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Ghasemi V, Kiani Z, Alizadeh S, Roozbeh N, Mehrnoush V, MohammadSouri B, Saniee N, Shahrour W, Banaei M. Prevalence of stress urinary incontinence and urge urinary incontinence in multiples sclerosis patients: a systematic review and meta-analysis. Neurol Sci 2024:10.1007/s10072-024-07570-0. [PMID: 38710988 DOI: 10.1007/s10072-024-07570-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024]
Abstract
Urinary incontinence (UI), encompassing stress urinary incontinence (SUI) and urge urinary incontinence (UUI), is a prevalent and debilitating condition in patients with multiple sclerosis (MS), profoundly impacting their quality of life. This systematic review and meta-analysis aimed to elucidate the worldwide prevalence rates of SUI and UUI among MS patients. This study was conducted by examining observational studies published between 2000 and 2023. An exhaustive literature search was conducted across databases such as PubMed, MEDLINE, Web of Science, Scopus, ProQuest, and Google Scholar. The Meta-prop method facilitated pooled prevalence estimation of UUI and SUI, while Egger tests assessed publication bias. In total, 27 studies with 15,052 participants were included in the meta-analysis. The findings revealed a high random effect pooled prevalence of UUI at 41.02% (95% Confidence Interval [CI]: 30.57-51.89; I2 = 99%, p < 0.001) and SUI at 25.67% (95% CI: 19.30-32.58%; I2 = 94.9%, P < 0.001). Additionally, the pooled prevalence of mixed urinary incontinence (MUI) was reported at 18.81% (95% CI: 7.55-33.48; I2:95.44%, p < 0.001). The high heterogeneity observed suggests variable prevalence across populations and highlights the intricate nature of UI in MS. These findings underscore the critical need for dedicated supportive, therapeutic, and rehabilitative interventions to manage this common complaint in MS patients effectively.
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Affiliation(s)
- Vida Ghasemi
- Asadabad School of Medical Sciences, Asadabad, Iran
| | - Zahra Kiani
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiva Alizadeh
- Department of Midwifery & Reproductive Health, Zeynab School of Nursing & Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Nasibeh Roozbeh
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Vahid Mehrnoush
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Behzad MohammadSouri
- Urology and Nephrology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nadia Saniee
- Asadabad School of Medical Sciences, Asadabad, Iran
| | - Walid Shahrour
- Urology Department, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Mojdeh Banaei
- Mother and Child Welfare Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
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Ghezelhesari EM, Nahayati MA, Heydari A, Ebrahimipour H, Khadivzadeh T. Understanding the meaning of the lived experience "maternal role" in women with multiple sclerosis and planning a supportive program: a combined exploratory study protocol. Reprod Health 2024; 21:59. [PMID: 38693529 PMCID: PMC11064364 DOI: 10.1186/s12978-024-01799-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND The maternal role is one of the most challenging yet rewarding roles that women experience in their lives. It begins when a woman becomes pregnant, and as the pregnancy progresses, she prepares to fulfill her role as a mother. A woman's health plays a crucial role in her ability to fulfill the maternal role. Multiple sclerosis (MS), as an autoimmune disease, presents unique challenges in achieving this role. Failing to fulfill the maternal role can have lasting consequences for both the mother and the baby. Given the increasing number of women with MS of reproductive age in Iran and the absence of specific programs for this group during pregnancy and postpartum, researchers have decided to develop a supportive program by exploring the meaning of the maternal role and identifying the needs of these women during this period. METHODS/MATERIALS This study will be conducted in 3 stages. The first stage involves a qualitative study to explore the meaning of the "maternal role" in women with MS through a descriptive and interpretive phenomenological approach based on Van Manen's method. Data will be collected through semi-structured interviews with pregnant women with MS and mothers with MS who have children under one-year-old, recruited from the Multiple Sclerosis Society of Mashhad, Iran. The second stage will involve designing a support program based on the findings of the phenomenological study, literature review, and exploratory interviews. A logical model will guide the development of the program, and validation will be conducted using the nominal group technique. DISCUSSION This study is the first of its kind in Iran to explore the meaning of the maternal role and develop a support program for women with MS. It is hoped that the results of this study will help address the challenges of motherhood faced by these women.
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Affiliation(s)
| | - Mohamad Ali Nahayati
- Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Abbas Heydari
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Ebrahimipour
- Department of Health Economics and Management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Health Sciences Reseach Center, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran
| | - Talat Khadivzadeh
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Ebn Sina Street, Mashhad, 9137913199, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
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Kurze I, Jaekel AK. [Neuro-urological diagnostics and treatment of non-traumatic/degenerative neurogenic lower urinary tract dysfunction exemplified by multiple sclerosis]. Aktuelle Urol 2024. [PMID: 38653466 DOI: 10.1055/a-2281-7924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Neurogenic lower urinary tract dysfunction in multiple sclerosis is often underestimated, underdiagnosed, and inadequately treated. Depending on the course of the disease and the location of neural damage, it occurs with varying frequency and types of impairment of urine storage and voiding function. Symptoms such as urinary incontinence, recurrent urinary tract infections, urgency, pollakiuria, reduced urinary flow, hesitancy as well as postvoid residual urine may occur. However, the symptoms do not allow any conclusions to be drawn about the underlying type of neurogenic lower urinary tract dysfunction. Although numerous data, publications, and guidelines are available on this topic today, there continues to be a lack of standardized screening parameters and algorithms that have been tested in prospective studies for multiple sclerosis. This article presents the current diagnostic and therapeutic options of neurogenic lower urinary tract dysfunction in multiple sclerosis. A crucial issue is the initial delay in diagnosis, not least due to a lack of communication between neurologists and urologists. Initial indicators of the presence of neurogenic lower urinary tract dysfunction can be obtained by actively asking about the subjective presence of symptoms such as urinary incontinence or the occurrence of urinary tract infections. However, a subjective lack of symptoms does not rule out a neurogenic lower urinary tract dysfunction. Regardless of the stage of the disease, an early and individualized neuro-urological diagnosis and treatment should be implemented. All aspects of the damage and the extent of functional deficits in other organ systems caused by multiple sclerosis must be included in this neuro-urological treatment decision, which requires a consistent interdisciplinary exchange between neurologists, general practitioners, and urologists. This interdisciplinary and interprofessional way of thinking and acting is key for an optimal treatment using the numerous therapeutic procedures. Lifelong, individual, risk-adapted urological care for the early detection and prevention of neuro-urological complications should be offered to persons with multiple sclerosis.
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Affiliation(s)
- Ines Kurze
- Klinik für Paraplegiologie und Neuro-Urologie, Zentralklinik Bad Berka Gmbh, Bad Berka, Germany
| | - Anke K Jaekel
- Klinik für Urologie und Kinderurologie, Sektion Neuro-Urologie, Universitätsklinikum Bonn, Bonn, Germany
- Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshoehe GmbH, Bonn, Germany
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Salazar BH, Hoffman KA, Lincoln JA, Karmonik C, Rajab H, Helekar SA, Khavari R. Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol. BMC Urol 2024; 24:20. [PMID: 38273296 PMCID: PMC10809615 DOI: 10.1186/s12894-023-01358-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Multiple Sclerosis (MS) is an often debilitating disease affecting the myelin sheath that encompasses neurons. It can be accompanied by a myriad of pathologies and adverse effects such as neurogenic lower urinary tract dysfunction (NLUTD). Current treatment modalities for resolving NLUTD focus mainly on alleviating symptoms while the source of the discomfort emanates from a disruption in brain to bladder neural circuitry. Here, we leverage functional magnetic resonance imaging (fMRI), repetitive transcranial magnetic stimulation (rTMS) protocols and the brains innate neural plasticity to aid in resolving overactive bladder (OAB) symptoms associated with NLUTD. METHODS By employing an advanced neuro-navigation technique along with processed fMRI and diffusion tensor imaging data to help locate specific targets in each participant brain, we are able to deliver tailored neuromodulation protocols and affect either an excitatory (20 min @ 10 Hz, applied to the lateral and medial pre-frontal cortex) or inhibitory (20 min @ 1 Hz, applied to the pelvic supplemental motor area) signal on neural circuitry fundamental to the micturition cycle in humans to restore or reroute autonomic and sensorimotor activity between the brain and bladder. Through a regimen of questionnaires, bladder diaries, stimulation sessions and analysis, we aim to gauge rTMS effectiveness in women with clinically stable MS. DISCUSSION Some limitations do exist with this study. In targeting the MS population, the stochastic nature of MS in general highlights difficulties in recruiting enough participants with similar symptomology to make meaningful comparisons. As well, for this neuromodulatory approach to achieve some rate of success, there must be enough intact white matter in specific brain regions to receive effective stimulation. While we understand that our results will represent only a subset of the MS community, we are confident that we will accomplish our goal of increasing the quality of life for those burdened with MS and NLUTD. TRIAL REGISTRATION This trial is registered at ClinicalTrials.gov (NCT06072703), posted on Oct 10, 2023.
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Affiliation(s)
- Betsy H Salazar
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Kristopher A Hoffman
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - John A Lincoln
- Department of Neurology, The University of Texas Health Science Center, Houston, TX, USA
| | - Christof Karmonik
- Translational Imaging Center, Houston Methodist Research Institute, Houston, TX, USA
| | - Hamida Rajab
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA
| | - Santosh A Helekar
- Center for Translational Biomagnetics and Neurometry, Houston Methodist Research Institute, Houston, TX, USA
| | - Rose Khavari
- Department of Urology, Houston Methodist Hospital, 6560 Fannin St. Suite 2100, Houston, TX, 77030, USA.
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Liu W, Sun X, Gao Y, Sun H, Feng H, Tan H, Chen Q, Peng L, Wu IX. Comparative effectiveness of nonsurgical interventions for urinary incontinence in older women: A systematic review and network meta-analysis. Arch Gerontol Geriatr 2024; 116:105214. [PMID: 37832271 DOI: 10.1016/j.archger.2023.105214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/11/2023] [Accepted: 09/23/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE To compare the effectiveness of existing nonsurgical interventions to improve or cure urinary incontinence in older women. METHODS Five English databases (Medline, EMBASE, Web of Science, PsychINFO and the Cochrane Library) were searched from January 1, 2018, until August 27, 2023. Studies published before 2018 were directly extracted from a review published in 2019 on a similar research question. Three Chinese databases (China National Knowledge Infrastructure (CNKI), Wanfang and SinoMed) were searched from January 1, 2000, until August 27, 2023. Randomized controlled trials of nonsurgical interventions for women aged ≥ 60 years with urinary incontinence were considered eligible. The primary outcome was the rate of improvement and cure. Pairwise meta-analysis and network meta-analysis were performed, with the pooled risk ratio (RR) and 95 % confidence interval (CI) being reported. RESULTS There were 15 intervention categories among the included 32 randomized controlled trials for older women with urinary incontinence. The combination of behavioral therapy with other interventions, including Chinese herbal medicine, electrical stimulation, and acupuncture were effective for both improvement and cure rates. Behavioral therapy plus Chinese herbal medicine was the most effective intervention category for both improvement and cure rates. CONCLUSION Behavioral therapy plus Chinese herbal medicine was currently the optimal selection for the management of older women with urinary incontinence. However, the clinicians should carefully consider the effectiveness and quality of evidence because of the limited quality and quantity of the randomized controlled trials included.
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Affiliation(s)
- Wenqi Liu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xuemei Sun
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Yinyan Gao
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hui Sun
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Hui Feng
- Xiangya Nursing School, Central South University, Changsha, Hunan, China
| | - Hongzhuan Tan
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Qiong Chen
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linlin Peng
- Department of Geriatrics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Irene Xy Wu
- Department of Epidemiology and Biostatistics, Xiangya School of Public Health, Central South University, Changsha, Hunan, China; Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, China.
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Foong YC, Merlo D, Gresle M, Zhu C, Buzzard K, Lechner-Scott J, Barnett M, Taylor B, Kalincik T, Kilpatrick T, Darby D, Dobay P, van Beek J, Hyde R, Butzkueven H, van der Walt A. The Patient-Determined Disease Steps scale is not interchangeable with the Expanded Disease Status Scale in mild to moderate multiple sclerosis. Eur J Neurol 2024; 31:e16046. [PMID: 37584176 DOI: 10.1111/ene.16046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND PURPOSE The validity, reliability, and longitudinal performance of the Patient-Determined Disease Steps (PDDS) scale is unknown in people with multiple sclerosis (MS) with mild to moderate disability. We aimed to examine the psychometric properties and longitudinal performance of the PDDS. METHODS We included relapsing-remitting MS patients with an Expanded Disability Status Scale (EDSS) score of less than 4. Validity and test-retest reliability was examined. Longitudinal data were analysed with mixed-effect modelling and Cohen's kappa for concordance in confirmed disability progression (CDP). RESULTS We recruited a total of 1093 participants, of whom 904 had complete baseline data. The baseline correlation between PDDS and EDSS was weak (ρ = 0.45, p < 0.001). PDDS had stronger correlations with patient-reported outcomes (PROs). Conversely, EDSS had stronger correlations with age, disease duration, Kurtzke's functional systems and processing speed test. PDDS test-retest reliability was good to excellent (concordance correlation coefficient = 0.73-0.89). Longitudinally, PDDS was associated with EDSS, age and depression. A higher EDSS score was associated with greater PDSS progression. The magnitude of these associations was small. There was no concordance in CDP as assessed by PDDS and EDSS. CONCLUSION The PDDS has greater correlation with other PROs but less correlation with other MS-related outcome measures compared to the EDSS. There was little correlation between PDDS and EDSS longitudinally. Our findings suggest that the PDDS scale is not interchangeable with the EDSS.
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Affiliation(s)
- Yi Chao Foong
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
- Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Daniel Merlo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Melissa Gresle
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Melbourne Health, Melbourne, Victoria, Australia
| | - Chao Zhu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Katherine Buzzard
- Eastern Health, Melbourne, Victoria, Australia
- Melbourne Health, Melbourne, Victoria, Australia
| | - Jeannette Lechner-Scott
- The University of Newcastle, Newcastle, New South Wales, Australia
- Hunter New England Health, Newcastle, New South Wales, Australia
| | - Michael Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Neuroimaging Analysis Centre, Camperdown, New South Wales, Australia
| | - Bruce Taylor
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tomas Kalincik
- Department of Medicine, CORe, University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Trevor Kilpatrick
- Department of Neurology, Neuroimmunology Centre, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - David Darby
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | | | | | | | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Yavas I, Kahraman T, Sagici O, Ozdogar AT, Yigit P, Baba C, Ozakbas S. Feasibility of Telerehabilitation-Based Pelvic Floor Muscle Training for Urinary Incontinence in People With Multiple Sclerosis: A Randomized, Controlled, Assessor-Blinded Study. J Neurol Phys Ther 2023; 47:217-226. [PMID: 37306430 DOI: 10.1097/npt.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND PURPOSE Urinary incontinence is a common symptom in people with multiple sclerosis. The primary aim was to investigate feasibility of telerehabilitation-based pelvic floor muscle training (Tele-PFMT) and compare its effects on leakage episodes and pad usage with home exercise-based pelvic floor muscle training (Home-PFMT) and control groups. METHODS Forty-five people with multiple sclerosis with urinary incontinence were randomized into 3 groups. Tele-PFMT and Home-PFMT groups followed the same protocol for 8 weeks, but Tele-PFMT performed exercises 2 sessions/week under a physiotherapist's supervision. The control group did not receive any specific treatment. Assessments were made at baseline, weeks 4, 8, and 12. Primary outcome measures were feasibility (compliance to exercise, patient satisfaction, and number of participants included in the study), number of leakage episodes, and pad usage. Secondary outcomes included severity of urinary incontinence and overactive bladder symptoms, sexual function, quality of life, anxiety, and depression. RESULTS Participant eligibility rate was 19%. Patient satisfaction and compliance to exercise were significantly higher in Tele-PFMT than in Home-PFMT ( P < 0.05). No significant differences in the change of leakage episodes and pad usage were found between Tele-PFMT and Home-PFMT. No significant differences in secondary outcomes were found between PFMT groups. Participants in both the Tele-PFMT and Home-PFMT groups had significantly better scores for some measures of urinary incontinence, and overactive bladder and quality of life in compared with the control group. DISCUSSION AND CONCLUSIONS Tele-PFMT was feasible and acceptable in people with multiple sclerosis, and this mode of delivery was associated with greater exercise compliance and satisfaction compared with Home-PFMT. However, Tele-PFMT did not exhibit superiority in terms of leakage episodes and pad usage compared with Home-PFMT. A large trial comparing Home-PFMT and Tele-PFMT is warranted.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A440 ).
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Affiliation(s)
- Ipek Yavas
- Department of Physiotherapy and Rehabilitation, Graduate School of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey, and Department of Physiotherapy and Rehabilitation, Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey (I.Y.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkey (T.K.); Department of Neurosciences, Graduate School of Health Sciences, Dokuz Eylül University, Izmir, Turkey (O.S., P.Y., C.B.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Van Yüzüncü Yil University, Van, Turkey (A.T.O.); and Department of Neurology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey (S.O.)
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Shah A, Panchal V, Patel K, Alimohamed Z, Kaka N, Sethi Y, Patel N. Pathogenesis and management of multiple sclerosis revisited. Dis Mon 2023; 69:101497. [PMID: 36280474 DOI: 10.1016/j.disamonth.2022.101497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Multiple sclerosis is an autoimmune chronic inflammatory disease characterized by selective destruction of myelin in the CNS neurons (including optic nerve). It was first described in the 19th century and remained elusive owing to the disease's unique relapsing and remitting course. The widespread and debilitating prevalence of multiple sclerosis (MS) has prompted the development of various treatment modalities for its effective management. METHODS AND OBJECTIVES A literature review was conducted using the electronic databases PubMed and Google Scholar. The main objective of the review was to compile the advances in pathogenesis, classifications, and evolving treatment modalities for MS. RESULTS The understanding of the pathogenesis of MS and the potential drug targets for its precise treatment has evolved significantly over the past decade. The experimental developments are also motivating and present a big change coming up in the next 5 years. Numerous disease-modifying therapies (DMTs) have revolutionized the management of MS: interferon (IFN) preparations, monoclonal antibodies-natalizumab and ocrelizumab, immunomodulatory agents-glatiramer acetate, sphingosine 1-phosphate receptor 1 (S1PR1) modulators (Siponimod) and teriflunomide. The traditional parenteral drugs are now available as oral formulations improving patient acceptability. Repurposing various agents used for related diseases may reinforce the drug reserve to manage MS and are under trials. Although at a nascent phase, strategies to enhance re-myelination by stimulating oligodendrocytes are fascinating and hold promise for better outcomes in patients with MS. CONCLUSIONS The recent past has seen staggering inclusions to the management of multiple sclerosis catalyzing a significant turnabout in our approach to diagnosis, treatment, and prognosis. Since the advent of DMTs various other oral and injectable agents have been approved. The advances in MS therapeutics and diagnostics have laid the ground for further research and development to enhance the quality of life of afflicted patients.
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Affiliation(s)
- Abhi Shah
- Smt NHL MMC, Ahmedabad, Gujarat, 380006, India; PearResearch, India
| | - Viraj Panchal
- Smt NHL MMC, Ahmedabad, Gujarat, 380006, India; PearResearch, India
| | - Kashyap Patel
- Baroda Medical College, Vadodara, India; PearResearch, India
| | - Zainab Alimohamed
- Muhimbili University of Health and Allied Sciences (MUHAS), Tanzania; PearResearch, India
| | - Nirja Kaka
- PearResearch, India; GMERS Medical College, Himmatnagar, India
| | - Yashendra Sethi
- PearResearch, India; Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Neil Patel
- PearResearch, India; GMERS Medical College, Himmatnagar, India.
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Sharifiaghdas F, Narouie B, Taheri M, Jalali S, Shalbafan B, Azadvari M, Dadpour M, Rouientan H, Ahmadzade M, Hanafi Bojd H. Multiple sclerosis and lower urinary tract symptoms: A survey of prevalence, characteristic and urological evaluations. SAGE Open Med 2023; 11:20503121231178047. [PMID: 37384196 PMCID: PMC10293526 DOI: 10.1177/20503121231178047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 06/30/2023] Open
Abstract
Objective Most multiple sclerosis patients have urological complications such as lower urinary tract symptoms. This study was conducted to evaluate the prevalence of these symptoms and whether they result in a urological evaluation. Methods A cross-sectional study of 517 multiple sclerosis patients at Tehran's referral multiple sclerosis center and neurology clinics between 2018 and 2022 was performed. Data were collected through interviews after patients completed informed consent forms. Urological examinations, including urine analysis and ultrasonography, were evaluated as final assessments. The data were analyzed using descriptive and inferential statistical tests in Statistical Package for Social Science. Results Among all participants, the prevalence of lower urinary tract symptoms was 73% (n = 384), with urgency (44.8% n = 232) being the most common symptom. The prevalence of intermittency was significantly higher among women (p = 0.004). There was no gender-significant difference in terms of the prevalence of other symptoms (p > 0.050). Lower urinary tract symptoms were significantly correlated with age, clinical course, disease duration, and disability (p < 0.001). Additionally, 37.3% and 18.7% of patients with lower urinary tract symptoms, as well as 17.9% and 37.5% of patients with multiple sclerosis attacks, respectively, had undergone urine analysis and ultrasonography. Conclusion Multiple sclerosis patients rarely undergo urological evaluations during the course of their disease. Proper assessment is essential as these symptoms are among the most detrimental manifestations of this disease.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behzad Narouie
- Department of Urology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Maryam Taheri
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saba Jalali
- Faculty of land and food systems, University of British Colombia Vancouver, Vancouver, Canada
| | - Bita Shalbafan
- Clinical Research Development Unit of Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohaddeseh Azadvari
- Department of Physical Medicine and Rehabilitation, Urology Research Center, Sina & Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Rouientan
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohadese Ahmadzade
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamideh Hanafi Bojd
- Department of Urology, Shahid Labbafinejad Medical Center, Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Vartolomei L, Cotruș A, Tătaru SO, Vartolomei MD, Man A, Ferro M, Stanciu C, Sin AI, Shariat SF. Lower urinary tract symptoms are associated with clinically relevant depression, anxiety, and stress symptoms. Aging Male 2022; 25:62-66. [PMID: 35179090 DOI: 10.1080/13685538.2022.2040981] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To investigate the correlation between lower urinary tract symptoms (LUTS), erectile dysfunction (ED), and testosterone deficiency (TD) with depressive, stress, and anxiety symptoms. MATERIAL AND METHODS From October 2019 to March 2020, 113 males were included. Inclusion criteria: age 40-75, no clinical suspicion of prostate cancer, no serious cardiovascular comorbidities. All patients completed a set of questionnaires: International Prostate Symptom Score (IPSS), International Index of Erectile Function (IIEF-5), and Depression Anxiety Stress Scales (DASS-21). RESULTS Median age was 62 years (range 40-74), mean IPSS score was 10.94 (SD 7.75), mean IIEF-5 score 13.12 (SD 7.08), and mean DASS-21 score 11.35 (SD 8.24). According to DASS-21 subscales, 28 (24.8%) patients had depressive symptoms, 25 (22.1%) anxiety symptoms, and 25 (22.1%) stress symptoms. Depression was associated with LUTS (14.5 vs. 8 score, p = .002). Similarly, stress symptoms were associated with LUTS (IPSS 15 vs. 7 score, p = .0001) and with ED (IIEF-5 5 vs. 15 score, p = .01). Positive Spearman's rho correlations between LUTS and all three, depression, anxiety, and stress symptoms were found (p values <.001). CONCLUSIONS LUTS is associated with depression, anxiety, and stress symptoms. Screening for these symptoms could help with individual counseling and management.
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Affiliation(s)
- Liliana Vartolomei
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Andrei Cotruș
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Sabin Octavian Tătaru
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Mihai Dorin Vartolomei
- I.O.S.U.D., George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Adrian Man
- Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Camelia Stanciu
- Department of Psychology, Dimitrie Cantemir University from Târgu Mureș, Târgu Mureș, Romania
| | - Anca Ileana Sin
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology from Târgu Mureș, Târgu Mureș, Romania
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Urology, Weill Cornell Medical College, New York, NY, USA
- Department of Urology, University of Texas Southwestern, Dallas, TX, USA
- Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
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Yusuf FLA, Wijnands JMA, Karim ME, Kingwell E, Zhu F, Evans C, Fisk JD, Zhao Y, Marrie RA, Tremlett H. Sex and age differences in the Multiple Sclerosis prodrome. Front Neurol 2022; 13:1017492. [PMID: 36408518 PMCID: PMC9668896 DOI: 10.3389/fneur.2022.1017492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/04/2022] [Indexed: 08/12/2023] Open
Abstract
Background and objectives Little is known of the potential sex and age differences in the MS prodrome. We investigated sex and age differences in healthcare utilization during the MS prodrome. Methods This was a population-based matched cohort study linking administrative and clinical data from British Columbia, Canada (population = 5 million). MS cases in the 5 years preceding a first demyelinating event ("administrative cohort;" n = 6,863) or MS symptom onset ("clinical cohort;" n = 966) were compared to age-, sex- and geographically-matched controls (n = 31,865/4,534). Negative binomial and modified Poisson models were used to compare the rates of physician visits and hospitalizations per international classification of diseases chapter, and prescriptions filled per drug class, between MS cases and controls across sex and age-groups (< 30, 30-49, ≥50 years). Results In the administrative cohort, males with MS had a higher relative rate for genitourinary-related visits (males: adjusted Rate Ratio (aRR) = 1.65, females: aRR = 1.19, likelihood ratio test P = 0.02) and antivertigo prescriptions (males: aRR = 4.72, females: aRR = 3.01 P < 0.01). Injury and infection-related hospitalizations were relatively more frequent for ≥50-year-olds (injuries < 30/30-49/≥50: aRR = 1.16/1.39/2.12, P < 0.01; infections 30-49/≥50: aRR = 1.43/2.72, P = 0.03), while sensory-related visits and cardiovascular prescriptions were relatively more common in younger persons (sensory 30-49/≥50: aRR = 1.67/1.45, P = 0.03; cardiovascular < 30/30-49/≥50: aRR = 1.56/1.39/1.18, P < 0.01). General practitioner visits were relatively more frequent in males (males: aRR = 1.63, females: aRR = 1.40, P < 0.01) and ≥50-year-olds (< 30/≥50: aRR = 1.32/1.55, P = 0.02), while differences in ophthalmologist visits were disproportionally larger among younger persons, < 50-years-old (< 30/30-49/≥50: aRR = 2.25/2.20/1.55, P < 0.01). None of the sex and age-related differences in the smaller clinical cohort reached significance (P ≥ 0.05). Discussion Sex and age-specific differences in healthcare use were observed in the 5 years before MS onset. Findings demonstrate fundamental heterogeneity in the MS prodromal presentation.
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Affiliation(s)
- Fardowsa L. A. Yusuf
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - José M. A. Wijnands
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Elaine Kingwell
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
- Research Department of Primary Care & Population Health, University College London, London, United Kingdom
| | - Feng Zhu
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Charity Evans
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - John D. Fisk
- Nova Scotia Health and the Department of Psychiatry, Psychology & Neuroscience, and Medicine, Dalhousie University, Halifax, NS, Canada
| | - Yinshan Zhao
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Health Sciences Centre, Winnipeg, MB, Canada
| | - Helen Tremlett
- Division of Neurology, Department of Medicine, The Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, BC, Canada
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A Combination of Natural Products, BenPros (Green Tea Extract, Soybean Extract and Camellia Japonica Oil), Ameliorates Benign Prostatic Hyperplasia. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12126121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Benign prostatic hyperplasia (BPH) is one of the most common diseases in elderly men and causes lower urinary tract symptoms due to excessive proliferation of prostate stromal and epithelial cells. The present study investigated the improving effect of BenPros, an edible natural product mixture (green tea extract, soybean extract and camellia japonica oil), against the development of BPH in vitro and in vivo. BenPros treatment showed inhibitory ability on testosterone-induced androgen receptor, prostate-specific antigen (PSA), and 5α-reductase protein expression in LNCap-LN3 cells and anti-inflammatory effects on LPS-induced increases in interleukin-6 and tumor necrosis factor-α in RAW264.7 cells. In a testosterone propionate (TP)-induced BPH rat model, BenPros decreased the up-regulated serum 5α-dihydrotestosterone and PSA levels. Moreover, BenPros also significantly reduced PSA protein expression in prostate tissue. Furthermore, TP-induced increased expression of cyclooxygenase 2 and B-cell lymphoma 2 (Bcl-2) were reduced by BenPros, resulting in an increase in the Bcl-2/BCL2-related X ratio. These regulatory abilities of BenPros on BPH inducing markers also reduced prostate size and epithelial thickness based on histological analysis. These results indicate that BenPros has a protective ability against BPH in vitro and in vivo, and it may be a promising candidate as a functional food in regulating BPH.
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Kaplan TB, Gopal A, Block VJ, Suskind AM, Zhao C, Polgar-Turcsanyi M, Saraceno TJ, Gomez R, Santaniello A, Consortium SUMMIT, Ayoubi NE, Cree BA, Hauser SL, Weiner H, Chitnis T, Khoury S, Bove R. Challenges to Longitudinal Characterization of Lower Urinary Tract Dysfunction in Multiple Sclerosis. Mult Scler Relat Disord 2022; 62:103793. [DOI: 10.1016/j.msard.2022.103793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/01/2022] [Accepted: 04/03/2022] [Indexed: 11/24/2022]
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Buchter ML, Kjellberg J, Ibsen R, Sternhufvud C, Petersen B. Burden of illness the first year after diagnosed bladder dysfunction among people with spinal cord injury or multiple sclerosis - a Danish register study. Expert Rev Pharmacoecon Outcomes Res 2022; 22:919-926. [PMID: 35296209 DOI: 10.1080/14737167.2022.2054804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND People with spinal cord injury (SCI) or multiple sclerosis (MS) are often living with some degree of bladder and/or bowel dysfunction due to acquired neurogenic damage. The objective was to estimate the burden of illness of SCI and MS the first year after diagnosed bladder dysfunction. METHODS Data were extracted from registers covering all Danish citizens. People with SCI or MS were indexed at diagnosis of bladder dysfunction. Inclusion period was 2002-2015 and cases and matched controls were followed for one year. RESULTS A total of 2,132 subjects with SCI and 1,887 subjects with MS were identified. Healthcare utilization and societal costs per patient-year were significantly higher for cases compared to controls driven primarily by inpatient care. Cases with urinary tract infection had significantly higher inpatient costs per patient-year compared to controls (SCI: 544 EUR vs 23, p < 0.05; MS: 497 EUR vs 6, p< 0.05) and medication for constipation was significantly more costly per patient-year (SCI: 178 EUR vs 3, p < 0.05; MS: 78 vs 1, p < 0.05). CONCLUSIONS The study demonstrates heavy societal and personal costs in the first year after bladder dysfunction in people with SCI or MS. This emphasizes the need for medical and social interventions to reduce the burden of illness.
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Affiliation(s)
| | - Jakob Kjellberg
- VIVE, Danish Center for Social Science Research, Copenhagen, Denmark
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15
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Yavas I, Emuk Y, Kahraman T. Pelvic floor muscle training on urinary incontinence and sexual function in people with multiple sclerosis: A systematic review. Mult Scler Relat Disord 2022; 58:103538. [DOI: 10.1016/j.msard.2022.103538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/09/2022] [Accepted: 01/16/2022] [Indexed: 11/29/2022]
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Choi S, Guo L, Cordeiro MF. Retinal and Brain Microglia in Multiple Sclerosis and Neurodegeneration. Cells 2021; 10:cells10061507. [PMID: 34203793 PMCID: PMC8232741 DOI: 10.3390/cells10061507] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022] Open
Abstract
Microglia are the resident immune cells of the central nervous system (CNS), including the retina. Similar to brain microglia, retinal microglia are responsible for retinal surveillance, rapidly responding to changes in the environment by altering morphotype and function. Microglia become activated in inflammatory responses in neurodegenerative diseases, including multiple sclerosis (MS). When activated by stress stimuli, retinal microglia change their morphology and activity, with either beneficial or harmful consequences. In this review, we describe characteristics of CNS microglia, including those in the retina, with a focus on their morphology, activation states and function in health, ageing, MS and other neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, glaucoma and retinitis pigmentosa, to highlight their activity in disease. We also discuss contradictory findings in the literature and the potential ways of reducing inconsistencies in future by using standardised methodology, e.g., automated algorithms, to enable a more comprehensive understanding of this exciting area of research.
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Affiliation(s)
- Soyoung Choi
- UCL Institute of Ophthalmology, London EC1V 9EL, UK; (S.C.); (L.G.)
| | - Li Guo
- UCL Institute of Ophthalmology, London EC1V 9EL, UK; (S.C.); (L.G.)
| | - Maria Francesca Cordeiro
- UCL Institute of Ophthalmology, London EC1V 9EL, UK; (S.C.); (L.G.)
- ICORG, Imperial College London, London NW1 5QH, UK
- Correspondence:
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Jacob L, Tanislav C, Kostev K. Multiple Sclerosis and Incidence of Urinary and Fecal Incontinence in Almost 9,000 Patients Followed Up for up to 10 Years in Germany. Neuroepidemiology 2021; 55:92-99. [PMID: 33662954 DOI: 10.1159/000513234] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 11/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a lack of large studies on urinary (UI) and fecal incontinence (FI) following multiple sclerosis (MS) diagnosis. Thus, our goal was to investigate the association between MS and the incidence of UI and FI in patients followed up for up to 10 years in Germany. METHODS This study included patients who received an initial documentation of MS diagnosis in general practices in Germany during 2005-2018 (index date). Patients without MS were matched (1:1) to those with MS using propensity scores based on sex, age, index year, follow-up time (in years), general practice, and the Charlson Comorbidity Index score (index date: a randomly selected visit date). RESULTS This retrospective study included 4,461 patients with MS and 4,461 patients without MS (69.9% women; mean [SD] age 44.2 [12.7] years). Within 10 years of index date, a higher proportion of patients with MS were diagnosed with UI (11.7 vs. 3.2%) and FI (2.3 vs. 0.5%; p values <0.001) than those without MS. MS was further found to be associated with both UI (hazard ratio [HR] = 3.85) and FI (HR = 5.38; p values <0.001) in the Cox regressions. CONCLUSIONS UI and FI are frequent complications of MS, and the presence of these complications should be regularly assessed in primary care practices.
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Affiliation(s)
- Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Hospital Jung Stilling, Siegen, Germany
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The effect of pelvic floor exercise program on incontinence and sexual dysfunction in multiple sclerosis patients. Int Urol Nephrol 2021; 53:1059-1065. [PMID: 33620664 DOI: 10.1007/s11255-021-02804-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/08/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE Multiple sclerosis (MS) is a chronic neuroinflammatory disease of the central nervous system that involves different neurological areas. In addition to lower urinary tract symptoms (LUTS), sexual dysfunction (SD), and psychopathological effects, MS sometimes seriously impairs the quality of life (QoL). We hypothesize that the pelvic floor exercise program (PFEP) could improve bladder, sexual function, depression, and QoL in MS patients. METHODS Patients diagnosed with MS completed the Incontinence Questionnaire Short Form (ICIQ-SF), the Beck Depression Inventory (BDI), the Multiple Sclerosis Quality of Life-54 (MSQoL-54) questionnaire, and either the Female Sexual Function Index (FSFI) or the Sexual Health Inventory for Men (SHIM). Maximum bladder volumes (MBV) and post-voiding residual (PVR) volumes were measured using ultrasonography. The patients who regularly completed the PFEP for 12 weeks were asked to fill out the questionnaires again, and their MBV and PVR were remeasured. RESULTS Seventy-two patients with relapsing-remitting multiple sclerosis (RRMS) were included in the study. Forty-two (58.3%) RRMS patients reached the end of the study. The patients' post-PFEP average MBV statistically increased (p = 0.01). In contrast, no statistically significant difference was found in the PVR (p = 0.2). After exercise, the FSFI values in women increased (p = 0.02), and ICIQ-SF and BDI values in all the RRMS patients statistically decreased (p = 0.004, p = 0.01, respectively), but there was no improvement in the MSQoL-54 score (p > 0.05). CONCLUSION PFEP, which causes a reduction in LUTS by enhancing the MBV of RRMS patients, can be seen as an investment in the future in terms of reducing depression in MS patients and preventing or delaying SD in women.
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Kister I, Bacon T, Cutter GR. A longitudinal study of symptom botheration in Multiple Sclerosis. Mult Scler Relat Disord 2020; 46:102585. [PMID: 33296981 DOI: 10.1016/j.msard.2020.102585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is well documented that ambulatory disability in MS worsens over time, but there is a dearth of information on symptom evolution in other domains commonly affected by MS. METHODS SymptoMScreen (SyMS) is a validated tool for assessing symptom severity in 12 domains commonly affected by MS. Patients who attended two specialized MS centers filled out SyMS at each visit. We included in the study patients with neurologist-diagnosed MS who completed two SyMS questionnaires separated at least 12 months. We used the first and final assessment and adjusted for time on study, baseline SyMS score, age, sex, race, MS type, disability strata, and site. Changes over time were also examined using Markov chain estimates of moving from one level of botheration to another for each domain over 1-year periods. RESULTS A total of 1,014 MS patients met the inclusion criteria. Mean composite SyMS score was 1.4 (±1.16) at baseline and increased by 0.084 (±0.73) points during 21.0 (±5.5) months of followup (p<0.0001). The initial mean composite SyMS score correlated strongly with the final mean composite SyMS score (r=0.81). Individual domain SyMS scores at baseline were highest for fatigue: 2.2 (±1.7), and lowest for vision: 1.1 (±1.3) and dexterity: 1.1 (±1.4). Small but significant increases during followup were seen in dexterity, bladder, vision, and pain domains, while significant decreases were seen in anxiety and sensory domains. We observed a high degree of inter-individual variability in symptom severity with the more extreme scores tending to resolve over time. CONCLUSIONS Symptom botheration increases modestly year-to-year, as would be expected in a slowly progressive disease that evolves over decades. Initial symptom burden strongly correlated with final symptom burden, but there was a high degree of individual variability in symptom severity.
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Affiliation(s)
- Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY; NJ, USA.
| | - Tamar Bacon
- NYU Multiple Sclerosis Comprehensive Care Center, NYU Langone Medical Center, New York, NY; NJ, USA
| | - Gary R Cutter
- Department of Biostatistics, UAB School of Public Health, Birmingham, AL
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