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through a special needle. The electrodes are connected with an implanted stimulator or radio receiver. This procedure is ineffective and dangerous. The costs and risks are high. It is not recommended for use in patients with MS.

Hyperbaric Oxygen. Breathing oxygen under increased pressure in a specially constructed chamber. Large-scale, double-blind controlled studies have proven that HBO is ineffective as a treatment for MS.

Transcutaneous Nerve Stimulation. Transcutaneous nerve stimulation (TNS) is a procedure in which electrodes are placed on the surface of the skin over certain nerves and electrical stimulation is carried out. The dose, varied by changing frequency, pulse width, and intensity, determines which nerve fibers are activated. TNS is a moderately effective treatment for pain, but there is no evidence that it alters the underlying disease in MS.

Thalamotomy, Thalamic Stimulation. Destruction of part of the thalamus by surgical means. More recently, electrical stimulation of the thalamus by surgically implanted electrodes has been reported to have a similar effect. Thalamotomy and thalamic stimulation are not recommended for MS except in a small number of carefully selected MS patients.

Sympathectomy and Ganglionectomy. Sympathetic nerves and ganglions supplying blood vessels to the head are surgically removed in an effort to increase blood supply to the CNS. There is no convincing evidence that this surgical procedure is effective in treating MS.

Surgical Spinal Cord Relaxation. Surgical procedure to fix the cervical spine to restrict forward bending. This therapy is without value in MS.

Vertebral Artery Surgery. An operation devised to eliminate kinking or narrowing of the vertebral arteries in the neck. The existing evidence does not support the conclusion that these procedures may be effective in the treatment of MS.

Ultrasound. Repeated application of ultrasound, i.e., high-frequency sound, to the area of the back next to the spinal column (backbone). The evidence suggests that this treatment if unlikely to be effective in MS. The high price clearly reflects commercial exploitation.

Magnetotherapy. Repeated application of a low-frequency pulsing magnetic field. This treatment is not yet proven. Further controlled studies are underway.

Dental Occlusal Therapy. Correction of dental malocclusion with occlusal splints and other procedures, attention to other dental needs, and physi-

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