Exploratory pilot study exploring clinical effects of exogenous sustained-release Melatonin on nocturia in Parkinson’s Disease

Introduction: Nocturia is one of the commonest non‐motor symptoms in Parkinson’s disease (PD). Nocturia has evolved from being understood as a symptom of urological disorders or neurogenic bladder dysfunction to being considered as a form of circadian dysregulation. Exogenous melatonin is known to help circadian function and can be an effective strategy for nocturia in PD. Methods: In this open label single‐site exploratory phase 2 pilot study, adults with PD and nocturia underwent assessments using standardised questionnaires, urodynamics studies and a bladder scan. This was followed by completion of a frequency volume charts (FVC) and two weeks sleep diary. Sustained‐release melatonin 2mg was then administered once nightly for six weeks. A repeat assessment using questionnaires, the FVC and sleep diary was performed whilst on treatment with melatonin. Companion or bed partners filled in sleep questionnaires to assess their sleep during the intervention. Results: 20 patients (12 males; mean 68.2 (SD=7.8) years; mean PD duration 8.0 (±5.5) years with PD reporting nocturia were included. Administration of melatonin was associated with a significant reduction in the primary outcome bother related to nocturia measured using the International Consultation on Incontinence Questionnaire Nocturia (ICIQ‐N) (p=0.01), number of episodes of nocturia per night (p=0.013) and average urine volume voided at night (p=0.013). No serious adverse events were reported. No significant improvement was noted in bed‐partner sleep scores. Conclusion: In this preliminary open‐label study, administration of sustained‐release melatonin 2mg was found to be safe for clinical use and was associated with significant improvements in night‐time frequency and nocturnal voided volumes in PD patients

The Management of Lower Urinary Tract Dysfunction in Multiple Sclerosis

Purpose of Review Multiple sclerosis (MS) is the most frequent neuroinflammatory disease of the central nervous system and is commonly associated with lower urinary tract (LUT) dysfunction. As a consequence, health-related quality of life is often impaired and the upper urinary tract might be at risk for damage. The aim of this review is to give an overview of current treatment options for LUT dysfunction in patients with MS. Recent Findings The treatment is tailored to the type of dysfunction—storage or voiding dysfunction—beginning with conservative treatment options and ending with invasive therapies and surgery. Additionally, alternative options, e.g., different intravesical therapies or cannabinoids, have been evaluated in recent years with promising results. Summary Current available therapies offer different possible treatments for LUT dysfunction in patients with MS. They address either voiding or storage dysfunction and therefore ameliorate LUT symptoms improve quality of life and protect the upper urinary tract

Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease.

Bowel and bladder symptoms are highly prevalent in patients with multiple sclerosis (MS). Bladder dysfunction (affecting 75% of these patients) is caused by disease in the spinal cord, whilst the pathophysiology of bowel dysfunction is unknown. Pathways regulating both the organs lie in close proximity to the spinal cord, and coexistence of their dysfunction might be the result of a common pathophysiology. If so, the prevalence of bladder symptoms should be greater in patients with MS and bowel symptoms. This hypothesis is tested in the study. We also evaluated how patient-reported symptoms quantify bowel dysfunction

COVID-19 and fear processing

The world faces a global crisis that encompasses health, financial, and psychological aspects as a result of the coronavirus disease. While the health crisis is significant, it is important to recognize that the human and social crises that have emerged are equally impactful. These crises have resulted in various negative outcomes, such as social rejection, economic disparity, unemployment, and mental distress. Fear is a significant psychological barrier that can impede recovery from any disease process, and thus, it plays a critical role in determining the mortality and morbidity of any given disease. The COVID-19 pandemic has generated a pervasive fear of infection that has further exacerbated the situation. This study explored the mechanisms by which humans may have elicited conditional fear, using the COVID-19 pandemic as a specific case study. Our goal was to examine the process of fear in humans by exploring our knowledge of neuroanatomy and the systemic response regulated by the autonomic nervous system

The prevention and management of hospital admissions for urinary tract infection in patients with multiple sclerosis

Introduction Urinary tract infections (UTIs) are one of the commonest reasons for patients with multiple sclerosis (PwMS) presenting to hospital. Management of recurrent UTIs in PwMS can be challenging and characteristics of such patients are not well described. Aims To describe the neurological and urological features of PwMS presenting to hospital for UTIs and identify areas of management that could be improved to reduce UTI frequency. Methods Health episode statistics data were used to identify PwMS presenting to a tertiary hospital with UTI over a 5-year period. Medical records were reviewed for demographic, MS and urological history. The seven PwMS with the highest numbers of encounters were seen in a multidisciplinary clinic to enable detailed assessments. Results 52 PwMS (25 female, 27 male) with mean age of 60 had 112 emergency department presentations and 102 inpatient admissions for UTI. 24 presented multiple times and were more likely to be older and male with progressive MS. Almost two-thirds were using a urinary catheter. Less than half were under current urological and neurological follow-up. Escherichia coli and Pseudomonas spp were the commonest organisms cultured. Resistance to antibiotics was more frequent in patients with multiple presentations. Conclusions PwMS presenting to hospital for UTIs are more often male, older, with progressive MS and high levels of disability. A small group of PwMS accounted for a large number of encounters. Preventative and management strategies can be applied in primary and secondary care settings, with an emphasis on bladder, catheter and general physical care

Screening for urinary tract colonisation prior to corticosteroid administration in acute multiple sclerosis relapses: Validation of an updated algorithm

INTRODUCTION: To evaluate an updated algorithm in the detection of urinary tract infection (UTI) prior to high-dose corticosteroid treatment in acute relapses in multiple sclerosis (MS). This updated algorithm aimed to decrease the unnecessary use of antibiotics, whilst maintaining accuracy and safety. METHODS: Prospective cohort study of 471 consecutive patients with MS relapses in a hospital-based outpatient acute relapse clinic. 172 patients met exclusion criteria, leaving 299 patients for analysis. Patients underwent urine dipstick and were treated for UTI if 2 or more of: nitrites, leukocyte esterase and cloudy urine were positive. Patients with confirmed acute MS relapse were treated with high dose intravenous or oral methylprednisolone. RESULTS: Significant bacteriuria (>105 colony forming units/mL) was present in 33 (11%, 95% CI 8-15) patients. The algorithm sensitivity and specificity was 24% and 94% respectively; the negative predictive value was 91%. The overall accuracy of the algorithm was 87%. No adverse sequelae were identified in 25 patients who received high dose methylprednisolone in the presence of an untreated UTI. CONCLUSION: With an improved specificity, this updated algorithm addresses previous issues concerning the unnecessary prescription of antibiotics, whilst improving accuracy and maintaining safety