Electrical Stimulation for Lower Urinary Tract Dysfunction in People with Multiple Sclerosis: A Systematic Review

Introduction: Lower urinary tract dysfunction (LUTD) is highly prevalent in patients with multiple sclerosis (MS) who suffer from some degrees of voiding dysfunction and/or urinary incontinence (UI), six to eight years after the initial diagnosis of MS. Electrostimulation is an established therapeutic option for neurogenic LUTD. This study aimed to investigate the efficacy of various types of electrical stimulation (ES) used for LUTD in MS patients. Materials and Methods: A systematic review of English-language articles was carried out in PEDro, PubMed, Science Direct, and Google Scholar databases between 1980 and 2017 using the following keywords: multiple sclerosis, electrical stimulation, LUTD, and neurogenic bladder. All the titles and abstracts were checked. Thereafter, full-text copies were obtained in cases where the studies had possible relevance. We carried out a background search by examining reference lists of all obtained articles. Ten treatment studies were identified in the search process. Results: Out of 10 articles, four were about the effects of percutaneous tibial nerve stimulation (PTNS) on LUTD. In three studies, neuromuscular ES, and in one study, interferential current was used. One study surveyed the effect of ES on the dorsal penile or clitoral nerve, and another studied the effect of ES on sacral dermatomes with regard to urinary symptoms. Also, three studies surveyed the effect of ES and its combination with pelvic floor muscle (PFM) training. Conclusion: This review showed that various types of non-invasive ES used for neurogenic LUTD in patients with MS for suppressing detrusor overactivity have also improved bladder compliance. Patients with MS require daily home stimulation treatments. Also, a combination of ES with PFM training is effective in reducing the symptoms of LUTD in MS patients.Keywords: Electrical Neuromodulation, Lower Urinary Tract Dysfunction, Multiple Sclerosis, Neurogenic Bladde

Effect of dry needling on pain and central sensitization in women with chronic pelvic pain: A randomized parallel-group controlled clinical trial

Chronic pelvic pain (CPP) is a debilitating problem in women with clear evidence of myofascial dysfunction. It seems that Myofascial trigger points (MTrPs) contribute to the development of central sensitization (CS). This study aimed to investigate the effect of dry needling on pain and CS in women with CPP. Thirty-six women with CPP participated in this randomized controlled clinical trial and randomly assigned into three groups: dry needling group (DNG), placebo needling group (PNG) and control group (CG). The DNG received five sessions of DN using the “static needling”, the PNG received non-penetrating method, and the CG did not receive any intervention. Assessment of outcomes including central sensitization inventory (CSI), short-form McGill pain questionnaire (SF-MPQ), electroencephalography (EEG), conditioned pain modulation (CPM), salivary cortisol concentration, 7-item general anxiety disorder scale (GAD-7), pain catastrophizing scale (PCS), and SF-36 questionnaire was performed pre-intervention, post-intervention, and three months post-intervention by a blind examiner. The result showed a significant group-by-time interaction for CSI, SF-MPQ, and PCS. There was a significant decrease in CSI score in post-intervention and three-months post-intervention compare to pre-intervention in the DNG and PNG. SF-MPQ-PPI score in DNG significantly decreased post-intervention. PCS-Total score decreased significantly post-intervention in DNG and PNG. No significant group-by-time interactions were observed for other variables. EEG results showed regional changes in the activity of frequency bands in both eye closed and eye open conditions. It seems that DN can affect central pain processing by removing the source of peripheral nociception.Trial registration: Iranian Registry of Clinical Trials (IRCT20211114053057N1, registered on: December 03, 2021. https://irct.behdasht.gov.ir/search/result?query=IRCT20211114053057N1)

Exosomes: Promising Delivery Tools for Overcoming Blood-Brain Barrier and Glioblastoma Therapy

Gliomas make up virtually 80% of all lethal primary brain tumors and are categorized based on their cell of origin. Glioblastoma is an astrocytic tumor that has an inferior prognosis despite the ongoing advances in treatment modalities. One of the main reasons for this shortcoming is the presence of the blood-brain barrier and blood-brain tumor barrier. Novel invasive and non-invasive drug delivery strategies for glioblastoma have been developed to overcome both the intact blood-brain barrier and leverage the disrupted nature of the blood-brain tumor barrier to target cancer cells after resection—the first treatment stage of glioblastoma. Exosomes are among non-invasive drug delivery methods and have emerged as a natural drug delivery vehicle with high biological barrier penetrability. There are various exosome isolation methods from different origins, and the intended use of the exosomes and starting materials defines the choice of isolation technique. In the present review, we have given an overview of the structure of the blood-brain barrier and its disruption in glioblastoma. This review provided a comprehensive insight into novel passive and active drug delivery techniques to overcome the blood-brain barrier, emphasizing exosomes as an excellent emerging drug, gene, and effective molecule delivery vehicle used in glioblastoma therapy