This systematic review aims to determine the effectiveness of non-pharmacological interventions for the management of spasticity in people with multiple sclerosis (pwMS). A comprehensive literature search in health science databases (MEDLINE, Embase, CENTRAL, CINHAL) was performed to identify randomized controlled trials (RCTs) (up to April 2024). Manual searching in journals and screening of the reference lists of identified studies were conducted. Two authors independently selected the studies, assessed the methodological quality, and summarized the evidence. A meta-analysis was not feasible due to the methodological, clinical, and statistical diversity of the included studies. Overall, 32 RCTs (n=1,481 participants) investigated various types of non-pharmacological interventions including: physical activity, transcranial magnetic stimulation (intermittent theta burst stimulation [iTBS], repetitive transcranial magnetic stimulation [rTMS]), electromagnetic therapy, transcutaneous electrical nerve stimulation, vibration therapy, shock wave therapy, self-management educational programs, and acupuncture. All studies scored ‘low’ on the methodological quality assessment, implying a high risk of bias. The findings suggest ‘moderate to low certainty’ evidence for physical activity programs used in isolation or combination with other interventions (pharmacological or non-pharmacological), and for iTBS/rTMS with or without adjuvant exercise therapy in improving spasticity in adults with MS. There is ‘very low certainty’ evidence supporting the use of other modalities for treating spasticity in this population. Despite a wide range of non-pharmacological interventions used for the management of spasticity in pwMS, there is a lack of conclusive evidence for many. More robust trials with larger sample sizes and longer-term follow-ups are needed to build evidence for these interventions.

Objective
To assess the influence of cognitive therapy, in combination with cognitive software, on manual dexterity in individuals with multiple sclerosis (MS).
Methods
The Nine-Hole Peg Test (NHPT) was used to establish the eligibility of individuals with MS for testing and to assess their upper limb performance. In addition to standard upper limb rehabilitation, 20 participants received RehaCom-based visual-motor therapy, administered three times a week in 20-minute routines.
Results
A significant relationship was found between the use of manual therapy that utilized the cognitive function platform and the improvement of the non-dominant hand (p=0.037). Compared to controls, the experimental group scored higher on the NHPT, when using the dominant hand (p=0.007). All members of the experimental group, aged ≤60 years, needed considerably less time to do the NHPT with the dominant hand (p=0.008).
Conclusion
Application of manual therapy using the cognitive function platform improves performance of the hand. However, further research is needed to analyze the correlation between cognitive function and motor performance in patients with MS.

Citations

• Enhancing Neuroplasticity Post Stroke: The Role of Cognitive–Behavioral Training
  Mohamed Rasmy Moursy, Abdulalim A. Atteya, Hoda M. Zakaria, Zizi M. Ibrahim, Olfat Ibrahim Ali, Nouf H. Alkhamees, Mye A. Basheer, Noura A. Elkafrawy
  Brain Sciences.2025; 15(4): 330.     CrossRef
• Comparison of the Clinical Effectiveness of Telerehabilitation with Traditional Rehabilitation Methods in Multiple Sclerosis Patients: A Systematic Review
  Fatemeh Sarpourian, Roxana Sharifian, Maryam Poursadeghfard, Seyed Raouf Khayami, Leila Erfannia
  Telemedicine and e-Health.2024; 30(8): e2214.     CrossRef
• Effect of cognitive training on selected gait parameters in patients with stroke
  Asmaa Tahoon, Nahed Salem, Enas Elsayed, Ebtesam Fahmy, Rasha M Hegazy, Ahmed M. Aboeleneen, Ryan Jastania, Ayman A Alhammad, Shereen S. Mohamed
  Fizjoterapia Polska.2024; 24(4): 25.     CrossRef
• Effectiveness of computer-based telerehabilitation software (RehaCom) compared to other treatments for patients with cognitive impairments: A systematic review
  Fatemeh Sarpourian, Kambiz Bahaadinbeigy, Seyed Ali Fatemi Aghda, Farhad Fatehi, Saeid Ebrahimi, Meysam Fallahnezhad
  DIGITAL HEALTH.2024;[Epub]     CrossRef
• Effect of RehaCom cognitive rehabilitation software on working memory and processing speed in chronic ischemic stroke patients
  Sanaz Amiri, Peyman Hassani-Abharian, Salar Vaseghi, Rouzbeh Kazemi, Mohammad Nasehi
  Assistive Technology.2023; 35(1): 41.     CrossRef
• Modern Technologies in the Rehabilitation of Patients with Multiple Sclerosis and Their Potential Application in Times of COVID-19
  Ewa Zasadzka, Tomasz Trzmiel, Anna Pieczyńska, Katarzyna Hojan
  Medicina.2021; 57(6): 549.     CrossRef
• Rehabilitation in multiple sclerosis in 2021
  Cécile Donzé, Caroline Massot
  La Presse Médicale.2021; 50(2): 104066.     CrossRef

Objective
To investigate dosage changes in intrathecal baclofen during long-term treatment of patients with severe leg spasticity.
Methods
We performed a retrospective chart review of 49 patients treated with an intrathecal baclofen pump (ITB) because of severe leg spasticity, for a minimum of 7 years. Eight patients were excluded due to catheter/pump failure or factors aggravating spasticity. Of the remaining 41 patients, 19 had spinal cord injury (SCI) and 22 were diagnosed with multiple sclerosis (MS). Among the SCI patients, 15 had cervical and 4 thoracic SCI, with 7 patients showing the American Spinal Injury Association impairment scale (AIS) A and 12 patients with AIS B–D. The dose was regulated by discussion among the patients and their physicians, usually 4–10 times annually, to reduce leg spasticity and also avoid leg/trunk weakness.
Results
After 1 year patients on ITB needed a median dose of 168 mg/24 hr (range, 30–725 mg) for an optimal effect. After 7 to 10 years the dosage needed to reduce leg spasticity in the MS patients was significantly increased compared with the initial dose (mean 157%, n=22 and mean 194%, n=18). In contrast, the SCI patients needed only a modest increase (mean 113% and 121%). The difference between MS and SCI patients was significant (t-test p=0.006 and p=0.004).
Conclusion
The increased dosage in MS patients compared with patients diagnosed with SCI probably reflects the progressive disease course. The need for a large dosage increase in patients with SCI suggests possible pump failure, triggering factors for spasticity or progressive spinal disease.

Citations

• Quality of life of individuals with intrathecal baclofen pump therapy
  Abdulaziz Al Mosallam, Ahmad Zaheer Qureshi, Anas J. AlSaleh
  The Journal of the International Society of Physical and Rehabilitation Medicine.2025; 8(2): 50.     CrossRef
• Scar Tissue Catheter Tip Occlusion From an Intrathecal Baclofen Delivery: A Case Report and Review of the Literature
  James W Leiphart, Thaddeus J Leiphart
  Cureus.2024;[Epub]     CrossRef
• Spasticity Management after Spinal Cord Injury: The Here and Now
  Zackery J. Billington, Austin M. Henke, David R. Gater
  Journal of Personalized Medicine.2022; 12(5): 808.     CrossRef
• Results of Intrathecal Baclofen Treatment in Sixteen Spasticity Patients According to Four Different Measurement Scales: A Retrospective Analysis
  Hasan Burak Gündüz
  Cureus.2022;[Epub]     CrossRef

The concurrence of multiple sclerosis and primary intracranial neoplasm is uncommon. We reported a 15-year old girl known to have multiple sclerosis (MS), who later developed cerebral glioma. The tumor was documented on the brain magnetic resonance imaging during the work up for an apparent relapsing MS, and subsequently confirmed pathologically by stereotactic biopsy. Because no singleclinical feature or diagnostic test was sufficient for the diagnosis of MS, a combination of both clinical and paraclinical studies should be included. If clinical and paraclincal studies are atypical, additional studies, such as brain biopsy, may help differential diagnosis of other MS mimicking diseases. (J Korean Acad Rehab Med 2005; 29: 521-526)

Objective
We studied effects of dexamethasone on neurogenic bladder and paralysis in experimental autoimmune encephalomyelitis (EAE) rat model for multiple sclerosis.

Method: Thirty-five female Lewis rats were used in the study. Thirteen rats used as normal cystometrogram controls. Twenty-two rats induced EAE were divided into two groups: ten rats as control and twelve rats as dexamethasone injection group. Bladder dysfunction by cystometrogram, severity of weakness, and duration of paralysis were evaluated every other day after the onset of paralysis.

Results: Dexamethasone injection group compared to control group presented short duration of bladder dysfunction (2.5 vs. 4.2 day, p＜0.05) and paralysis (4.5 vs. 7.3 day, p＜0.05). There was a trend for lesser paralysis in the dexamethasone injection group, than control group (weakness scores were 2.4 vs. 3.6, p＞0.05), but it was not statistically significant.

Conclusion: Dexamethasone ameliorates the course of paralysis and bladder dysfunction in EAE. We suggest that dexamethasone treatment is an effective method in treating neurogenic bladder and paralysis in multiple sclerosis.