Efficacy of traditional swallowing therapy plus neuromuscular electrostimulation in multiple sclerosis: A randomized controlled trial

Background: Dysphagia is a common and potentially life-threatening complication in people with multiple sclerosis (pwMS), even in early disease stages. Although compensatory strategies may reduce aspiration risk, they do not restore normal swallowing. Neuromuscular Electrical Stimulation (NMES) has shown promise in dysphagic populations, but evidence in pwMS is scarce. Objectives: This double-blind, randomized, placebo-controlled trial aimed to evaluate the feasibility and added benefit of NMES combined with standard swallowing therapy in pwMS with dysphagia. Results: Of 151 dysphagic pwMS screened, 101 were enrolled and randomized to receive NMES plus conventional swallowing exercises (TST-NMES) (n = 52) or sham stimulation with the same therapy (TST-S) (n = 49). Both groups improved in dysphagia disturbances over time. However, when we analysed the two groups according to disease severity, significantly greater ASHA score gains were observed in severely disabled patients (EDSS ≥7) receiving NMES. Baseline ASHA predicted outcomes, while EDSS influenced only controls. At follow-up, no adverse effects were reported, confirming treatment safety and tolerability. Conclusion: NMES combined with standard swallowing therapy appears to be a feasible and effective intervention for dysphagia in pwMS, especially in more disabled people. These results support further investigation in larger randomized trials.