Case description: The patient is a 51-year-old Caucasian man diagnosed with herpetic encephalitis at 10 years of age and a left cerebellar stroke in 2006, with demyelinating disease type submissive-recurrent MS since 2007. His last outbreak occurred in November 2020 after receiving seven months of outpatient rehabilitation. Patients with multiple sclerosis who were previously treated in the rehabilitation service in the past years were invited to participate in a clinical trial to research the effectiveness of ultrasound-guided percutaneous neuromodulation. This patient was recruited in January 2022 and he didn t receive any other treatments since November 2020. He had a left hemiparesis, with a muscular strength of 3 points in the Daniels-5-point scale in the left finger flexor muscles, with hypoesthesia in the 4th and 5th left hand finger, as well as dystonia in some postures.
Intervention: A single application of ultrasound-guided PN was performed. DN needles (APS, 0.30x40 with guide), an electro stimulator (Globus Genesy SII) and an imaging ultrasound device (Logiq e, GE) were used (Figure 1). The median nerve was stimulated between the two fascicles of the pronator teres muscle (Figure 2), using 10 trains of 10 seconds of electrostimulation and 10 seconds of pause between them, with a frequency of 10 Hz and an impulse width of 240 micros, as established by the protocol of Valera-Garrido et al The procedure was performed at the University Hospital of the Canary Islands after being approved by the Ethical Committee (code NEUROECO-2020) and after having signed the informed consent. This clinical trial was registered with reference NCT05053984 at www.clinicaltrials.gov. Informed consent was obtained from the patient to publish the case report.  
Assessment: The grip strength was measured with a dynamometer (KERN MAP 130K1, Figure 3) whereas the hand function was measured with the nine hold peg test (9HPT) (Figure 4). Three measurements were taken, choosing the highest value in the case of the grip force and the lowest one for hand function. Measurements were taken at baseline, immediately after, 24 hours and four days after the intervention.