulation.
If FES is not suitable for you, you may be able to try an alternative treatment such as a support, ankle foot orthotic (AFO) orphysiotherapy.
What are the benefits of FES?
Research and experience has shown that treatment with FES produces a more normal walking pattern, enabling people to walk faster, further and with less effort. It can also help build confidence in walking and increase independence as well as reducing the risk of trips and falls.
What side effects could I get with FES?
The electrical stimulation causes a tingling 'pins and needles' or buzzing sensation on the skin. Ensuring that wires and pads are in the correct positions can help minimise some of these sensations. For most people this is not a problem, but some can find the effect uncomfortable and some may not want to continue using the FES.
Very occasionally people find that the stimulation or the electrodes causes irritation of their skin. Using hypoallergenic electrode patches or asking your health professional about changing the type of stimulation that is used can often solve these problems.
How do I get FES treatment?
In January 2009, NICE (National Institute for Health and Clinical Excellence) issued guidance that FES can be offered routinely as a treatment option for people with foot drop caused by damage to the brain or spinal cord if the health professional considers it is appropriate. Decisions about whether to fund the cost of FES are taken by local NHS bodies, such as the local Clinical Commissioning Group (CCG) or Health Board.
An assessment by a health professional trained in the use of FES is required to ensure that the treatment will be suitable for you. The health professional will also teach you to place the pads correctly so the FES works as well as possible and that the equipment is being used most effectively.
The National Clinical FES Centre in Salisbury provide services across the south of England and the use of FES is growing, with an increasing number of other centres offering the treatment around the UK. To access treatment you usually need to be referred to a FES service by your GP, MS nurse or neurologist. You can find out about FES clinics near you on the MS Trust's map of MS services.
https://www.mstrust.org.uk/a-z/functional-electrical-stimulation-fes
Dear Behrad,
It is a good question. Unfortunately we currently have no cure for MS and also don't know how to tackle the demyelination of the axons. FES (functional electrical stimulation) can only provide limited functional recovery but it is not the cure. Without the myelin the axons are short-circuited and therefore without fixing the demyelination by remyelination, it is not possible to cure by FES. Furthermore FES has its own limitations as a method, such as specific stimulation of individual nerves or coordinated stimulation of multiple nerves at will.
Best wishes, Refik
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