Multiple Sclerosis: Autoimmune Demyelinating Disease of the CNS
Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system, characterized by inflammatory demyelination of axons and the formation of gliosis plaques in the brain and spinal cord. It is the most common cause of non-traumatic neurological disability in young adults in the Western world, affecting approximately 2.8 million people — with female predominance (3:1 ratio) and peak onset between 20 and 40 years.
In addition to classic neurological attacks — optic neuritis, posterior cord syndrome, transverse myelitis —, patients face chronic symptoms that profoundly compromise their daily quality of life and functional capacity:
Specific Role of Acupuncture in MS
Medical acupuncture does not modify the course of the disease nor replace disease-modifying therapies (DMTs) such as interferons, natalizumab, or ocrelizumab. Its well-defined clinical role is the symptomatic management: reducing fatigue, spasticity, neuropathic pain, and bladder dysfunction — improving quality of life while the DMT controls the inflammatory activity. It is always used in coordination with the responsible neurologist.
Conventional Management of MS
MS treatment is stratified into two complementary fronts: control of the disease's inflammatory and immunological activity (DMTs) and management of chronic symptoms.
DISEASE-MODIFYING THERAPIES (DMTS) — OVERVIEW
| CLASS | EXAMPLES | EFFICACY (RELAPSE REDUCTION) | MAIN LIMITATION |
|---|---|---|---|
| First-line immunomodulators | Interferon-β, glatiramer acetate | 30–35% | Subcutaneous injection, flu-like syndrome |
| Oral immunomodulators | Fingolimod, dimethyl fumarate, teriflunomide | 50–60% | Continuous cardiac and hepatic monitoring |
| Monoclonal antibodies | Natalizumab, ocrelizumab, alemtuzumab | 65–80% | Risk of PML, significant immunosuppression |
| High efficacy | Cladribine, ofatumumab, ublituximab | 70–80% | Prolonged lymphopenia, hematological monitoring |
SYMPTOMATIC MANAGEMENT — LIMITATIONS OF CONVENTIONAL TREATMENTS
| SYMPTOM | STANDARD TREATMENT | RELEVANT CLINICAL LIMITATION |
|---|---|---|
| Spasticity | Baclofen, tizanidine, cannabinoids (nabiximols) | Drowsiness, generalized muscle weakness, tolerance |
| Fatigue | Amantadine, modafinil, methylphenidate | Modest efficacy (response in <40%), insomnia, headache |
| Neuropathic pain | Gabapentin, pregabalin, amitriptyline | Sedation, weight gain, dry mouth, dizziness |
| Bladder dysfunction | Oxybutynin, solifenacin, mirabegron | Dry mouth, constipation, urinary retention |
Mechanisms of Action in Multiple Sclerosis
Medical acupuncture acts through multiple neuromodulatory mechanisms that specifically address the main symptoms of MS — each with documented neurophysiological substrate.
Mechanisms of Action by Target Symptom
1. Control of Neurological Fatigue
Experimental studies suggest that electroacupuncture at ST-36 and SP-6 (2 Hz) can modulate the HPA axis and inflammatory markers such as IL-6 and TNF-α — mediators associated with immune-mediated fatigue. The findings are hypothetical, and clinical translation still requires confirmation in larger studies.
2. Reduction of Spasticity
GV-20 + GB-34 (point of influence on tendons) modulate descending corticospinal circuits, reducing the hyperexcitability of the stretch reflex. EA at BL-40 inhibits spinal interneurons that facilitate the H-reflex. Result: mean reduction of −0.6 points on the Modified Ashworth Scale.
3. Neuropathic Pain and Dysesthesias
Activation of descending inhibitory pathways (PAG → nucleus raphe magnus → posterior horn): opioid and serotonergic components. LI-4 + LR-3 (Four Gates) raise the central sensitization threshold. KI-3 is used specifically for allodynia in extremities — reference point for deficit-related neuropathic pain.
4. Bladder Dysfunction
CV-3 + SP-6 + BL-23 modulate the hypogastric plexus and the sacral reflex arc S2–S4. Urodynamic studies show increased functional bladder capacity and reduction of uninhibited detrusor contractions in patients with neurogenic overactive bladder due to MS.
5. Immunological Modulation — Supporting Hypothesis
Some experimental studies suggest possible effects of acupuncture on Th17 markers (IFN-γ, IL-17) and regulatory cytokines (IL-10, TGF-β). The findings are preliminary and heterogeneous; any clinical impact in human MS remains hypothetical. Acupuncture does not replace DMTs — its role in MS management is strictly symptomatic.
Spasticity
GV-20 + GB-34 + BL-40 with EA: inhibition of the spinal H-reflex and descending corticospinal modulation. MAS reduction −0.6 pts in 8 weeks (15 RCTs).
Neurological Fatigue
ST-36 + SP-6 + GV-20: activation of the HPA axis, reduction of IL-6 and TNF-α, optimization of mitochondrial efficiency. MFIS −8.2 pts versus −2.4 in the control.
Bladder Dysfunction
CV-3 + SP-6 + BL-23: modulation of the sacral reflex arc S2–S4 and hypogastric plexus. Reduction of voiding urgency in 68% of treated patients.
Scientific Evidence
Research on acupuncture and MS focuses primarily on symptomatic management — a domain with growing and consistent evidence, especially for fatigue and spasticity.
CLINICAL OUTCOMES — SYNTHESIS OF EVIDENCE
| SYMPTOM | SCALE | RESULT (ACUPUNCTURE) | RESULT (CONTROL) | QUALITY OF EVIDENCE |
|---|---|---|---|---|
| Fatigue | MFIS (0–84) | −8.2 pts | −2.4 pts | Moderate (15 RCTs) |
| Spasticity | MAS (0–4) | −0.6 pts | −0.2 pts | Moderate (11 RCTs) |
| Neuropathic pain | VAS (0–10) | −2.8 pts | −1.3 pts | Low-Moderate |
| Bladder dysfunction | NBSS total | −6.4 pts | −2.1 pts | Low (4 RCTs) |
| Quality of life | MSQoL-54 | +9.2 pts | +3.8 pts | Moderate (8 RCTs) |
Integrated Clinical Protocol in MS
Protocol by Clinical Phase
Initial Assessment — Coordination with Neurologist
Current EDSS, DMT in use, white-blood-cell count (if on immunosuppressants), predominant symptoms (fatigue vs. spasticity vs. pain). Formal communication with the responsible neurologist. Contraindications: active relapse (wait >4 weeks of stabilization), severe neutropenia (neutrophils <500/mm³).
Intensive Phase — Sessions 1 to 8
Two sessions per week. Base points: GV-20, ST-36, SP-6, LI-4, LR-3. Symptomatic modules added: fatigue (+BL-23, KI-3), spasticity (+GB-34, BL-40 with EA 2 Hz), pain (+GB-20, BL-17), bladder (+CV-3, SP-9). Duration: 30 minutes per session.
Maintenance Phase
One session per week in weeks 9–12, then biweekly. 12-month follow-up data show preservation of fatigue and spasticity gains with monthly maintenance. MFIS reassessment every 4 sessions.
Specific Safety for the Immunosuppressed
Absolute rigor: sterile single-use needles, antisepsis with 70% alcohol before each point, procedure gloves. Avoid points with skin lesions. Contraindicate semi-permanent auricular acupuncture in patients on natalizumab or alemtuzumab. Notify the neurologist immediately if fever occurs after the session.
When to Indicate Medical Acupuncture in MS
Priority Indications
- • Fatigue refractory to amantadine or modafinil (unsatisfactory response)
- • Spasticity with intolerance to baclofen due to excessive sedation
- • Neuropathic pain with limiting adverse effects of gabapentinoids
- • Urinary urgency/overactive bladder with unsatisfactory anticholinergic
- • Anxiety and sleep disturbances associated with MS
- • Patient seeking to complement DMT with a non-pharmacological approach
Relative Contraindications
- • Active relapse in the acute phase (wait for stabilization ≥4 weeks)
- • Severe immunosuppression: neutropenia (<500/mm³)
- • Active skin infection at the planned acupuncture sites
- • Full anticoagulation — adapt points, avoid deep ones
- • EDSS >7: adapt protocol (supine position, shorter sessions)
- • Cardiac pacemaker: replace EA with manual stimulation
Frequently Asked Questions
Frequently Asked Questions
No. Medical acupuncture neither cures MS nor modifies its progression when used in isolation. Disease-modifying therapies (DMTs) are the only treatments with robust evidence of reducing relapses and progression of disability. Acupuncture is a valuable complementary symptomatic resource — but it should never replace the DMT prescribed by the neurologist.
Clinical studies show significant response on the MFIS after 4–6 weeks of intensive treatment (2 sessions/week). Most patients report perceptible subjective improvement as early as sessions 3–4. Monthly maintenance is recommended to preserve long-term gains.
There are no pharmacological interactions described in the literature between acupuncture and the DMTs approved for MS (interferons, natalizumab, fingolimod, ocrelizumab), although the body of data on the topic is limited. The precaution in immunosuppressed patients is sanitary: ensuring rigorous needle sterility and skin antisepsis before each point, always in coordination with the responsible neurologist.
Electroacupuncture (EA) is contraindicated in patients with a conventional cardiac pacemaker. In these cases, manual acupuncture with stimulation by rotation or lifting is used — a technique that obtains similar results for spasticity and fatigue without electrical risk.
There is preliminary evidence that acupuncture at GV-20, GV-24, and PC-6 may improve sustained attention and working memory in MS patients. An RCT published in 2023 in the Journal of Neurological Sciences showed improvement in the cognitive component of the MSFC (Multiple Sclerosis Functional Composite) after 12 weeks. The evidence is still of low quality and requires confirmation in larger studies.