Objective: To assess transcutaneous spinal cord stimulation (tSCS) as a treatment for hereditary spastic paraplegias (HSPs).

Background: Hereditary spastic paraplegias (HSPs) are genetic disorders characterized by degeneration of the distal corticospinal tracts and dorsal columns causing lower extremity weakness, spasticity, and neurogenic bladder^1,2.

Transcutaneous spinal cord stimulation (tSCS) is a non-invasive technique that enhances motor function in people with spinal cord injury (SCI) by improving strength and reducing spasticity when combined with targeted physical or occupational therapy^3,4,5,6.

Given the anatomic overlap of HSPs and SCI, we postulated that tSCS has potential to improve function for people with HSP.

Method: Two patients with HSP participated in this preliminary study. Each participant received five days of intensive locomotor training with 60 minutes/day of tSCS via electrodes at T11 and L1 spinal levels. tSCS was delivered at 30Hz with a 10kHz carrier frequency, with biphasic waveform and a pulse width of 1ms [Fig 1]. The current was individualized based on observed benefits and tolerance of skin sensation. We collected baseline dynamometric, electrophysiologic, and clinical data for each patient before, during, and after the five-day session.

Results: The first participant (P1), a 62-year-old male, had an average 2.8-fold increase in strength across five lower extremity muscle groups [Fig2A], a 34% reduction in mean lower extremity Modified Ashworth Scale (MAS) score [Fig2B], a 54% improvement in stimulation-off 25 meter walk test (25MWT) time [Fig2C], a reduction in the spastic paraplegia rating scale (SPRS) from 27 to 21 [Fig2D], and a reduction in the ratio of the maximum amplitude of the Hoffmann reflex to the maximum motor response (H_max/M_max) over the course of the session [Fig2E].  

The second participant (P2), a 32-year-old male, showed an average 1.8-fold increase in strength across five lower extremity muscle groups [Fig 2A], a 16.5% reduction in mean lower extremity MAS score [Fig2B], a 2% improvement in stimulation-off 25MWT time [Fig2C], and a reduction in SPRS from 38 to 36 [Fig2D]. We were unable to obtain reliable electrophysiologic data due to edema in this participant.

Conclusion: tSCS may increase strength and decrease spasticity in patients with HSPs. Larger randomized and sham-controlled studies are needed to confirm the feasibility and efficacy of this therapy.

Figure 1

Figure 2

References: 1. Fink, J. K. (2023). The hereditary spastic paraplegias. Handbook of Clinical Neurology, 196, 59–88. https://doi.org/10.1016/B978-0-323-98817-9.00022-3

2. Blackstone, C. (2018). Hereditary spastic paraplegia. Handbook of Clinical Neurology, 148, 633–652. https://doi.org/10.1016/B978-0-444-64076-5.00041-7

3. Tefertiller, C., Trumbower, R. D., Morse, L., Pradarelli, J., Gelenitis, K., D’Amico, J. M., Moritz, C., & Field-Fote, E. C. (2025). Home-Based Noninvasive Spinal Cord Stimulation Safely Enhances Hand and Arm Function in People With Spinal Cord Injury. Neurology. Clinical Practice, 15(6). https://doi.org/10.1212/CPJ.0000000000200537

4. Moritz, C., Field-Fote, E. C., Tefertiller, C., van Nes, I., Trumbower, R., Kalsi-Ryan, S., Purcell, M., Janssen, T. W. J., Krassioukov, A., Morse, L. R., Zhao, K. D., Guest, J., Marino, R. J., Murray, L. M., Wecht, J. M., Rieger, M., Pradarelli, J., Turner, A., D’Amico, J., … Courtine, G. (2024). Non-invasive spinal cord electrical stimulation for arm and hand function in chronic tetraplegia: a safety and efficacy trial. Nature Medicine, 30(5), 1276–1283. https://doi.org/10.1038/S41591-024-02940-9

5. Inanici, F., Brighton, L. N., Samejima, S., Hofstetter, C. P., & Moritz, C. T. (2021). Transcutaneous Spinal Cord Stimulation Restores Hand and Arm Function After Spinal Cord Injury. IEEE Transactions on Neural Systems and Rehabilitation Engineering : A Publication of the IEEE Engineering in Medicine and Biology Society, 29, 310–319. https://doi.org/10.1109/TNSRE.2021.3049133

6. Inanici, F., Samejima, S., Gad, P., Edgerton, V. R., Hofstetter, C. P., & Moritz, C. T. (2018). Transcutaneous Electrical Spinal Stimulation Promotes Long-Term Recovery of Upper Extremity Function in Chronic Tetraplegia. IEEE Transactions on Neural Systems and Rehabilitation Engineering : A Publication of the IEEE Engineering in Medicine and Biology Society, 26(6), 1272–1278. https://doi.org/10.1109/TNSRE.2018.2834339

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MDS Abstracts - https://www.mdsabstracts.org/abstract/transcutaneous-spinal-cord-stimulation-in-hereditary-spastic-paraplegias/