{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T12:08:11Z","timestamp":1777982891981,"version":"3.51.4"},"reference-count":56,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T00:00:00Z","timestamp":1745020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","msard-journal.com","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Multiple Sclerosis and Related Disorders"],"published-print":{"date-parts":[[2025,7]]},"DOI":"10.1016\/j.msard.2025.106457","type":"journal-article","created":{"date-parts":[[2025,4,19]],"date-time":"2025-04-19T15:14:24Z","timestamp":1745075664000},"page":"106457","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Neuromuscular electrical stimulation reduces spinal excitability in Multiple Sclerosis patients with spasticity symptoms"],"prefix":"10.1016","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3305-2435","authenticated-orcid":false,"given":"Martina","family":"Scalia","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Riccardo","family":"Borzuola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina","family":"Parrella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanna","family":"Borriello","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Sica","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabrizia","family":"Monteleone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Macaluso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"78","reference":[{"key":"10.1016\/j.msard.2025.106457_bib0001","doi-asserted-by":"crossref","DOI":"10.1186\/1743-0003-5-18","article-title":"The relation between Ashworth scores and neuromechanical measurements of spasticity following stroke","volume":"5","author":"Alibiglou","year":"2008","journal-title":"J. Neuroeng. Rehabil."},{"key":"10.1016\/j.msard.2025.106457_bib0002","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/1545968317753681","article-title":"Pulse width does not influence the gains achieved with neuromuscular electrical stimulation in people with multiple sclerosis: double-blind, randomized trial","volume":"32","author":"Almuklass","year":"2018","journal-title":"Neurorehabil. Neural Rep."},{"key":"10.1016\/j.msard.2025.106457_bib0003","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1007\/s002219900260","article-title":"Posture-related changes in heteronymous recurrent inhibition from quadriceps to ankle muscles in humans","volume":"130","author":"Barbeau","year":"2000","journal-title":"Exp. Brain Res."},{"key":"10.1016\/j.msard.2025.106457_bib0004","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1152\/jn.00946.2003","article-title":"Spastic long-lasting reflexes in the awake rat after sacral spinal cord injury","volume":"91","author":"Bennett","year":"2004","journal-title":"J. Neurophysiol."},{"key":"10.1016\/j.msard.2025.106457_bib0005","doi-asserted-by":"crossref","DOI":"10.1007\/s00421-011-2087-9","article-title":"Neuromuscular electrical stimulation: implications of the electrically evoked sensory volley","author":"Bergquist","year":"2011","journal-title":"Eur. J. Appl. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0006","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/00019052-200106000-00003","article-title":"Axonal and neuronal degeneration in multiple sclerosis: mechanisms and functional consequences","volume":"14","author":"Bjartmar","year":"2001","journal-title":"Curr. Opin. Neurol."},{"key":"10.1016\/j.msard.2025.106457_bib0007","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1249\/MSS.0000000000001637","article-title":"Effects of neuromuscular electrical stimulation in people with spinal cord injury","volume":"50","author":"Bochkezanian","year":"2018","journal-title":"Med. Sci. Sports Exerc."},{"key":"10.1016\/j.msard.2025.106457_bib0008","doi-asserted-by":"crossref","first-page":"1150","DOI":"10.1136\/jnnp.55.12.1150","article-title":"Modulation of the soleus H-reflex during pedalling in normal humans and in patients with spinal spasticity","volume":"55","author":"Boorman","year":"1992","journal-title":"J Neurol. Neurosurg. Psychiatry"},{"issue":"21","key":"10.1016\/j.msard.2025.106457_bib57","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e40145","article-title":"Frequency-dependent effects of superimposed NMES on spinal excitability in upper and lower limb muscles","volume":"10","author":"Borzuola","year":"2024","journal-title":"Heliyon"},{"key":"10.1016\/j.msard.2025.106457_bib0009","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1007\/s00421-020-04430-5","article-title":"Modulation of spinal excitability following neuromuscular electrical stimulation superimposed to voluntary contraction","volume":"120","author":"Borzuola","year":"2020","journal-title":"Eur. J. Appl. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0010","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.1152\/jn.00085.2023","article-title":"Acute effects of neuromuscular electrical stimulation on cortical dynamics and reflex activation","volume":"129","author":"Borzuola","year":"2023","journal-title":"J. Neurophysiol."},{"key":"10.1016\/j.msard.2025.106457_bib0011","doi-asserted-by":"crossref","first-page":"2461","DOI":"10.1007\/s00421-011-2093-y","article-title":"Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning","volume":"111","author":"Botter","year":"2011","journal-title":"Eur. J. Appl. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0012","first-page":"401","article-title":"Spasticity as an adaptation to pyramidal tract injury","volume":"47","author":"Burke","year":"1988","journal-title":"Adv. Neurol."},{"key":"10.1016\/j.msard.2025.106457_bib0013","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1111\/1467-8721.ep10768783","article-title":"Statistical power analysis","volume":"1","author":"Cohen","year":"1992","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"10.1016\/j.msard.2025.106457_bib0014","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1053\/j.otns.2005.02.003","article-title":"Evaluation of spasticity in adults","volume":"7","author":"Decq","year":"2004","journal-title":"Operat. Tech. Neurosur."},{"key":"10.1016\/j.msard.2025.106457_bib0015","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-021-85645-0","article-title":"Modulation of torque evoked by wide-pulse, high-frequency neuromuscular electrical stimulation and the potential implications for rehabilitation and training","volume":"11","author":"Donnelly","year":"2021","journal-title":"Sci. Rep."},{"key":"10.1016\/j.msard.2025.106457_bib0016","series-title":"Retrospective Study On the Presence of Spasticity-Plus Syndrome in the Advanced Practice Nurse\u2019s Office in Multiple Sclerosis","author":"Goicochea Brice\u00f1o","year":"2023"},{"key":"10.1016\/j.msard.2025.106457_bib0017","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.jelekin.2018.04.012","article-title":"Presynaptic inhibition mechanisms may subserve the spinal excitability modulation induced by neuromuscular electrical stimulation","volume":"40","author":"Grospr\u00eatre","year":"2018","journal-title":"J. Electromyogr. Kinesiol."},{"key":"10.1016\/j.msard.2025.106457_bib0018","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1152\/jn.00355.2016","article-title":"High-frequency neuromuscular electrical stimulation modulates interhemispheric inhibition in healthy humans","volume":"117","author":"Gueugneau","year":"2017","journal-title":"J. Neurophysiol."},{"key":"10.1016\/j.msard.2025.106457_bib0019","doi-asserted-by":"crossref","DOI":"10.1177\/1073858408314986","article-title":"Persistent inward currents in spinal motoneurons and their influence on human motoneuron firing patterns","author":"Heckman","year":"2008","journal-title":"Neuroscientist"},{"key":"10.1016\/j.msard.2025.106457_bib0020","doi-asserted-by":"crossref","DOI":"10.1038\/ncpneuro0154","article-title":"Immunopathogenesis and immunotherapy of multiple sclerosis","author":"Hemmer","year":"2006","journal-title":"Nat. Clin. Pract. Neurol."},{"key":"10.1016\/j.msard.2025.106457_bib0021","first-page":"587","article-title":"Effects of downslope walking on Soleus H-reflexes and walking function in individuals with multiple sclerosis: a preliminary study","volume":"44","author":"Hoque","year":"2019","journal-title":"NeuroRehabilitation"},{"key":"10.1016\/j.msard.2025.106457_bib0022","doi-asserted-by":"crossref","DOI":"10.1007\/s11910-019-0991-2","article-title":"Assessment and measurement of spasticity in MS: state of the evidence","author":"Hugos","year":"2019","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"10.1016\/j.msard.2025.106457_bib0023","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1113\/jphysiol.1979.sp013037","article-title":"Changes in recurrent inhibition during voluntary soleus contractions in man studied by an H-reflex technique","volume":"297","author":"Hultborn","year":"1979","journal-title":"J. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0024","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1113\/jphysiol.1987.sp016484","article-title":"Inhibition of monosynaptic reflexes in the human lower limb","volume":"385","author":"Iles","year":"1987","journal-title":"J. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0025","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1093\/brain\/105.1.103","article-title":"Recurrent inhibition of \u03b1 - motoneurons in patients with upper motor neuron lesions","volume":"105","author":"Katz","year":"1982","journal-title":"Brain"},{"key":"10.1016\/j.msard.2025.106457_bib0026","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1007\/s00221-012-3194-5","article-title":"Changes in spinal but not cortical excitability following combined electrical stimulation of the tibial nerve and voluntary plantar-flexion","volume":"222","author":"Lagerquist","year":"2012","journal-title":"Exp. Brain Res."},{"key":"10.1016\/j.msard.2025.106457_bib0027","doi-asserted-by":"crossref","DOI":"10.1016\/j.msard.2022.103932","article-title":"Multiple sclerosis incidence: a systematic review of change over time by geographical region","volume":"63","author":"Lane","year":"2022","journal-title":"Mult. Scler. Relat Disord."},{"key":"10.1016\/j.msard.2025.106457_bib0028","doi-asserted-by":"crossref","first-page":"2520","DOI":"10.1007\/s00415-015-7878-1","article-title":"Sativex\u00ae and clinical\u2013neurophysiological measures of spasticity in progressive multiple sclerosis","volume":"262","author":"Leocani","year":"2015","journal-title":"J. Neurol."},{"key":"10.1016\/j.msard.2025.106457_bib0029","first-page":"293","article-title":"Effects of dry needling on spasticity in multiple sclerosis evaluated through the rate-dependent depression of the H reflex: a case report","volume":"16","author":"Le\u00f3n","year":"2023","journal-title":"Int. Med. Case Rep. J."},{"key":"10.1016\/j.msard.2025.106457_bib0030","article-title":"Are H and stretch reflexes in hemiparesis reproducible and correlated with spasticity?","author":"Levin","year":"1993","journal-title":"Original Commun. J. Neurol."},{"key":"10.1016\/j.msard.2025.106457_bib0031","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1007\/s00421-010-1502-y","article-title":"Physiological and methodological considerations for the use of neuromuscular electrical stimulation","volume":"110","author":"Maffiuletti","year":"2010","journal-title":"Eur. J. Appl. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0032","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1113\/jphysiol.1994.sp020457","article-title":"Depression of Renshaw recurrent inhibition by activation of corticospinal fibres in human upper and lower limb","volume":"481","author":"Mazzocchio","year":"1994","journal-title":"J. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0033","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1007\/s00221-018-5437-6","article-title":"Short-term inhibition of spinal reflexes in multiple lower limb muscles after neuromuscular electrical stimulation of ankle plantar flexors","volume":"237","author":"Milosevic","year":"2019","journal-title":"Exp. Brain Res."},{"key":"10.1016\/j.msard.2025.106457_bib0034","doi-asserted-by":"crossref","DOI":"10.1093\/brain\/124.4.826","article-title":"Modulation of presynaptic inhibition and disynaptic reciprocal ia inhibition during voluntary movement in spasticity spinal reflex modulation in spasticity","author":"Morita","year":"2001","journal-title":"Brain"},{"key":"10.1016\/j.msard.2025.106457_bib0035","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1002\/mus.10479","article-title":"Acute leg-cycling exercise attenuates the h-reflex recorded in soleus but not flexor carpi radialis","volume":"28","author":"Motl","year":"2003","journal-title":"Muscle Nerve"},{"key":"10.1016\/j.msard.2025.106457_bib0036","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1016\/j.mehy.2013.08.013","article-title":"Neuromuscular electrical stimulation for stroke rehabilitation: is spinal plasticity a possible mechanism associated with diminished spasticity?","volume":"81","author":"Motta-Oishi","year":"2013","journal-title":"Med. Hypotheses"},{"key":"10.1016\/j.msard.2025.106457_bib0038","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/09638280400014576","article-title":"Spasticity: clinical perceptions, neurological realities and meaningful measurement","volume":"27","author":"Pandyan","year":"2005","journal-title":"Disabil Rehabil"},{"issue":"9","key":"10.1016\/j.msard.2025.106457_bib0039","doi-asserted-by":"crossref","first-page":"925","DOI":"10.1016\/j.autrev.2017.07.004","article-title":"Spasticity in multiple sclerosis: contribution of inflammation, autoimmune mediated neuronal damage and therapeutic interventions","volume":"16","author":"Patejdl","year":"2017","journal-title":"Autoimmun. Rev."},{"key":"10.1016\/j.msard.2025.106457_bib0040","series-title":"The Circuitry of the Human Spinal Cord","author":"Pierrot-Deseilligny","year":"2005"},{"key":"10.1016\/j.msard.2025.106457_bib0041","article-title":"Electrical stimulation as a means for achieving recovery of function in stroke patients","author":"Popovi\u0107","year":"2009","journal-title":"NeuroRehabilitation"},{"key":"10.1016\/j.msard.2025.106457_bib0042","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1080\/08990220701318148","article-title":"How proprioceptive impairments affect quiet standing in patients with multiple sclerosis","volume":"24","author":"Rougier","year":"2007","journal-title":"Somatosens Mot. Res."},{"key":"10.1016\/j.msard.2025.106457_bib0043","doi-asserted-by":"crossref","DOI":"10.3390\/jcm13030704","article-title":"Neuromuscular electrical stimulation does not influence spinal excitability in multiple sclerosis patients","volume":"13","author":"Scalia","year":"2024","journal-title":"J. Clin. Med."},{"key":"10.1016\/j.msard.2025.106457_bib0044","article-title":"Comparison of acute responses in spinal excitability between older and young people after neuromuscular electrical stimulation","author":"Scalia","year":"2023","journal-title":"Eur. J. Appl. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0045","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1152\/jn.1980.43.6.1700","article-title":"Properties of a persistent inward current in normal and TEA-injected motoneurons","volume":"43","author":"Schwindt","year":"1980","journal-title":"J. Neurophysiol."},{"key":"10.1016\/j.msard.2025.106457_bib0046","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1016\/S1047-9651(18)30243-2","article-title":"Beyond Ashworth. Electrophysiologic quantification of spasticity","volume":"9","author":"Sehgal","year":"1998","journal-title":"Phys. Med. Rehabil. Clin. N Am"},{"key":"10.1016\/j.msard.2025.106457_bib0047","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1111\/j.1600-0404.1995.tb06997.x","article-title":"H-reflex modulation during gait in multiple sclerosis patients with spasticity","volume":"91","author":"Sinkjaer","year":"1995","journal-title":"Acta Neurol. Scand."},{"key":"10.1016\/j.msard.2025.106457_bib0048","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.neulet.2010.05.086","article-title":"Effect of acute unloaded arm versus leg cycling exercise on the soleus H-reflex in adults with multiple sclerosis","volume":"479","author":"Sosnoff","year":"2010","journal-title":"Neurosci. Lett."},{"key":"10.1016\/j.msard.2025.106457_bib0049","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.jns.2016.09.054","article-title":"Cortical and spinal excitability in patients with multiple sclerosis and spasticity after oromucosal cannabinoid spray","volume":"370","author":"Squintani","year":"2016","journal-title":"J. Neurol. Sci."},{"key":"10.1016\/j.msard.2025.106457_bib0050","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1161\/STROKEAHA.115.009633","article-title":"Effects of electrical stimulation in spastic muscles after stroke: systematic review and meta-analysis of randomized controlled trials","volume":"46","author":"Stein","year":"2015","journal-title":"Stroke"},{"key":"10.1016\/j.msard.2025.106457_bib0051","doi-asserted-by":"crossref","first-page":"2453","DOI":"10.1113\/JP278173","article-title":"H-reflex conditioning during locomotion in people with spinal cord injury","volume":"599","author":"Thompson","year":"2021","journal-title":"J. Physiol."},{"key":"10.1016\/j.msard.2025.106457_bib0052","doi-asserted-by":"crossref","unstructured":"Traversa, R., Cicinelli, P., Oliveri, M., Palmieri, M.G., Filippi, M.M., Pasqualetti, P., Rossini, P.M., 2000. Neurophysiological follow-up of motor cortical output in stroke patients.","DOI":"10.1016\/S1388-2457(00)00373-4"},{"key":"10.1016\/j.msard.2025.106457_bib0053","doi-asserted-by":"crossref","DOI":"10.1080\/09638280400014600","article-title":"Neurophysiological methods for the assessment of spasticity: the Hoffman reflex, the tendon reflex, and the stretch reflex","author":"Voerman","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"10.1016\/j.msard.2025.106457_bib0054","doi-asserted-by":"crossref","first-page":"1343","DOI":"10.1089\/acm.2010.0080","article-title":"Rehabilitation with neuromuscular electrical stimulation leads to functional gains in ambulation in patients with secondary progressive and primary progressive multiple sclerosis: a case series report","volume":"16","author":"Wahls","year":"2010","journal-title":"J. Alternat. Complement. Med."},{"key":"10.1016\/j.msard.2025.106457_bib0055","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1016\/j.clinph.2014.10.001","article-title":"Extra forces induced by wide-pulse, high-frequency electrical stimulation: occurrence, magnitude, variability and underlying mechanisms","volume":"126","author":"Wegrzyk","year":"2015","journal-title":"Clin. Neurophysiol."},{"key":"10.1016\/j.msard.2025.106457_bib0056","doi-asserted-by":"crossref","DOI":"10.1093\/ptj\/pzx053","article-title":"Torque, current, and discomfort during 3 types of neuromuscular electrical stimulation of Tibialis anterior","volume":"97","author":"Wiest","year":"2017","journal-title":"Phys. Ther."}],"container-title":["Multiple Sclerosis and Related Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2211034825001993?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2211034825001993?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,6,12]],"date-time":"2025-06-12T19:29:28Z","timestamp":1749756568000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2211034825001993"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7]]},"references-count":56,"alternative-id":["S2211034825001993"],"URL":"https:\/\/doi.org\/10.1016\/j.msard.2025.106457","relation":{},"ISSN":["2211-0348"],"issn-type":[{"value":"2211-0348","type":"print"}],"subject":[],"published":{"date-parts":[[2025,7]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Neuromuscular electrical stimulation reduces spinal excitability in Multiple Sclerosis patients with spasticity symptoms","name":"articletitle","label":"Article Title"},{"value":"Multiple Sclerosis and Related Disorders","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.msard.2025.106457","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier B.V.","name":"copyright","label":"Copyright"}],"article-number":"106457"}}