The Effect Of Pelvic Floor Muscle Training Alone Or In Combination With Electrostimulation In The Treatment Of Sexual Dysfunction In Women With Multiple Sclerosis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Background: Sexual dysfunction (SD) affects up to 80% of multiple sclerosis (MS) patients and pelvic floor muscles (PFMs) play an important role in the sexual function of these patients.Objectives: The objective of this paper is to evaluate the impact of a rehabilitation program to treat lower urinary tract symptoms on SD of women with MS.Methods: Thirty MS women were randomly allocated to one of three groups: pelvic floor muscle training (PFMT) with electromyographic (EMG) biofeedback and sham neuromuscular electrostimulation (NMES) (Group I), PFMT with EMG biofeedback and intravaginal NMES (Group II), and PFMT with EMG biofeedback and transcutaneous tibial nerve stimulation (TTNS) (Group III). Assessments, before and after the treatment, included: PFM function, PFM tone, flexibility of the vaginal opening and ability to relax the PFMs, and the Female Sexual Function Index (FSFI) questionnaire.Results: After treatment, all groups showed improvements in all domains of the PERFECT scheme. PFM tone and flexibility of the vaginal opening was lower after the intervention only for Group II. All groups improved in arousal, lubrication, satisfaction and total score domains of the FSFI questionnaire.Conclusion: This study indicates that PFMT alone or in combination with intravaginal NMES or TTNS contributes to the improvement of SD.2013176117682010/51656-5; FAPESP; São Paulo Research FoundationFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Gruenwald, I., Vardi, Y., Yarnitsky, I.D., Sexual dysfunction in females with multiple sclerosis: Quantitative sensory testing (2007) Multi Scler, 13, pp. 95-105Demirkiran, M., Sarica, Y., Uguz, S., Multiple sclerosis patients with and without sexual dysfunction: Are there any differences? (2006) Mult Scler, 12, pp. 209-211Schmidt, E.Z., Hofmann, P., Niederwieser, G., Sexuality in multiple sclerosis (2005) J Neural Transm, 112, pp. 1201-1211Lowenstein, L., Gruenwald, I., Gartman, I., Can stronger pelvic muscle floor improve sexual function? (2010) Int Urogynecol J, 21, pp. 553-556Beji, N.K., Yalcin, O., Erkan, H.A., The effect of pelvic floor training on sexual function of treated patients (2003) Int Urogynecol J, 14, pp. 234-238Zahariou, A.G., Karamouti, M.V., Papaioannou, P.D., Pelvic floor muscle training improves sexual function of women with stress urinary incontinence (2008) Int Urogynecol J, 19, pp. 401-406Seze, M., Raibaut, P., Even-Schneider, A., Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: Results of a multicenter prospective study (2011) Neurourol Urodyn, 30, pp. 306-311McClurg, D., Ashe, R.G., Lowe-Strong, A.S., Neuromuscular electrical stimulation and the treatment of lower urinary tract dysfunction in multiple sclerosis - A double blind, placebo controlled randomised clinical trial (2008) Neurourol Urodyn, 27, pp. 231-237Okada, N., Igawa, Y., Nishizawa, O., Functional electrical stimulation for detrusor instability (1999) Int Urogynecol J, 10, pp. 329-335Rosen, R., Brown, C., Heiman, J., The female sexual function index (FSFI): A multidimensional self-report instrument for the assessment of female sexual function (2000) J Sex Marital Ther, 26, pp. 191-208Polman, C.H., Reigold, S.C., Edan, G., Diagnostic criteria for multiple sclerosis: 2005 revisions to the "McDonald criteria" (2005) Ann Neurol, 58, pp. 840-846Kurtzke, J.F., Rating neurologic impairment in multiple sclerosis: An expanded disability status scale (EDSS) (1983) Neurology, 33, pp. 1444-1452Laycock, J., Jerwood, D., Pelvic floor muscle assessment: The PERFECT scheme (2001) Physiotherapy, 87, pp. 631-641Gentilcore-Saulnier, E., McLean, L., Goldfinger, C., Pelvic floor muscle assessment outcomes in women with and without provoked vestibulodynia and the impact of a physical therapy program (2010) J Sex Med, 7, pp. 1003-1022Wiegel, M., Meston, C., Rosen, R., The female sexual function index (FSFI): Cross-validation and development of clinical cut-off scores (2005) J Sex Marital Ther, 31, pp. 1-20Thiel Rdo, R.C., Dambros, M., Palma, P.C.R., Translation into portuguese, cross-national adaptation and validation of the female sexual function index [article in portuguese] (2008) Rev Bras Ginecol Obstet, 30, pp. 504-510Fall, M., Lindstrom, S., Electrical stimulation: A physiologic approach to the treatment of urinary incontinence (1991) Urol Clin North Am, 18, pp. 393-407Kabay, S., Kabay, S.C., Yucel, M., The clinical and urodynamic results of a 3-month percutaneous posterior tibial nerve stimulation treatment in patients with multiple sclerosis-related neurogenic bladder dysfunction (2009) Neurourol Urodyn, 28, pp. 964-968Fjorback, M.V., Van Rey, F.S., Van Der Pal, F., Acute urodynamic effects of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with MS (2007) Eur Urol, 51, pp. 464-472Kabay, S.C., Yucel, M., Kabay, S., Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: Urodynamic study (2008) Urology, 71, pp. 641-645Khan, F., Ng, L., Pallant, J.F., Whishaw, M., Sexual dysfunction in multiple sclerosis (2011) Sex Disabil, 29, pp. 101-111Jameson, J.S., Rogers, J., Chia, Y.W., Pelvic floor function in multiple sclerosis (1994) Gut, 35, pp. 388-390Lúcio, A.C., Campos, R.M., Perissinotto, M.C., Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis (2010) Neurourol Urodyn, 29, pp. 1410-1413De Ridder, D., Vermeulen, C., Ketelaer, P., Pelvic floor rehabilitation in multiple sclerosis (1999) Acta Neurol Belg, 99, pp. 61-64Graber, B., Kline-Graber, G., Female orgasm: Role of pubococcygeus muscle (1979) J Clin Psychiatry, 40, pp. 348-351Foldes, P., Buisson, O., The clitoral complex: A dynamic sonographic study (2009) J Sex Med, 5, pp. 1223-123

Transcutaneous Tibial Nerve Stimulation In The Treatment Of Lower Urinary Tract Symptoms And Its Impact On Health-related Quality Of Life In Patients With Parkinson Disease: A Randomized Controlled Trial

PURPOSE:: A randomized controlled trial study was performed to evaluate the efficacy of transcutaneous tibial nerve stimulation (TTNS) and sham TTNS, in patients with Parkinson disease (PD) with lower urinary tract symptoms (LUTS). DESIGN:: Randomized controlled trial. SUBJECTS AND SETTINGS:: Thirteen patients with a diagnosis of PD and bothersome LUTS were randomly allocated to one of the following groups: Group I: TTNS group (n = 8) and group II: Sham group (n = 5). Both groups attended twice a week during 5 weeks; each session lasted 30 minutes. METHODS:: Eight patients received TTNS treatment and 5 subjects allocated to group II were managed with sham surface electrodes that delivered no electrical stimulation. Assessments were performed before and after the treatment; they included a 3-day bladder diary, Overactive Bladder Questionnaire (OAB-V8), and the International Consultation on Incontinence Quality of Life Questionnaire Short Form (ICIQ-SF), and urodynamic evaluation. RESULTS:: Following 5 weeks of treatment, patients allocated to TTNS demonstrated statistically significant reductions in the number of urgency episodes (P = .004) and reductions in nocturia episodes (P < .01). Participants allocated to active treatment also showed better results after treatment in the OAB-V8 and ICIQ-SF scores (P < .01, respectively). Urodynamic testing revealed that patients in the active treatment group showed improvements in intravesical volume at strong desire to void (P < .05) and volume at urgency (P < .01) when compared to subjects in the sham treatment group. CONCLUSION:: These findings suggest that TTNS is effective in the treatment of LUTS in patients with PD, reducing urgency and nocturia episodes and improving urodynamic parameters as well as symptom scores measured by the OAB-V8 and health-related quality-of-life scores measured by the ICIQ-SF.4219499Campeau, L., Soler, R., Anderson, K.E., Bladder dysfunction and parkinsonism: Current pathophysiological understanding and management strategies (2011) Curr Urol Rep, 12, pp. 396-403Yeo, L., Singh, R., Gundeti, M., Urinary tract dysfunction in Parkinson's disease: A review (2012) Int Urol Nephrol, 44, pp. 415-424Araki, I., Kitahara, M., Oida, T., Voiding dysfunction and Parkinson's disease: Urodynamic abnormalities and urinary symptoms (2000) J Urol, 164, pp. 1640-1643Sammour, Z.M., Gomes, C.M., Barbosa, E.R., Voiding dysfunction in patients with Parkinson's disease: Impact of neurological impairment and clinical parameters (2009) Neurourol Urodyn, 28, pp. 510-515Madhuvrata, P., Cody, J.D., Ellis, G., Which anticholinergic drug for overactive bladder symptoms in adults (2012) Cochrane Database Syst Rev, 18, p. 1Basra, R.K., Wagg, A., Chapple, C., A review of adherence to drug therapy in patients with overactive bladder (2008) BJU Int, 102, pp. 774-779Chancellor, M.B., Anderson, R.U., Boone, T.B., Pharmacotherapy for neurogenic detrusor overactivity (2006) Am J Phys Med Rehabil, 85, pp. 536-545Stöhrer, M., Blok, B., Castro-Diaz, D., EAU guidelines on neurogenic lower urinary tract dysfunction (2009) Eur Urol, 56, pp. 81-88Kabay, S.C., Yucel, M., Kabay, S., Acute effect of posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with multiple sclerosis: Urodynamic study (2008) Urology, 71 (4), pp. 641-645McClurg, D., Ashe, R.G., Marshall, K., Comparison of pelvic floor muscle training, electromyography biofeedback, and neuromuscular electrical stimulation for bladder dysfunction in people with multiple sclerosis: A randomized pilot study (2006) Neurourol Urodyn, 25, pp. 337-348Kabay, S.C., Kabay, S., Yucel, M., Acute urodynamic effects of percutaneous posterior tibial nerve stimulation on neurogenic detrusor overactivity in patients with Parkinson's disease (2009) Neurourol Urodyn, 28, pp. 62-67Lúcio, A.C., Campos, R.M., Perissinotto, M.C., Pelvic floor muscle training in the treatment of lower urinary tract dysfunction in women with multiple sclerosis (2010) Neurourol Urodyn, 29, pp. 1410-1413Amarenco, G., Ismael, S.S., Even-Schneider, A., Urodynamic effect of acute transcutaneous posterior tibial nerve stimulation in overactive bladder (2003) J Urol, 169, pp. 2210-2215Vaughan, C.P., Juncos, J.L., Burgio, K.L., Behavioral therapy to treat urinary incontinence in Parkinson disease (2011) Neurology, 76, pp. 1631-1634Monga, A.K., Tracey, M.R., Subbaroyan, J., A systematic review of clinical studies of electrical stimulation for treatment of lower urinary tract dysfunction (2012) Int Urogynecol J, 23 (8), pp. 993-1005Lúcio, A.C., McR, P., Cal, D., A comparative study of pelvic floor muscle training in women with multiple sclerosis: Its impact on lower urinary tract symptoms and quality of life (2011) Clinics, 66, pp. 1563-1568Goetz, C.G., Tilley, B.C., Shaftman, S.R., Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): Scale presentation and clinimetric testing results (2008) Mov Disord, 23, pp. 2129-2170Abrams, P., Cardozo, L., Fall, M., The standardization of terminology in lower urinary tract function: Report from the standardization subcommittee of the International Continence Society (2003) Urology, 61, pp. 37-49Shafer, W., Abrams, P., Liao, L., Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure-flow studies (2002) Neurourol Urodyn, 21, pp. 261-274Sèze, M., Raibaut, P., Gallien, P., Transcutaneous posterior tibial nerve stimulation for treatment of the overactive bladder syndrome in multiple sclerosis: Results of a multicenter prospective study (2011) Neurourol Urodyn, 30, pp. 306-311Acquadro, C., Kopp, Z., Coyne, K.S., Translating overactive bladder questionnaires in 14 languages (2006) Urology, 67, pp. 536-540Tamanini, J.T., Dambros, M., D'ancona, C.A., Validation Of The, E., "International Consultation on Incontinence Questionnaire- Short Form" (ICIQ-SF) for Portuguese (2004) Rev Saúde Pública, 38, pp. 438-444Blackett, H., Walker, R., Wood, B., Urinary dysfunction in Parkinson's disease: A review (2009) Park Relat Disord, 15, pp. 81-8

Extracellular regulators of axonal growth in the adult central nervous system

Robust axonal growth is required during development to establish neuronal connectivity. However, stable fibre patterns are necessary to maintain adult mammalian central nervous system (CNS) function. After adult CNS injury, factors that maintain axonal stability limit the recovery of function. Extracellular molecules play an important role in preserving the stability of the adult CNS axons and in restricting recovery from pathological damage. Adult axonal growth inhibitors include a group of proteins on the oligodendrocyte, Nogo-A, myelin-associated glycoprotein, oligodendrocyte-myelin glycoprotein and ephrin-B3, which interact with axonal receptors, such as NgR1 and EphA4. Extracellular proteoglycans containing chondroitin sulphates also inhibit axonal sprouting in the adult CNS, particularly at the sites of astroglial scar formation. Therapeutic perturbations of these extracellular axonal growth inhibitors and their receptors or signalling mechanisms provide a degree of axonal sprouting and regeneration in the adult CNS. After CNS injury, such interventions support a partial return of neurological function

Use of the Mini Nutritional Assessment to detect frailty in hospitalised older people

ObjectivesThe aims of this study were to: (1) determine the prevalence of undernutrition and frailty in hospitalised elderly patients and (2) evaluate the efficacy of both the Mini-Nutritional Assessment (MNA) screening tool and the MNA short form (MNA-SF) in identifying frailty.Setting and participantsA convenient sample of 100 consecutive patients (75.0 % female) admitted to the Geriatric Evaluation and Management Unit (GEMU) at The Queen Elizabeth Hospital in South Australia.MeasurementsFrailty status was determined using Fried's frailty criteria and nutritional status by the MNA and MNA-SF. Optimal cut-off scores to predict frailty were determined by Youden's Index, Receiver Operator Curves (ROC) and area under curve (AUC).ResultsUndernutrition was common. Using the MNA, 40.0% of patients were malnourished and 44.0% were at risk of malnutrition. By Fried's classification, 66.0 % were frail, 30.0 % were pre-frail and 4.0 % robust. The MNA had a specificity of 0.912 and a sensitivity of 0.516 in predicting frailty using the recommended cut-off for malnourishment (ConclusionThe quickly and easily administered MNA-SF appears to be a good tool for predicting both under-nutrition and frailty in elderly hospitalised people. Further studies would show whether the MNA-SF could also detect frailty in other populations of older people.E. Dent, R. Visvanathan, C. Piantadosi, I. Chapma