Findings from 18 studies support the effectiveness and safety of percutaneous tibial nerve stimulation (PTNS) and sacral neuromodulation (SNM) as therapeutic options for managing lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). These approaches are particularly valuable in cases with overactive bladder symptoms.

PTNS reduced the frequency, number, and urgency of incontinence episodes, as well as nocturia. It also improved quality of life in most patients. Patients reported generally well-accepted adverse effects, such as pain and mild discomfort at the site of needle insertion.

Two approaches can be used to perform tibial nerve stimulation. The transcutaneous approach is better tolerated by patients than the percutaneous approach since it can be performed at home. Therefore, the scientific community is currently working to improve the quality of implantable devices for tibial nerve stimulation. Pericolini et al said, “This innovative approach, well tolerated and safe, can reduce the logistical limits of a maintenance therapy, which forces the patient to undergo [constant] hospital sessions.”

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SNM reduced the frequency, urgency, and number of incontinence episodes in all patients with MS affected by disorders of the filling phase. It also increased the voided volume and reduced the need for daily clean intermittent catheterization in MS patients with chronic retention.

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However, the implementation of a permanent sacral electrode may lead to infections and/or mechanical problems, which can result in further dysfunction. Moreover, long-term results depend on the progression of the neurologic pathology.

Hence, the researchers said, “the use of the SNM has been discouraged in patients with unstable or rapidly progressive MS and, as suggested by some experts, it should be limited to MS patients with relapsing–remitting form without relapses for at least 2 years.”

These therapeutic approaches were effective even in patients who failed to respond to conservative therapies, such as anticholinergics. Moreover, patients often preferred stimulation approaches to other conventional treatments. Therefore, the study authors believe that stimulation approaches, such as PTNS, could be considered as a first-line treatment for overactive bladder in patients with MS.

The team of medical doctors also found spinal cord stimulation (SCS) and transcranial magnetic stimulation (TMS) to be effective approaches, despite the limited information found in the literature. Further studies would help to clarify their role in managing LUTS in patients with MS.


Pericolini M, Miget G, Hentzen C, et al. Cortical, spinal, sacral, and peripheral neuromodulations as therapeutic approaches for the treatment of lower urinary tract symptoms in multiple sclerosis patients: a review. Neuromodulation. Published online September 8, 2021. doi:10.1111/ner.13525