Botulinumtoxin bei nichtneurogenen Blasenfunktionsstörungen

Zusammenfassung: Die nichtneurogene überaktive Harnblase mit oder ohne Detrusorüberaktivität und/oder Inkontinenz ist ein belastendes Symptom für viele Menschen, das bis vor wenigen Jahren nur mit anticholinergen Medikamenten oder operativ behandelt werden konnte. Intradetrusorinjektionen mit BotulinumtoxinTypA stellen eine minimal-invasive Alternative für Patienten dar, die auf Anticholinergika nicht ansprechen oder diese nicht vertragen. Dieser Übersichtsartikel fasst die relevanten Arbeiten der letzten 6Jahre zu diesem Thema zusammen und gibt Auskunft über die Wirksamkeit, die Nebenwirkungen, die verwendeten Dosierungen und Injektionstechniken. Insgesamt zeigte sich eine gute initiale Wirksamkeit, die etwa ab dem 4. Tag nach Injektion beginnt und durchschnittlich bis zu 31Wochen anhalten kann. Es ist allerdings je nach Dosis mit einer Erhöhung der Restharnmengen zu rechnen, die auch die Anwendung von intermittierendem Selbstkatheterismus notwendig machen können. Die Anwendung von Botulinumtoxin in der Harnblase ist noch immer keine offiziell zugelassene Therapi

OnabotulinumtoxinA and multiple sclerosis.

Lower urinary tract dysfunction is present in two of three patients with multiple sclerosis five years after the diagnosis. Most frequent symptoms are related to neurogenic detrusor overactivity, often associated with detrusor-sphincter dyssynergia. From the end of the 1990s, there is growing evidence that neurogenic detrusor overactivity can be effectively managed by intradetrusorial injections of botulinum toxin type A. This treatment has shown, in different randomised placebo-controlled trials, to be safe and effective on clinical and urodynamic parameters with significant improvement in quality of life. The median duration of effect is in mean nine months. The vast majority of studies have been conducted with onabotulinumtoxinA. The dose of onabotulinumtoxinA commonly used to treat neurogenic detrusor overactivity in patients with multiple sclerosis is 200 UI, even if in selected patients lower doses can be preferred. To be considered eligible for treatment, all patients should accept and be instructed to perform clean intermittent self-catheterisation, since the risk of increased post-void residual volume and/or urinary retention after injection is high, especially with 200 UI of onabotulinumtoxinA. However, quality of life and patient satisfaction seem not to be affected by the need of intermittent catheterisation. The risk of urinary infection after the procedure is to be kept in mind, mainly in patients with multiple sclerosis, so that adequate antibiotic prophylaxis is highly recommended

Lebensqualität bei deutschsprachigen Patienten mit Rückenmarkverletzungen und Blasenfunktionsstörungen: Validierung der deutschen Adaption des Qualiveen®-Fragebogens

Zusammenfassung: Hintergrund: Blasenfunktionsstörungen bei Rückenmarkverletzten können zu erheblichen Einschränkungen der Lebensqualität führen. Zur Erfassung existiert ein validierter Fragebogen in französischer Sprache. Ziel war es, den Fragebogen in deutscher Sprache zu validieren. Material und Methoden: Übersetzung, sprachliche und interkulturelle Adaption erfolgten in Kooperation mit einer Forschungsstelle für Gesundheitssystemforschung. Die so entstandene Version wurde von 439Patienten an 18 Zentren in Deutschland, Österreich und der Schweiz ausgefüllt. Die Daten wurden deskriptiv hinsichtlich klinischer und soziodemographischer Charakteristika ausgewertet. Die Gütekriterien der Items und Skalen wurden mit einer detaillierten Skalenanalyse geprüft. Ergebnisse: Die Stichprobe bestand aus 65,8% Paraplegikern und 32,8% Tetraplegikern. Interne Konsistenz, Reliabilität und Validität des Fragebogens waren sehr gut. Differenzielle Effekte in den erhobenen klinischen Variablen wurden sichtbar. Schlussfolgerungen: Der Qualiveen®-Fragebogen steht als erstes Instrument in deutscher Sprache zur Untersuchung des Einflusses von Blasenfunktionsstörungen auf die Lebensqualität bei Rückenmarkverletzten zur Verfügun

The facilitatory effect of duloxetine combined with pelvic floor muscle training on the excitability of urethral sphincter motor neurons

INTRODUCTION AND HYPOTHESIS: Aim of this study was to investigate the excitability of sphincter motor neurons under the influence of pelvic floor muscle training (PFMT) and duloxetine. Due to their mechanisms of action, there might be a synergistic effect of duloxetine and PFMT in regard to the facilitation of spinal reflexes controlling urethral sphincter contractions and hence continence. METHODS: In ten healthy female subjects, clitoral electric stimulation (CES) and transcranial magnetic stimulation (TMS) were used to determine individual motor thresholds for external urethral sphincter (EUS) contractions before and after PFMT, duloxetine, and PFMT + duloxetine. RESULTS: PFMT and duloxetine alone significantly decreased the motor thresholds for EUS contractions during CES and TMS. However, the combined treatment reduced the motor threshold for EUS contractions significantly stronger compared to PFMT or duloxetine alone. CONCLUSIONS: The results are suggestive for a synergistic facilitatory effect of PFMT and duloxetine on sphincter motor neuron activation

Cortical substrate of bladder control in SCI and the effect of peripheral pudendal stimulation

We investigate (i) the central representation of lower urinary tract (LUT) control and (ii–iii) the acute and 23 short-term central neuromodulatory effect of peripheral pudendal nerve stimulation in incomplete spinal 24 cord injured (SCI) patients using functional magnetic resonance imaging (fMRI). The urinary bladder of eight 25 SCI patients has been passively filled and emptied using a catheter, to identify the neural substrate of bladder 26 control (i), and with simultaneous peripheral pudendal nerve stimulation to investigate its acute central 27 neuromodulatory effect (ii). To identify the potential effects of pudendal nerve stimulation treatment (iii), 28 six patients underwent a 2-week training using pudendal nerve stimulation followed by another fMRI 29 session of bladder filling. The pre- and post-training fMRI results have been compared and correlated with 30 the patient's pre- and post-training urological status. Our results suggest that the central representation of 31 bladder filling sensation is preserved in the subacute stage of incomplete SCI. However, compared to earlier 32 data from healthy subjects, it shows decreased neural response in right prefrontal areas and increased in left 33 prefrontal regions, indicating diminished inhibitory micturition control as well as, compensatory or de- 34 compensatory reorganization of bladder control. We also provide evidence for a neuromodulatory effect of 35 acute pudendal nerve stimulation, which was most prominent in the right posterior insula, a brain region 36 implicated in homeostatic interoception in human. Pudendal stimulation training also induced significant 37 neuromodulation, predominantly signal increases, in the normal cortical network of bladder control. 38 Correlations with the patient's urological status indicate that this neuromodulatory effect may reflect the 39 clinical improvement following training

A return to strong radio flaring by Circinus X-1 observed with the Karoo Array Telescope test array KAT-7

Circinus X-1 is a bright and highly variable X-ray binary which displays strong and rapid evolution in all wavebands. Radio flaring, associated with the production of a relativistic jet, occurs periodically on a ~17-day timescale. A longer-term envelope modulates the peak radio fluxes in flares, ranging from peaks in excess of a Jansky in the 1970s to an historic low of milliJanskys during the years 1994 to 2007. Here we report first observations of this source with the MeerKAT test array, KAT-7, part of the pathfinder development for the African dish component of the Square Kilometre Array (SKA), demonstrating successful scientific operation for variable and transient sources with the test array. The KAT-7 observations at 1.9 GHz during the period 13 December 2011 to 16 January 2012 reveal in temporal detail the return to the Jansky-level events observed in the 1970s. We compare these data to contemporaneous single-dish measurements at 4.8 and 8.5 GHz with the HartRAO 26-m telescope and X-ray monitoring from MAXI. We discuss whether the overall modulation and recent dramatic brightening is likely to be due to an increase in the power of the jet due to changes in accretion rate or changing Doppler boosting associated with a varying angle to the line of sight.Comment: 7 pages, 5 figures, accepted for publication in MNRAS 14 May 201

INTEGRAL observations of the Small Magellanic Cloud

The first INTEGRAL observations of the Small Magellanic Cloud (carried out in 2003) are reported in which two sources are clearly detected. The first source, SMC X-1, shows a hard X-ray eclipse and measurements of its pulse period indicate a continuation of the long-term spin-up now covering ~30 years. The second source is likely to be a high mass X-ray binary, and shows a potential periodicity of 6.8s in the IBIS lightcurve. An exact X-ray or optical counterpart cannot be designated, but a number of proposed counterparts are discussed. One of these possible counterparts shows a strong coherent optical modulation at ~2.7d, which, together with the measured hard X-ray pulse period, would lead to this INTEGRAL source being classified as the fourth known high mass Roche lobe overflow system.Comment: Accepted for publication in MNRA

The Orbital Solution and Spectral Classification of the High-Mass X-Ray Binary IGR J01054-7253 in the Small Magellanic Cloud

We present X-ray and optical data on the Be/X-ray binary (BeXRB) pulsar IGR J01054-7253 = SXP11.5 in the Small Magellanic Cloud (SMC). Rossi X-ray Timing Explorer (RXTE) observations of this source in a large X-ray outburst reveal an 11.483 +/- 0.002s pulse period and show both the accretion driven spin-up of the neutron star and the motion of the neutron star around the companion through Doppler shifting of the spin period. Model fits to these data suggest an orbital period of 36.3 +/- 0.4d and Pdot of (4.7 +/- 0.3) x 10^{-10} ss^{-1}. We present an orbital solution for this system, making it one of the best described BeXRB systems in the SMC. The observed pulse period, spin-up and X-ray luminosity of SXP11.5 in this outburst are found to agree with the predictions of neutron star accretion theory. Timing analysis of the long-term optical light curve reveals a periodicity of 36.70 +/- 0.03d, in agreement with the orbital period found from the model fit to the X-ray data. Using blue-end spectroscopic observations we determine the spectral type of the counterpart to be O9.5-B0 IV-V. This luminosity class is supported by the observed V-band magnitude. Using optical and near-infrared photometry and spectroscopy, we study the circumstellar environment of the counterpart in the months after the X-ray outburst.Comment: 12 pages, 13 figures and 3 tables. This paper has been accepted for publication in MNRA

Now you see it, now you don't - the circumstellar disk in the GRO J1008--57 system

Multiwavelength observations are reported here of the Be/X-ray binary pulsar system GRO J1008-57. Over ten years worth of data are gathered together to show that the periodic X-ray outbursts are dependant on both the binary motion and the size of the circumstellar disk. In the first instance an accurate orbital solution is determined from pulse periods, and in the second case the strength and shape of the Halpha emission line is shown to be a valuable indicator of disk size and its behaviour. Furthermore, the shape of the emission line permits a direct determination of the disk size which is in good agreement with theoretical estimates. A detailed study of the pulse period variations during outbursts determined the binary period to be 247.8, in good agreement with the period determined from the recurrence of the outbursts.Comment: Accepted for publication in MNRA