scholarly journals Neuromodulation for functional bladder disorders in patients with multiple sclerosis

2019 ◽  
Vol 26 (11) ◽  
pp. 1274-1280 ◽  
Author(s):  
Mohammad Sajjad Rahnama’i
Keyword(s):  
Multiple Sclerosis ◽  
Nervous System ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Disease Onset ◽  
Tibial Nerve Stimulation ◽  
Urological Symptoms ◽  
Bladder Symptoms ◽  
Bladder Disorders

The function of the lower urinary tract is mainly storage and voiding of urine, which is coordinated by the nervous system. Various diseases of the nervous system may cause neuro-urological symptoms. Neuro-urological symptoms depend on the localization of the disease and the extension of the neurological lesion. About 80% of multiple sclerosis (MS) patients have neuro-urological symptoms within 10 years after diagnosis. In addition, 10% of MS patients may even present with voiding dysfunction at disease onset. In this review, different types of neuromodulation are discussed. The available studies suggest that sacral neuromodulation (SNM) and percutaneous tibial nerve stimulation (PTNS) may be helpful in the neuromodulation of MS-related overactive bladder symptoms. These techniques may not only decrease the severity of symptoms but also significantly improve the quality of life of affected patients. Exploring the role of implantable tibial nerve stimulation devices in patients with MS could open new doors in the management of urgency and urgency incontinence in this patient group.

scholarly journals Pudendal but not tibial nerve stimulation inhibits bladder contractions induced by stimulation of pontine micturition center in cats

2016 ◽  
Vol 310 (4) ◽  
pp. R366-R374 ◽  
Author(s):  
Timothy D. Lyon ◽  
Matthew C. Ferroni ◽  
Brian T. Kadow ◽  
Richard C. Slater ◽  
Zhaocun Zhang ◽  
...  
Keyword(s):  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Area Under The Curve ◽  
Sympathetic Nerves ◽  
Detrusor Muscle ◽  
Tibial Nerve Stimulation ◽  
Parasympathetic Neurons ◽  
Bladder Disorders ◽  
Stimulation Of

This study examined the possibility that pudendal nerve stimulation (PNS) or tibial nerve stimulation (TNS) inhibits the excitatory pathway from the pontine micturition center (PMC) to the urinary bladder. In decerebrate cats under α-chloralose anesthesia, electrical stimulation of the PMC (40 Hz frequency, 0.2-ms pulse width, 10–25 s duration) using a microelectrode induced bladder contractions >20 cmH2O amplitude when the bladder was filled to 60–70% capacity. PNS or TNS (5 Hz, 0.2 ms) at two and four times the threshold (2T and 4T) to induce anal or toe twitch was applied to inhibit the PMC stimulation-induced bladder contractions. Propranolol, a nonselective β-adrenergic receptor antagonist, was administered intravenously (1 mg/kg iv) to determine the role of sympathetic pathways in PNS/TNS inhibition. PNS at both 2T and 4T significantly ( P < 0.05) reduced the amplitude and area under the curve of the bladder contractions induced by PMC stimulation, while TNS at 4T facilitated the bladder contractions. Propranolol completely eliminated PNS inhibition and TNS facilitation. This study indicates that PNS, but not TNS, inhibits PMC stimulation-induced bladder contractions via a β-adrenergic mechanism that may occur in the detrusor muscle as a result of reflex activity in lumbar sympathetic nerves. Neither PNS nor TNS activated a central inhibitory pathway with synaptic connections to the sacral parasympathetic neurons that innervate the bladder. Understanding the site of action involved in bladder neuromodulation is important for developing new therapies for bladder disorders.

SINGLE CENTRE RANDOMISED PILOT STUDY OF TWO REGIMENS (30 MINS DAILY OR 30 MINS WEEKLY FOR 12 WEEKS) OF TRANSCUTANEOUS TIBIAL NERVE STIMULATION USING A NOVEL DEVICE FOR TREATING MULTIPLE SCLEROSIS-RELATED OVERACTIVE BLADDER SYMPTOMS

2015 ◽  
Vol 86 (11) ◽  
pp. e4.20-e4 ◽  
Author(s):  
Jai Seth ◽  
Collette Haslam ◽  
Gwen Gonzales ◽  
Mahreen Pakzad ◽  
Arvind Vashisht ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Pilot Study ◽  
Overactive Bladder ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Multilevel Regression ◽  
Single Centre ◽  
Novel Device ◽  
Tibial Nerve Stimulation ◽  
Bladder Symptoms

IntroductionPercutaneous tibial nerve stimulation (PTNS) is effective for managing multiple sclerosis (MS)-related overactive bladder (OAB) symptoms. However the need for weekly clinic visits restricts its use. The purpose of this study was to evaluate safety and efficacy of a novel, self-applying device for managing OAB symptoms.Study design, materials and methods48 patients reporting OAB (MS n=24, idiopathic n=24), were randomized (1:1) to either daily or weekly treatments for 12 weeks with geko™, a novel device stimulating the tibial nerve transcutaneously. Efficacy was assessed using validated questionnaires (ICIQ-OAB, ICIQLUTS-QoL) and bladder diaries filled at weeks 4, 8, and 12. Urinary neurotrophins (Nerve growth factor (NGF) and Brain derived neurotrophic factor) were measured.Results34 patients (MS n=19) completed the study. 18 patients responded to treatment (53%); 72% of responders belonged to the MS cohort. Multilevel regression analysis suggested significant improvements in questionnaire scores (ICIQ-OAB –10.2 (–13.5 to –6.9; p=0.001), ICIQLUTS-QOL –40.8 (–57.4 to –24.3; p=0.000)), without differences between weekly and daily-treated arms. No significant adverse effects were reported and patients rated the treatment as easy to use and comfortable. NGF levels at baseline were significantly greater in non-responders (p=0.05).Concluding messageIn this pilot study, a patch device suitable for self-application at home appears to be an effective, safe and convenient alternative for managing MS-related OAB symptoms.

scholarly journals Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

2017 ◽  
Vol 25 (4) ◽  
pp. 245-54
Author(s):  
Elita Wibisono ◽  
Harrina E. Rahardjo
Keyword(s):  
Overactive Bladder ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Botulinum Toxin Injection ◽  
Treatment Options ◽  
Bladder Function ◽  
World Population ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Tibial Nerve Stimulation

Overactive bladder (OAB) is a common condition that is experienced by around 455 million people (11% of the world population) and associated with significant impact in patients’ quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS) is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA) in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration.

scholarly journals Transcutaneous tibial nerve stimulation for the treatment of bladder storage symptoms in people with multiple sclerosis: Protocol of a single-arm feasibility study

2020 ◽  
Vol 3 ◽  
pp. 66
Author(s):  
Hawra B. Al Dandan ◽  
Rose Galvin ◽  
Katie Robinson ◽  
Dorren McClurg ◽  
Susan Coote
Keyword(s):  
Multiple Sclerosis ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Randomised Trial ◽  
Self Report ◽  
Urinary Symptoms ◽  
Lower Urinary Tract Dysfunction ◽  
Convenience Sample ◽  
Tibial Nerve Stimulation ◽  
Qualitative Interview Study

Background: Neurogenic lower urinary tract dysfunction (NLUTD) is common among people with multiple sclerosis (MS) with a pooled prevalence of 68.41% using self-report measures and 63.95% using urodynamic studies. Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive option to manage bladder storage symptoms; however, the potential efficacy of TTNS among people with MS is based on a small number of studies with the absence of high-quality evidence relating to efficacy, and lack of clarity of the optimal electrical stimulation parameters and frequency, duration and number of treatment sessions. This study aims to assess whether TTNS is feasible and acceptable as a treatment for bladder storage symptoms in people with MS. Methods: We will use a single-arm experimental study to explore the feasibility and acceptability of TTNS in the treatment of bladder storage symptoms in MS. The CONSORT extension for pilot and feasibility studies will be followed to standardise the conduct and reporting of the study. The recruitment plan is twofold: 1) Open recruitment for people with MS through MS Ireland’s communication channels; 2) recruitment from a convenience sample of people with MS who have previously participated in a qualitative interview study of urinary symptoms. We will assess recruitment/retention rates, the urinary symptoms changes and the effect on quality of life pre and post intervention using ICIQ-OAB, 3-day bladder diary, King’s Health Questionnaire and collect self-reported data on adherence and adverse events. Acceptability of using TTNS will be evaluated at the end of intervention. This study has been reviewed and approved by the Education and Health Science’s Faculty Research Ethics Committee, University of Limerick [2020_06_07_EHS].  Conclusion: It is anticipated that assessing the feasibility and acceptability of TTNS for storage bladder symptoms in MS will inform the development of a definitive randomised trial. Trial registration: ClinicalTrials.gov NCT04528784 27/08/2020

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