Effectiveness of the EXOPULSE Mollii Ⓡ Suit in Patients With Multiple Sclerosis

Effectiveness of the EXOPULSE Mollii Ⓡ Suit in Patients With Multiple Sclerosis: Randomized Clinical Trial

Abstract:

Background:

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system with unknown etiology, causing a variety of symptoms including impaired balance, coordination, and walking difficulties. The Exopulse Mollii Ⓡ suit is an innovative approach for non-invasive, self-administered electrical stimulation designed to alleviate spasticity and improve motor function in various neurological conditions.

Objective:

To determine the effectiveness of the Exopulse Mollii Ⓡ suit in improving motor control in patients with MS.

Methods:

A randomized, double-blind clinical trial will be conducted, recruiting patients diagnosed with MS , aged 18 or above, with a Functional Ambulation Category (FAC) score between 2 and 4. Patients will be randomly assigned to two groups receiving either inactive or active Exopulse Mollii Ⓡ treatment for 60 minutes, three times a week, for three weeks. Outcome measures include pain, balance, gait speed, risk of falls, perception of walking difficulties, and quality of life assessed using validated scales. Statistical analysis will be performed using SPSS v.29.0.0.0.

Results:

Data on age, sex, weight, and MS-related factors will be collected at baseline. Primary outcomes include changes in pain, balance, and gait speed, while secondary outcomes encompass risk of falls, perception of walking difficulties, and quality of life. Analysis will compare mean differences between groups using appropriate statistical tests.

Conclusion:

This study aims to evaluate the efficacy of the Exopulse Mollii Ⓡ suit in enhancing motor function in MS patients. Findings may contribute to the development of novel therapeutic strategies for managing MS-related symptoms and improving patients' quality of life.

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis
• Intervention / Treatment: Device: EXOPULSE Mollii Ⓡ

Detailed Description

Introduction:

Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system with unknown etiology. Common symptoms include fatigue, visual disturbances, balance and coordination problems, sensory disturbances, spasticity, cognitive and emotional disorders, speech impairments, bladder and bowel issues, and sexual dysfunction. MS affects approximately 2.2 million people worldwide. Gait abnormalities are a distinctive feature of MS and a significant cause of disability and reduced health-related quality of life. Individuals with MS typically exhibit slower walking speeds, lower cadence, and increased variability between strides, attributed to demyelination resulting in reduced conductivity in the somatosensory nervous system, decreased muscle strength, vestibular dysfunction, and severe fatigue.

The EXOPULSE Mollii Ⓡ method is an innovative approach to non-invasive, self-administered electrical stimulation using multiple electrodes incorporated into a full-body suit. Comprising comfortable, breathable, and washable synthetic material, the Mollii Ⓡ suit primarily aims to alleviate disabling spasticity and enhance motor function. The method operates on the concept of reciprocal inhibition induced by stimulating the antagonist of a spastic muscle at low frequencies and intensities, thus considered to reduce spasticity. Moreover, the EXOPULSE Mollii Ⓡ suit has demonstrated benefits in children with cerebral palsy, spasticity, and chronic stroke patients. Therefore, this study aims to evaluate the effects of a 60-minute session with the EXOPULSE Mollii Ⓡ suit on patients with multiple sclerosis.

Methodology:

A randomized, double-blind clinical trial will be conducted, with two investigators performing the intervention and a third responsible for programming the suits and attaching the belt. Patients will be recruited from the Fivan Foundation, where the intervention will take place. Recruitment and patient selection will be conducted through therapists at the center, informed in advance about the project's content. The suits, provided by the Fivan Foundation and Ottobock, consist of comfortable, breathable, and washable synthetic pants and jackets. Patients meeting the following inclusion criteria will be selected:

• Diagnosed with multiple sclerosis by their physician
• Aged 18 or above.
• Able to understand verbal commands.
• Having a Functional Ambulation Category (FAC) score between 2 and 4.

Exclusion criteria include:

• Pregnancy.
• Having an intrathecal baclofen pump.
• Having received botulinum toxin infiltration in the last 3 months.
• Wearing electronic or magnetic medical devices (pacemakers, shunts, etc.) that may be affected by magnets.
• BMI > 35.

Patients will be randomly divided into two groups using a coin toss method. An initial individual assessment session will be conducted, including randomization, providing each patient with an assessment sheet, and obtaining informed consent. The control group will wear the Exopulse Mollii Ⓡ suit with parameters set to 0, while the second group will wear the same suit with parameters adjusted to each individual assessment. Both groups will undergo 60-minute sessions, three times a week for three weeks, to assess potential beneficial effects of this device for MS patients. At three weeks, a crossover will occur, with the group initially having parameters set to 0 now receiving treatment for another 3 weeks, while the other group will have the treatment discontinued to assess maintenance of effects. Initial, 3-week, and 6-week assessments will be conducted for both groups using previously validated scales detailed in the following section. This intervention will be added to the patient's usual treatment without interfering with it. Sample size was determined using the GRANMO© program, with 11 subjects per group, considering an alpha risk of 0.05, a beta risk below 0.2 in a bilateral contrast, and an estimation based on a common standard deviation of 4.89, taking into account a 5% follow-up loss rate.

• Study Type: Interventional
• Enrollment (Actual): 12
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Madrid
    • Villaviciosa De Odón, Madrid, Spain, 28670
      • Cecilia Estrada Barranco

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• • Diagnosis of Multiple Sclerosis as confirmed by a physician using McDonald's criteria.

  • Age over 18 years.
  • Ability to comprehend verbal commands.
  • Scoring between 2 and 4 on the Functional Ambulation Category (FAC).

Exclusion Criteria:

• Pregnancy.

  • Having an intrathecal baclofen pump.
  • Having received botulinum toxin injections in the last 3 months.
  • Wearing electronic or magnetic medical devices (pacemakers, shunts, etc.) that may be affected by magnets.
  • BMI > 35.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Exopulse on group; An individual assessment will be conducted to determine the parameters of the suit, and they will wear the suit for 60 minutes three times a week for three weeks. An initial assessment will be conducted, followed by another assessment after the 3-week treatment period.	Device: EXOPULSE Mollii Ⓡ; The EXOPULSE Mollii method (EXONEURAL NETWORK AB, Danderyd, Sweden) is an innovative approach to non-invasive and self-administered electrical stimulation with multiple electrodes incorporated into a full-body suit. It consists of comfortable, breathable, and washable synthetic material pants and a jacket. It has been primarily designed to reduce disabling spasticity and improve motor function. The method refers to the concept of reciprocal inhibition induced by stimulating the antagonist of a spastic muscle, at low frequencies and intensities, which is considered to reduce spasticity.
Placebo Comparator: Exopulse of group; The suit will be worn with the parameters set to 0 for 60 minutes, three times a week, for three weeks. An initial assessment will be conducted, followed by another assessment after the 3-week treatment period. The suit will be worn with the parameters set to 0 for 60 minutes, three times a week, for three weeks. An initial assessment will be conducted, followed by another assessment after the 3-week treatment period.	Device: EXOPULSE Mollii Ⓡ; The EXOPULSE Mollii method (EXONEURAL NETWORK AB, Danderyd, Sweden) is an innovative approach to non-invasive and self-administered electrical stimulation with multiple electrodes incorporated into a full-body suit. It consists of comfortable, breathable, and washable synthetic material pants and a jacket. It has been primarily designed to reduce disabling spasticity and improve motor function. The method refers to the concept of reciprocal inhibition induced by stimulating the antagonist of a spastic muscle, at low frequencies and intensities, which is considered to reduce spasticity.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
referred pain	Visual analogue scale. Range: 0 to 10 Interpretation: Higher scores indicate higher levels of pain or symptoms.	3 weeks
Balance	Berg Balance Scale; Range: 0 to 56 Interpretation: Higher scores indicate better balance and motor function.	3 weeks
gait speed and distance	6 minutes walking test; Interpretation: Interpretation: Greater distances indicate better functional capacity and endurance.	3 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
fall risk	Tinetti scale: Range: 0 to 28 Interpretation: Higher scores indicate better balance and mobility.	3 weeks
perception of walking difficulties	Multiple Sclerosis Walking Scale-12: Range: 0 to 100 Interpretation: Higher scores indicate greater difficulty walking and poorer mobility.	3 weeks
perceived quality of life	Multiple Sclerosis Impact Scale-29: Range: 29 to 116 Interpretation: Higher scores indicate greater impact on quality of life and higher disability due to multiple sclerosis.	3 weeks

Collaborators and Investigators

• Sponsor: Universidad Europea de Madrid

Study record dates

Study Major Dates

• Study Start (Actual): April 1, 2024
• Primary Completion (Actual): May 1, 2024
• Study Completion (Actual): September 1, 2024

Study Registration Dates

• First Submitted: April 8, 2024
• First Submitted That Met QC Criteria: April 22, 2024
• First Posted (Actual): April 25, 2024

Study Record Updates

• Last Update Posted (Actual): June 17, 2025
• Last Update Submitted That Met QC Criteria: June 12, 2025
• Last Verified: June 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Nervous System Diseases; Pathologic Processes; Autoimmune Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Multiple Sclerosis; Sclerosis
• Other Study ID Numbers: 123 (Giresun University Scientific Research Project)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No