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

scholarly journals Feasibility and Acceptability of Transcutaneous Tibial Nerve Stimulation for the Treatment of Bladder Storage Symptoms Among People with Multiple Sclerosis.

2021 ◽  
Author(s):  
Hawra Dandan ◽  
Rose Galvin ◽  
Katie Robinson ◽  
Doreen McClurg ◽  
Susan Coote
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Outcome Measures ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Urinary Symptoms ◽  
Lower Urinary Tract Dysfunction ◽  
Post Intervention ◽  
Bladder Diary ◽  
Tibial Nerve Stimulation

Abstract Background: Neurogenic lower urinary tract dysfunction is an abnormality in the presence of underlying neurologic disease. A recent systematic review and meta-analysis demonstrated that storage phase symptoms are the predominant symptoms among people with multiple sclerosis (PwMS). Transcutaneous tibial nerve stimulation (TTNS) is a non-invasive treatment for bladder storage symptoms; however, the potential efficacy of stimulation among PwMS is based on a small number of studies with the absence of high-quality evidence. The aim of this study was to evaluate the feasibility, acceptability, and safety of TTNS in PwMS using an affordable transcutaneous electrical nerve stimulation (TENS) unit.Methods: A total of 23 participants with MS enrolled in the study. The primary outcomes included recruitment/retention rate, completion of the outcomes and the intervention, adherence to the protocol, adverse events, and acceptability of the intervention. The primary outcomes were assessed using diaries and satisfaction questionnaire. The secondary outcomes included changes in urinary symptoms and quality of life assessed using a set of validated outcome measures including 3- day bladder diary, PPIUS, ICIQ-OAB, and KHQ at baseline and post-intervention. Results: 20 participants completed the study. Three participants (13.04%) withdrew. All 20 participants completed the 6-week intervention and all the outcome measures (100%), with no reported adverse events. Participants were satisfied and found the unit acceptable. 3-day bladder diary showed changes in urinary frequency from a daily median of 10 times to 8 times and daily median urgency changed from 6 times at baseline to 2 times post-intervention. PPIUS showed changes in daily median sever urgency from 3 points (IQR=4) to 1 point (IQR=1) post-intervention. ICIQ-OAB total scores changed from 8 points (IQR=2.25) to 4 points (IQR=2.5) post-intervention. Median and mean scores of KHQ showed a clinical meaningful change of QoL in part-two and part-three of the questionnaire. Conclusions: TTNS is feasible, safe, and acceptable for PwMS. Changes of urinary symptoms scores and QoL post-intervention suggested improvements. Future implications need to consider the treatment protocol including frequency of treatment sessions, duration of treatment, and the electrical stimulation parameters as well as the outcome measures followed in the current study for the implementation of the future pilot RCT.Trial registration: ClinicalTrials.gov (NCT04528784). Registered 27 August 2020, https://register.clinicaltrials.gov/prs/app/action/LoginUser?ts=1&cx=-jg9qo4

scholarly journals Percutaneous Tibial Nerve Stimulation in Chronic Post-Surgical Anorectal Pain: A Case Report

2021 ◽  
pp. 1-6
Author(s):  
Marta Pacheco ◽  
João Xavier ◽  
Olga Santos ◽  
Carina Raposo ◽  
Ana Margarida Regalado
Keyword(s):  
Nerve Stimulation ◽  
Negative Impact ◽  
Tibial Nerve ◽  
Pain Syndrome ◽  
Brief Pain Inventory ◽  
Lower Urinary Tract Dysfunction ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Tibial Nerve Stimulation ◽  
Anorectal Pain ◽  
Patient Reported

<b><i>Introduction:</i></b> Anorectal pain is a symptom with a negative impact on quality of life and it can sometimes develop into a chronic pain syndrome. Structural anorectal pain is treated according to the underlying pathology. In situations of chronic post-surgical pain that is refractory to conventional therapeutic approaches, percutaneous tibial nerve stimulation (PTNS) is an option. PTNS is a neurostimulation technique used in the treatment of lower urinary tract dysfunction. There has been increasing evidence of its benefits for improving other conditions, such as chronic pelvic pain (CPP) and faecal incontinence (FI). <b><i>Case Presentation:</i></b> We report a case of a 45-year-old woman with chronic post-surgical anorectal pain (CPAP) treated with PTNS. The patient reported a consistent and dramatic decrease in both the frequency and intensity of pain, assessed by the Brief Pain Inventory (BPI). A decrease in the pain interference with mood, normal work, and walking/mobility was also noted, as evaluated by BPI and EQ-5D-3L questionnaires. <b><i>Discussion:</i></b> Neuromodulation treatments have been reported as effective for anorectal pain, but reports on the use of PTNS are rare. The tibial nerve is easily accessible and provides an optimal site for neurostimulation without the need of an operating room or anaesthesia. The overall improvement observed in this case of chronic anorectal pain suggests a potential new area of research for PTNS.

Long-Term Efficacy of Percutaneous Tibial Nerve Stimulation for Different Types of Lower Urinary Tract Dysfunction in Children

2009 ◽  
Vol 182 (4S) ◽  
pp. 2056-2061 ◽  
Author(s):  
Maria Luisa Capitanucci ◽  
Daniela Camanni ◽  
Francesca Demelas ◽  
Giovanni Mosiello ◽  
Antonio Zaccara ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Nerve Stimulation ◽  
Lower Urinary Tract ◽  
Tibial Nerve ◽  
Lower Urinary Tract Dysfunction ◽  
Percutaneous Tibial Nerve Stimulation ◽  
Tibial Nerve Stimulation ◽  
Different Types ◽  
Lower Urinary

Tibial Nerve Stimulation for Treating Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review

2015 ◽  
Vol 68 (5) ◽  
pp. 859-867 ◽  
Author(s):  
Marc P. Schneider ◽  
Tobias Gross ◽  
Lucas M. Bachmann ◽  
Bertil F.M. Blok ◽  
David Castro-Diaz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Urinary Tract ◽  
Nerve Stimulation ◽  
Lower Urinary Tract ◽  
Tibial Nerve ◽  
Lower Urinary Tract Dysfunction ◽  
Tibial Nerve Stimulation ◽  
Lower Urinary

scholarly journals Peripheral neuromodulation via posterior tibial nerve stimulation - a potential treatment for faecal incontinence?

2010 ◽  
Vol 92 (5) ◽  
pp. 385-390 ◽  
Author(s):  
John M Findlay ◽  
Justin Mc Yeung ◽  
Rachel Robinson ◽  
Helen Greaves ◽  
Charles Maxwell-Armstrong
Keyword(s):  
Faecal Incontinence ◽  
Nerve Stimulation ◽  
Tibial Nerve ◽  
Randomised Trial ◽  
Posterior Tibial Nerve ◽  
Posterior Tibial Nerve Stimulation ◽  
Posterior Tibial ◽  
Tibial Nerve Stimulation ◽  
Anal Ultrasound

INTRODUCTION Faecal incontinence is a prevalent and important condition, with a range of treatment options. Neuromodulation via sacral nerve stimulators is efficacious, but expensive and associated with complications due to device implantation. Peripheral neuromodulation via posterior tibial nerve stimulation (PTNS) has been assessed in urinary incontinence, but there is minimal evidence for its use in faecal incontinence and no literature from the UK. This retrospective review aimed to assess the efficacy of PTNS in faecal incontinence. PATIENTS AND METHODS Thirteen consecutive female patients with faecal incontinence of various causes (9 idiopathic, 3 obstetric, 1 surgery) underwent PTNS at a UK hospital. All were investigated with colonic imaging, anorectal physiology and endo-anal ultrasound. Prior treatments included physiotherapy (13), sphincteroplasty (3) biofeedback (3) and PTQ implants (1). PTNS was performed for 30 min, weekly for 12 weeks. RESULTS Median monthly episodes of incontinence of wind, liquid and solid reduced from 6, 10 and 18 respectively to 0 with 12 weeks' treatment (P < 0.05). Significant improvements in quality of life indices were also seen. At 1-month follow up, a sustained reduction in incontinence of wind was seen (0 episodes), with non-significant reductions of liquid and solid stool. CONCLUSIONS PTNS is a potentially efficacious, technically simple and minimally invasive alternative treatment modality for faecal incontinence. These early results are encouraging, but we await medium- and long-term follow-up, and a larger randomised trial comparing PTNS with alternative treatments and placebo.

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