Does threshold nighttime electrical stimulation benefit children with spina bifida? A pilot study

Background: Electrical stimulation is an established treatment for muscle weakness. However, traditional tectonic stimulation is poorly tolerated in children as a result of discomfort. Threshold electrical stimulation performed at night reportedly increases muscle strength in a variety of neuromuscular conditions and has been well tolerated in children. Questions/purposes: We asked whether threshold electrical stimulation treatment at night would increase strength and function in children with myelomeningocele. Methods: In a pilot study we prospectively followed 15 treated children who served as his or her own control. The patients were provided with a stimulator and instructed to use it on areas of muscular weakness during sleep, six nights per week. Followup phone calls at 2 weeks and then monthly were performed by a physical therapist to address patient concerns. Assessments of muscle strength, monofilament sensation, and physical function using the Functional Independence Measure for Children were to be performed at 3-month intervals up to 12 months and compared with the pretreatment assessment. Results: Only seven of the 15 subjects completed 9 months of treatment and none finished the 1-year study. The most frequent complaint was the treatment schedule was too intensive for the benefits received. We found small gains in muscle strength, gait, and bowel continence but no changes in physical function. Conclusions: Although threshold electrical stimulation made small improvements in muscle strength, the currently recommended treatment schedules are not practical for patients with myelomeningocele. Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.