Toward Brain-Computer Interface motor rehabilitation for people with Multiple Sclerosis.

Background: Multiple Sclerosis (MS) is a chronic neurodegenerative disease in which the immune system attacks the myelin sheaths around nerves. People with MS (pwMS) often experience pain, fatigue, cognitive dysfunction, and reduced mobility. Today, MS is incurable, and treatments can at best slow the progression of the disease and manage symptoms. We conducted a preliminary, single-arm study using a motor-imagery brain-computer interface (MI-BCI) with functional electrical stimulation (FES) and virtual reality avatar targeting gait in pwMS. Methods: Twenty-six pwMS were enrolled; 24 completed 30 BCI sessions. Outcomes were assessed at Baseline, immediately post-treatment (Post1, week 13) and during follow-up (Post2, week 17; Post3, week 37). Change from baseline was analyzed using mixed models for repeated measures (with log-ratio models for skewed measures) and multiplicity control. This uncontrolled study is hypothesis-generating. Results: Patients treated with the BCI-based intervention obtained significant improvements that were largely maintained to 6 months after the therapy. The walking endurance, assessed by the 6-minute walking test (6MWT), increased by 37.3 m (95% CI 21.50-53.10) after the treatment ( Conclusion: In this preliminary, single-arm study, a MI-BCI + FES system was associated with statistically significant, clinically meaningful gains in gait endurance, mobility/speed, spasticity, and patient-reported outcomes, sustained up to 6 months after the intervention.