{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:44:00Z","timestamp":1781624640313,"version":"3.54.5"},"reference-count":60,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Multiple sclerosis (MS) is a chronic neurological disease often resulting in motor and autonomic dysfunction. This case report investigates the acute and subacute effects of the EXOPULSE Mollii Suit (EMS), a wearable device capable of delivering transcutaneous electrical nerve stimulation to multiple anatomical regions, in a 43-year-old woman with MS. The patient underwent a clinical evaluation before the EMS treatment, during which central nervous system (CNS) and autonomic nervous system (ANS) responses were monitored using electroencephalography (EEG), heart rate variability (HRV), and infrared thermography (IRT). Immediately after the first EMS application, the clinical evaluation was repeated. The intervention continued at home for one month, followed by a post-treatment evaluation similar to the pre-intervention assessment. Functional evaluations showed improvements in sit-to-stand performance (from 8 s to 6 s), muscle tone (MAS scale for the right side from 3 to 2 and for the left side from 2 to 1), clonus, and spasticity (from 3 to 2). EEG results revealed decreased \u03b8-band power (on average, from 0.394 to 0.253) and microstates\u2019 reorganization. ANS activity modifications were highlighted by both HRV (e.g., RMSSD from 0.118 to 0.0837) and IRT metrics (e.g., nose tip temperature sample entropy from 0.090 to 0.239). This study provides the first integrated analysis of CNS and ANS responses to EMS in an MS patient, combining functional scales with multimodal instrumental measurements, emphasizing the possible advantages EMS for MS treatment. Although preliminary, these results demonstrated the potentiality of the EMS to deliver effective and personalized rehabilitative interventions for MS patients.<\/jats:p>","DOI":"10.3390\/bioengineering12090994","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T10:08:58Z","timestamp":1758276538000},"page":"994","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Acute and Subacute Effects of Session with the EXOPULSE Mollii Suit in a Multiple Sclerosis Patient: A Case Report"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6375-2360","authenticated-orcid":false,"given":"Serena","family":"Filoni","sequence":"first","affiliation":[{"name":"Unit of Neuro-Rehabilitation, IRCCS \u201cCasa Sollievo della Sofferenza\u201d, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Engineering and Geology, University \u201cGabriele D\u2019Annunzio\u201d of Chieti-Pescara, 65127 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1506-1995","authenticated-orcid":false,"given":"Daniela","family":"Cardone","sequence":"additional","affiliation":[{"name":"Department of Engineering and Geology, University \u201cGabriele D\u2019Annunzio\u201d of Chieti-Pescara, 65127 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Child and Adolescent Neuropsychiatry Unit, Department of Mental Health, ASL Foggia, 71121 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Forte","sequence":"additional","affiliation":[{"name":"Health Rehabilitation Management (HRM SRL), 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2899-146X","authenticated-orcid":false,"given":"Angelo","family":"Di Iorio","sequence":"additional","affiliation":[{"name":"Department of Innovative Technologies in Medicine & Dentistry, University \u201cGabriele d\u2019Annunzio\u201d of Chieti-Pescara, 66100 Chieti, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8566-3166","authenticated-orcid":false,"given":"Rocco Salvatore","family":"Calabr\u00f2","sequence":"additional","affiliation":[{"name":"IRCCS Centro Neurolesi Bonino-Pulejo, S.S. 113 Via Palermo, C.da Casazza, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5874-0376","authenticated-orcid":false,"given":"Raffaello","family":"Pellegrino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Clinica Medica, Department of Internal Medicine, Marche University Hospital, 60126 Ancona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2958-602X","authenticated-orcid":false,"given":"Emanuele Francesco","family":"Russo","sequence":"additional","affiliation":[{"name":"Padre Pio Foundation and Rehabilitation Centers, 71013 San Giovanni Rotondo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1903-0501","authenticated-orcid":false,"given":"David","family":"Perpetuini","sequence":"additional","affiliation":[{"name":"Department of Engineering and Geology, University \u201cGabriele D\u2019Annunzio\u201d of Chieti-Pescara, 65127 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arcangelo","family":"Merla","sequence":"additional","affiliation":[{"name":"Department of Engineering and Geology, University \u201cGabriele D\u2019Annunzio\u201d of Chieti-Pescara, 65127 Pescara, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e0158267","DOI":"10.1371\/journal.pone.0158267","article-title":"Coactivation of Lower Limb Muscles During Gait in Patients with Multiple Sclerosis","volume":"11","author":"Boudarham","year":"2016","journal-title":"PLoS ONE"},{"key":"ref_2","first-page":"e0158267","article-title":"Age, Motor Dysfunction and Neuropsychiatric Symptoms Impact Quality of Life in Multiple Sclerosis","volume":"75","author":"Lino","year":"2022","journal-title":"Rev. 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