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Kuo HC. Lower urinary tract dysfunction in the central nervous system neurogenic bladder and the real-life treatment outcome of botulinum toxin A. Tzu Chi Med J 2024; 36:260-270. [PMID: 38993829 PMCID: PMC11236072 DOI: 10.4103/tcmj.tcmj_29_24] [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: 02/07/2024] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 07/13/2024] Open
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with central nervous system (CNS) lesions. Cases of cerebrovascular accidents (CVA), Parkinson's disease, dementia, and other intracranial lesions develop poor bladder control with or without urinary difficulty due to loss of cortical perception of bladder filling sensation and poor coordination of urethral sphincter relaxation during reflex micturition. Patients with CNS lesions usually have overactive bladder (OAB) symptoms, including urgency, frequency, incontinence, voiding symptoms of dysuria, large postvoid residual volume, and retention. In elderly patients with severe CNS disease the OAB symptoms are usually difficult to adequately relieve by medical treatment, and thus, their quality of life is greatly. Botulinum toxin A (BoNT-A) is currently licensed and has been applied in patients with idiopathic and neurogenic OAB due to spinal cord injury or multiple sclerosis. However, the application of BoNT-A in the treatment of urinary incontinence due to NLUTD in chronic CNS lesions has not been well-documented. Although cohort studies and case series support BoNT-A treatment for neurogenic OAB, chronic urine retention after intravesical BoNT-A injection for OAB and exacerbated urinary incontinence after urethral BoNT-A injection for voiding dysfunction have greatly limited its application among patients with NLUTD due to CNS lesions. This article reviews the pathophysiology and clinical characteristics of NLUTD in patients with CNS lesions and the clinical effects and adverse events of BoNT-A injection for patients with NLUTD. A flowchart was created to outline the patient selection and treatment strategy for neurogenic OAB.
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Affiliation(s)
- Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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2
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Chow PM, Trump T, Goldman HB. Outcomes of sequential third-line therapies in patients with refractory overactive bladder. Int J Urol 2024; 31:772-777. [PMID: 38693892 DOI: 10.1111/iju.15463] [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: 12/14/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) and onabotulinumtoxinA (BoNTA) injection are third-line therapies for overactive bladder (OAB). Although the efficacy of each third-line treatment has been well established in clinical trials, there is far less information about performing one third-line therapy after the other. Our aim is thus to investigate the outcomes of post-SNM BoNTA and post-BoNTA SNM as "second" third-line treatments. METHODS We retrospectively reviewed all OAB patients who had both SNM and BoNTA between 2013 and 2022. The primary endpoint was the response rates (>50% improvements) of the second third-line treatments. Secondary endpoints were the proportion of the patients who achieved total dry, the duration of treatments of patients who had significant responses, and risk factors that are associated with treatment response or duration of treatments. RESULTS A total of 172 patients had two third-line therapies. There were 104 patients who had post-SNM BoNTA and 68 patients who had post-BoNTA SNM. In the post-SNM BoNTA group, 62.5% (65/104) had significant responses after BoNTA treatment. In the post-BoNTA SNM group, 61.8% (44/68) had significant responses after SNM treatment. The proportions of patients who became dry were 21.2% and 23.5%, respectively. In the post-SNM BoNTA group, spinal pathology is associated with a lower probability of a significant response (48.9% vs. 73.7%, p-value = 0.0105). CONCLUSIONS BoNTA or SNM remains a viable option for refractory OAB after patients fail from one another. Spinal pathology is associated with a poorer response of post-SNM BoNTA.
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Affiliation(s)
- Po-Ming Chow
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
- National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- National Taiwan University Hospital Hsin-Chu Branch, Zhubei City, Taiwan
| | - Tyler Trump
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Howard B Goldman
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio, USA
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3
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Zheng Y, Cameron AP. Sleep and Overactive Bladder in Parkinson's Disease. Urol Clin North Am 2024; 51:197-207. [PMID: 38609192 DOI: 10.1016/j.ucl.2024.02.005] [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: 04/14/2024]
Abstract
Patients with Parkinson's disease (PD) have disturbances in their bladder and sleep physiology that lead to nocturia and overactive bladder (OAB). These symptoms can be extremely bothersome and impact not only their quality of life (QoL) but also the QoL of their caretakers. We aim to highlight the changes in bladder and sleep physiology in PD and explore OAB/nocturia treatment strategies in this population.
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Affiliation(s)
- Yu Zheng
- Department of Urology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
| | - Anne P Cameron
- Department of Urology, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA
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Slouha E, Ibrahim F, Esposito S, Mursuli O, Rezazadah A, Clunes LA, Kollias TF. Botulinum Toxin for the Management of Parkinson's Disease: A Systematic Review. Cureus 2024; 16:e53309. [PMID: 38435899 PMCID: PMC10906698 DOI: 10.7759/cureus.53309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Parkinson's disease (PD) is a terminal, debilitating neurodegenerative disorder typically affecting individuals over 60. It is associated with various conditions that drastically affect the patient's quality of life (QoL). Although there is no cure for PD, its symptoms can be significantly improved and even resolved through different treatments. Mainstay treatments for PD include levodopa combined with carbidopa, dopamine agonists, and even deep brain stimulation (DBS) of the subthalamic nucleus. New treatment methods have emerged, such as botulinum toxin (BoNT), which further improve symptoms and, thus, the QoL of patients with PD. Botulinum toxin is a potent neurotoxin produced by Clostridium botulinum that typically causes descending paralysis by suppressing acetylcholine secretion. Serotypes used to treat various disorders include serotype A (BoNT-A) and serotype B (BoNT-B). This paper aims to evaluate the outcomes of BoNT injection on different symptoms associated with PD. An extensive review using PubMed, ScienceDirect, and ProQuest articles concerning 'botulinum toxin and Parkinson's disease' was done per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, resulting in 23,803 articles. After applying strict inclusion and exclusion criteria, the total number of articles was finally 41. The results showed that movement disorders were a common occurrence in PD, consisting of tremors, dystonia, and freezing of gait (FOG), with tremors being the most common symptom. Tremors and dystonia were significantly improved following BoNT-A, correlating with significant improvements in various scales subjectively and objectively evaluating the symptoms and QoL. In contrast, FOG was not significantly improved by either BoNT-A or BoNT-B. Pain is associated with movement disorders such as PD and was the primary indication for the administration of BoNT; studies found pain and QoL were significantly improved following BoNT injection. Quality of life can also be affected by sialorrhea and overactive bladder, which often occur as the disease progresses. Injections of BoNT-A and BoNT-B were shown to significantly improve saliva production, flow rate, drooling frequency, voiding frequency, and urinary urge incontinence. Across all studies analyzed, it is evident that BoNT may have a significant effect on improving the QoL of patients suffering from PD. While research continues to find a cure or stop the progression of PD, it remains critical to continue focusing on improving patients' QoL. Future research should evaluate whether BoNT can be used to successfully treat other symptoms of PD, such as epiphora or constipation.
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Affiliation(s)
- Ethan Slouha
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Fadi Ibrahim
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Sarah Esposito
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Odelin Mursuli
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Atbeen Rezazadah
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St George's University School of Medicine, St George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology, and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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Saraf U, Batla A, Sakakibara R, Panicker JN. The Impact of Polypharmacy on Management of Lower Urinary Tract Symptoms in Parkinson's Disease. Drugs Aging 2023; 40:909-917. [PMID: 37651023 DOI: 10.1007/s40266-023-01060-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/01/2023]
Abstract
Lower urinary tract (LUT) symptoms are a common presentation of autonomic dysfunction in Parkinson's disease (PD). Symptoms significantly impact quality of life and are associated with worsening of motor symptoms and increased risk for falls. Different medical co-morbidities can often contribute to LUT symptoms, and a thorough evaluation therefore becomes essential. The effects of medications used for Parkinson's disease and other co-existing medical co-morbidities on LUT symptoms is often underestimated. Treatment options include behavioural therapy, oral agents such as antimuscarinic and beta-3 receptor agonist agents, botulinum toxin and neuromodulation. The first-line oral agents cause adverse effects that may exacerbate pre-existing Parkinson's disease-related symptoms. Furthermore, these oral agents can interact with other medications used in Parkinson's disease, and the challenges posed by interactions on pharmacological effects and metabolism are discussed. Knowledge about drug interactions can help in effective management of such patients and mitigate the risks for developing adverse effects.
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Affiliation(s)
- Udit Saraf
- Department of Neurology, Amrita Institute of Medical Sciences, Kochi, India.
| | - Amit Batla
- Department of Clinical and Movement Neuroscience, Faculty of Brain Science, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Ryuji Sakakibara
- Department of Neurology, Sakura Medical Center, Toho University, Sakura, Japan
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, UCLH NHS Foundation Trust, London, UK
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
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6
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Hu JC, Hsu LN, Lee WC, Chuang YC, Wang HJ. Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson's Disease or Post-Stroke. Toxins (Basel) 2023; 15:166. [PMID: 36828479 PMCID: PMC9965145 DOI: 10.3390/toxins15020166] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
Botulinum toxin A (BoNT-A) paralyzes muscle by blocking acetylcholine release at the synaptic junction. BoNT-A has shown its therapeutic effects in neurological disorders such as Parkinson's disease (PD) and post-stroke spasticity. A high proportion of patients with PD and post-stroke develop neurogenic detrusor overactivity (nDO) and then develop urinary incontinence and overactive bladder (OAB) symptoms. This study aimed to disclose the safety and efficacy of BoNT-A injection in treating bladder and voiding dysfunction in PD and post-stroke patients by reviewing the current evidence. At present, intradetrusor injection of BoNT-A is a Food and Drug Administration (FDA)-approved third-line therapy for nDO and idiopathic OAB. Although intradetrusor injection of onaBoNT-A 200 U is already approved for nDO treatment, most researchers would like to manage PD and post-stroke patients by using onaBoNT-A 100 U intradetrusor injection to achieve long-term efficacy and reduce adverse effects. However, in contrast to its inclusion in the International Continence Society guidelines for PD treatment, the clinical use of BoNT-A for post-stroke patients is limited to experimental use due to the development of urinary retention in about one-fifth of patients. For treating urethral pseudodyssynergia, half of patients may respond to onaBoNT-A 100 U urethral injection. However, refinement is needed to reduce unwanted urinary incontinence.
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Affiliation(s)
- Ju-Chuan Hu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Lin-Nei Hsu
- Department of Urology, An Nan Hospital, China Medical University, Tainan City 833, Taiwan
| | - Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 807, Taiwan
| | - Hung-Jen Wang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 807, Taiwan
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Jing XZ, Yuan XZ, Luo X, Zhang SY, Wang XP. An Update on Nondopaminergic Treatments for Motor and Non-motor Symptoms of Parkinson's Disease. Curr Neuropharmacol 2023; 21:1806-1826. [PMID: 35193486 PMCID: PMC10514518 DOI: 10.2174/1570159x20666220222150811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/19/2022] [Accepted: 02/19/2022] [Indexed: 11/22/2022] Open
Abstract
Nondopaminergic neurotransmitters such as adenosine, norepinephrine, serotonin, glutamate, and acetylcholine are all involved in Parkinson's disease (PD) and promote its symptoms. Therefore, nondopaminergic receptors are key targets for developing novel preparations for the management of motor and non-motor symptoms in PD, without the potential adverse events of dopamine replacement therapy. We reviewed English-written articles and ongoing clinical trials of nondopaminergic treatments for PD patients till 2014 to summarize the recent findings on nondopaminergic preparations for the treatment of PD patients. The most promising research area of nondopaminergic targets is to reduce motor complications caused by traditional dopamine replacement therapy, including motor fluctuations and levodopa-induced dyskinesia. Istradefylline, Safinamide, and Zonisamide were licensed for the management of motor fluctuations in PD patients, while novel serotonergic and glutamatergic agents to improve motor fluctuations are still under research. Sustained- release agents of Amantadine were approved for treating levodopa induced dyskinesia (LID), and serotonin 5HT1B receptor agonist also showed clinical benefits to LID. Nondopaminergic targets were also being explored for the treatment of non-motor symptoms of PD. Pimavanserin was approved globally for the management of hallucinations and delusions related to PD psychosis. Istradefylline revealed beneficial effect on daytime sleepiness, apathy, depression, and lower urinary tract symptoms in PD subjects. Droxidopa may benefit orthostatic hypotension in PD patients. Safinamide and Zonisamide also showed clinical efficacy on certain non-motor symptoms of PD patients. Nondopaminergic drugs are not expected to replace dopaminergic strategies, but further development of these drugs may lead to new approaches with positive clinical implications.
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Affiliation(s)
- Xiao-Zhong Jing
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang-Zhen Yuan
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Shu-Yun Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, Shandong, China
| | - Xiao-Ping Wang
- Department of Neurology, TongRen Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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8
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Pautz A, Michel MC. Sex and Gender Differences in the Pharmacology of the Overactive Urinary Bladder. Handb Exp Pharmacol 2023; 282:57-74. [PMID: 37439844 DOI: 10.1007/164_2023_667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Dysfunction of the lower urinary tract in general and the overactive bladder syndrome (OAB) in particular are prevalent and have major impact on the quality of life of the afflicted patients and their partners. We concisely review sex and gender differences in patients and animal models in physiological bladder function, its alterations in disease (mostly OAB), and its responses to treatment. Women appear to have a smaller functional bladder capacity and, therefore, must void more often than men. On the other hand, men have a greater bladder outlet resistance, which is partly attributed to a longer urethra and partly to the presence of the prostate. Sex and gender differences in bladder contractility appear small and were not found consistently. The ability of bladder smooth muscle to relax may be somewhat smaller in females. However, females are heavily underrepresented in experimental studies on bladder function. Stress urinary incontinence is found predominantly in women (particularly those after childbirth). OAB is similarly prevalent in men and women. Females seek treatment much more often and are overrepresented in clinical trials. Treatment responses in OAB patients are similar in both genders for oral medications, but improvements upon injections of onabotulinum toxin type A appear smaller in men. We conclude that there is no evidence for major sex and gender differences in bladder dysfunction as related to OAB and its treatment responses, but female animals are heavily underrepresented in experimental studies.
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Affiliation(s)
- Andrea Pautz
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Martin C Michel
- Department of Pharmacology, University Medical Center, Johannes Gutenberg University, Mainz, Germany.
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9
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Zillioux J, Slopnick EA, Vasavada SP. Third-line therapy for overactive bladder in the elderly: Nuances and considerations. Neurourol Urodyn 2022; 41:1967-1974. [PMID: 35645033 PMCID: PMC9796112 DOI: 10.1002/nau.24965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/21/2022] [Accepted: 04/25/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Overactive bladder (OAB) disproportionally affects older adults in both incidence and severity. OAB pharmacotherapy is often problematic in the elderly due to polypharmacy, adverse side effect profiles and contraindications in the setting of multiple comorbidities, and concerns regarding the risk of incident dementia with anticholinergic use. The burden of OAB in older patients coupled with concerns surrounding pharmacotherapy options should motivate optimization of nonpharmacologic therapies in this population. At the same time, several aspects of aging may impact treatment efficacy and decision-making. This narrative review critically summarizes current evidence regarding third-line OAB therapy use in the elderly and discusses nuances and treatment considerations specific to the population. METHODS We performed an extensive, nonsystematic evidence assessment of available literature via PubMed on onabotulinumtoxinA (BTX-A), sacral neuromodulation, and percutaneous tibial nerve stimulation (PTNS) for OAB, with a focus on study in elderly and frail populations. RESULTS While limited, available studies show all three third-line therapies are efficacious in older populations and there is no data to support one option over another. BTX-A likely has a higher risk of urinary tract infection and retention in older compared to younger populations, especially in the frail elderly. PTNS incurs the lowest risk, although adherence is poor, largely due to logistical burdens. CONCLUSION Advanced age and frailty should not preclude third-line therapy for refractory OAB, as available data support their efficacy and safety in these populations. Ultimately, treatment choices should be individualized and involve shared decision-making.
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Affiliation(s)
- Jacqueline Zillioux
- Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandOhioUSA
| | - Emily A. Slopnick
- Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandOhioUSA
| | - Sandip P. Vasavada
- Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandOhioUSA
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10
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Moussa M, Abou Chakra M, Papatsoris AG, Dellis A, Dabboucy B, Peyromaure M, Barry Delongchamps N, Bailly H, Duquesne I. Perspectives on the urological care in Parkinson's disease patients. Arch Ital Urol Androl 2022; 94:107-117. [PMID: 35352535 DOI: 10.4081/aiua.2022.1.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Parkinson's disease (PD) is recognized as the most common neurodegenerative disorder after Alzheimer's disease. Lower urinary tract symptoms are common in patients with PD, either storage symptoms (overactive bladder symptoms or OAB) or voiding symptoms. The most important diagnostic clues for urinary disturbances are provided by the patient's medical history. Urodynamic evaluation allows the determination of the underlying bladder disorder and may help in the treatment selection. Pharmacologic interventions especially anticholinergic medications are the first-line option for treating OAB in patients with PD. However, it is important to balance the therapeutic benefits of these drugs with their potential adverse effects. Intra-detrusor Botulinum toxin injections, electrical stimulation were also used to treat OAB in those patients with variable efficacy. Mirabegron is a β3-agonist that can also be used for OAB with superior tolerability to anticholinergics. Desmopressin is effective for the management of nocturnal polyuria which has been reported to be common in PD. Deep brain stimulation (DBS) surgery is effective in improving urinary functions in PD patients. Sexual dysfunction is also common in PD. Phosphodiesterase type 5 inhibitors are first-line therapies for PD-associated erectile dysfunction (ED). Treatment with apomorphine sublingually is another therapeutic option for PD patients with ED. Pathologic hypersexuality has occasionally been reported in patients with PD, linked to dopaminergic agonists. The first step of treatment of hypersexuality consists of reducing the dose of dopaminergic medication. This review summarizes the epidemiology, pathogenesis, risk factors, genetic, clinical manifestations, diagnostic test, and management of PD. Lastly, the urologic outcomes and therapies are reviewed.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Beirut.
| | - Mohamad Abou Chakra
- Department of Urology, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Athanasios G Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens.
| | | | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut.
| | - Michael Peyromaure
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Nicolas Barry Delongchamps
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Hugo Bailly
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
| | - Igor Duquesne
- Department of Urology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris Descartes University, Paris.
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Smith MD, Tenison E, Hashim H, Ben-Shlomo Y, Henderson EJ. Neuromodulation for Storage Lower Urinary Tract Symptoms in Parkinson Disease: A Systematic Review. Neuromodulation 2022; 25:1076-1085. [PMID: 35300922 DOI: 10.1016/j.neurom.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Bladder symptoms are common in Parkinson disease (PD), affecting quality of life. Medications commonly used such as antimuscarinics can cause frequently intolerable side effects, and therefore, new, better tolerated approaches are needed. Neuromodulation techniques have an established role in urologic disorders; these techniques include tibial nerve stimulation (TNS) and sacral neuromodulation (SNM), which are localized therapies lacking the side effects associated with medication. OBJECTIVES This study aimed to undertake a systematic review of the literature reporting the use of neuromodulation techniques for the treatment of bladder symptoms in PD and related conditions. MATERIALS AND METHODS A systematic search of data bases was conducted including MEDLINE, CENTRAL, and Web of Science. Studies were required to present specific outcomes for individuals with PD for neuromodulation interventions. RESULTS Ten primary studies were identified concerning detailed outcomes of neuromodulation on bladder symptoms in PD, including seven for TNS, one for SNM, and one using transcranial magnetic stimulation (TMS). Two further mixed cohort studies documented minimal data on individuals with PD. All studies demonstrated benefit in a range of outcome measures following neuromodulation. Two randomized sham-controlled studies were carried out using TNS, with one clearly demonstrating superiority over sham, although difficulties with achieving believable yet ineffective sham treatment are highlighted. Further studies reported limited, uncontrolled outcomes of SNM in patients with PD, demonstrating benefit. CONCLUSIONS Evidence from case series suggests benefit from TNS in PD, with limited literature on SNM or TMS. Placebo effect from neuromodulation is a concern, and only limited controlled data exist. Future well-designed and sham-controlled studies need to be completed to provide definitive data on the benefit of neuromodulation in PD. Definitively proving the utility of a neuromodulation modality will allow better treatment of bladder symptoms without the need for pharmacologic measures that cause side effects.
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Abstract
Advanced Parkinson's disease (PD) often brings a set of motor and non-motor features that are particularly challenging to manage. Medication options can be limited by side-effects and quality of life can be severely affected by an accumulating burden of nonmotor symptoms. Here, we reviewed the literature and our clinical experience with the aim of providing a practical approach to the management of advanced PD. We provide guidelines for treatment of physical and neurobehavioral concerns, that occur in advanced PD.
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Antidepressant-Like Properties of Intrastriatal Botulinum Neurotoxin-A Injection in a Unilateral 6-OHDA Rat Model of Parkinson's Disease. Toxins (Basel) 2021; 13:toxins13070505. [PMID: 34357977 PMCID: PMC8310221 DOI: 10.3390/toxins13070505] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Parkinson’s patients often suffer from depression and anxiety, for which there are no optimal treatments. Hemiparkinsonian (hemi-PD) rats were used to test whether intrastriatal Botulinum neurotoxin-A (BoNT-A) application could also have antidepressant-like properties in addition to the known improvement of motor performance. To quantify depression- and anxiety-like behavior, the forced swim test, tail suspension test, open field test, and elevated plus maze test were applied to hemi-PD rats injected with BoNT-A or vehicle. Furthermore, we correlated the results in the forced swim test, open field test, and elevated plus maze test with the rotational behavior induced by apomorphine and amphetamine. Hemi-PD rats did not show significant anxiety-like behavior as compared with Sham 6-OHDA- + Sham BoNT-A-injected as well as with non-injected rats. However, hemi-PD rats demonstrated increased depression-like behaviors compared with Sham- or non-injected rats; this was seen by increased struggling frequency and increased immobility frequency. Hemi-PD rats intrastriatally injected with BoNT-A exhibited reduced depression-like behavior compared with the respective vehicle-receiving hemi-PD animals. The significant effects of intrastriatally applied BoNT-A seen in the forced swim test are reminiscent of those found after various antidepressant drug therapies. Our data correspond with the efficacy of BoNT-A treatment of glabellar frown lines in treating patients with major depression and suggest that also intrastriatal injected BoNT-A may have some antidepressant-like effect on hemi-PD.
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Atamian A, Sichez PC, Michel F, Bandelier Q, Fall M, Gaillet S, Azoulay JP, Lechevallier E, Karsenty G. [Intradetrusor injections of botulinum toxin A to treat urinary incontinence due to bladder overactivity during idiopathic Parkinson's disease]. Prog Urol 2021; 31:430-438. [PMID: 33579624 DOI: 10.1016/j.purol.2021.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION During idiopathic Parkinson's disease (IPD), lower urinary tract symptoms and dysfunctions are frequent, dominated by overactive bladder and detrusor overactivity (OAB, DO). Intradetrusor Injection (IDI) of Botulinum Toxin A (BTA) is recommended as second-line treatment for neurogenic urinary incontinence related to DO in multiple sclerosis or spinal cord injury patients. However, there is little data on BTA IDI to treat incontinence owing to OAB and DO during idiopathic Parkinson's disease. The objective of this study is to evaluate efficacy and tolerance of BTA IDI in patients suffering IPD. PATIENTS AND METHODS We conducted a retrospective study in IPD patients treated with BTA IDI from 2012 to 2018. For each patient we compared patient clinical and urodynamic data at baseline before the first injection and 8 weeks following the injection. We defined 3 levels of effects (perfect, improved, failure), corresponding to 3-dimension composite criteria: clinical, quality of life (Likert scale), urodynamics. RESULTS Sixteen patients were included from 2012 to 2018. The median age was 73 (70-78.25). The median number of micturition/day before and after TBA was 13 (10-16) and 9 (6.75-13.25) (p=0.022). The median number of pad used/day before and after BTA was 5.4 (2-5) and 1 (0-5) (p=0.035). Median USP scores for OAB was 15.5 (11.75-20) and 14 (6.75-15.25). Median score on the Likert scale was 1 (0-1.5) meaning "slight improvement" felt by the patient. The median maximum cystometric capacity raised from 130cm3 (41.25-187.75) to 217cm3 (165-376.75) (p=0,013). Among the patients, 20% had a perfect result, 40% were significantly improved and in 40% TBA injections failed. After TBA 4/14 patients (28%) needed intermittent self-catheterization. No severe side effect was observed. CONCLUSION In this retrospective study we observe some short-term efficacy of TBA IDI to treat urinary incontinence owing to OAB/DO in patients with IPD in 60% of patients. These results are consistent with findings from previous retrospective studies. Prospective data coming from larger cohorts are now tremendously needed to clarify the best patient responders profiles, the actual TBA dose, and eventually to define TBA IDI place in the therapeutic algorithm of IPD patients' incontinence. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- A Atamian
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - P C Sichez
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - F Michel
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - Q Bandelier
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - M Fall
- Hôpital Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - S Gaillet
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - J P Azoulay
- Hôpital Timone, 264, rue Saint-Pierre, 13005 Marseille, France.
| | - E Lechevallier
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
| | - G Karsenty
- Hôpital Conception, 147, boulevard Baille, 13005 Marseille, France.
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Use of Botulinum Neurotoxin in Parkinson's Disease: A Critical Appraisal. Toxins (Basel) 2021; 13:toxins13020087. [PMID: 33503872 PMCID: PMC7910947 DOI: 10.3390/toxins13020087] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
For well over 30 years, the botulinum neurotoxin (BoNT) has been used for a large number of indications, some of which however have not been licensed. Admittedly, approval varies in many countries and this permits a large spectrum for evaluation. Thus, BoNT is used for patients with Parkinson’s disease (PD) and other Parkinson’s syndromes (PS) in varying degrees of frequency. We have to distinguish between (1) indications that are either approved or (2) those not approved, (3) indications that might be a result of PS and (4) finally those which appear independent of PS. The most important indication for BoNT in PS patients is probably sialorrhea, for which approval has been granted in the majority of countries. Cervical dystonia is a frequent symptom in PS, with anterocollis as a specific entity. A further indication is blepharospasm in the different forms, especially the inhibition of eyelid opening in atypical PS. The use of BoNT in cases of camptocormia, the Pisa syndrome and neck rigidity is still a matter of debate. In dystonia of the extremities BoNT can be recommended, especially in dystonia of the feet. One well-known indication, for which however sufficient data are still lacking, involves treating tremor with BoNT. As to autonomic symptoms: Focal hyperhidrosis and detrusor hyperactivity can be mentioned, in this last case BoNT has already been approved. A number of further but rare indications such as freezing-of-gait, dyskinesia, and dysphagia will be discussed and evaluated.
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Abstract
Recognition of the importance of nonmotor dysfunction as a component of Parkinson's disease has exploded over the past three decades. Autonomic dysfunction is a frequent and particularly important nonmotor feature because of the broad clinical spectrum it covers. Cardiovascular, gastrointestinal, urinary, sexual, and thermoregulatory abnormalities all can appear in the setting of Parkinson's disease. Cardiovascular dysfunction is characterized most prominently by orthostatic hypotension. Gastrointestinal dysfunction can involve virtually all levels of the gastrointestinal tract. Urinary dysfunction can entail either too frequent voiding or difficulty voiding. Sexual dysfunction is frequent and frustrating for both patient and partner. Alterations in sweating and body temperature are not widely recognized but often are present. Autonomic dysfunction can significantly and deleteriously impact quality of life for individuals with Parkinson's disease. Because effective treatment for many aspects of autonomic dysfunction is available, it is vitally important that assessment of autonomic dysfunction be a regular component of the neurologic history and exam and that appropriate treatment be initiated and maintained.
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Affiliation(s)
- Ronald F Pfeiffer
- Department of Neurology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239-3098, USA.
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Kulshreshtha D, Ganguly J, Jog M. Managing autonomic dysfunction in Parkinson's disease: a review of emerging drugs. Expert Opin Emerg Drugs 2020; 25:37-47. [PMID: 32067502 DOI: 10.1080/14728214.2020.1729120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Autonomic dysfunction is an integral part of Parkinson disease (PD) complex and can be seen both in early and advanced stages. There is a paucity of medicines available to manage autonomic dysfunction in PD and this adds to the considerable morbidity associated with the illness.Areas covered: The pathophysiology and the available therapeutic options of autonomic dysfunction seen in PD are discussed in detail. The potential targets for novel regimens are reviewed and the available literature on the drugs emerging in management of autonomic dysfunction in PD is highlighted.Expert opinion: In the current scenario, there are several drugs that can be tried for constipation viz stool laxatives, prucalopride, prokinetic agents and a high fiber diet. Bladder dysfunction has been treated with β-agonists and with mirabegron, a selective β-3 agonist, the anticholinergic side effects are minimized, and the drug has been found to be effective. Orthostatic hypotension is managed with midodrine while droxidopa is a new drug with promising efficacy. Botulinum toxin works best for management of sialorrhea, but repeated injections are needed.
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Affiliation(s)
- Dinkar Kulshreshtha
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, Ontario, London, Canada
| | - Jacky Ganguly
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, Ontario, London, Canada
| | - Mandar Jog
- Movement Disorder Centre, London Health Sciences Centre, The University of Western Ontario, Ontario, London, Canada
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Chermansky C, Schurch B, Rahnama'i MS, Averbeck MA, Malde S, Mancini V, Valentini F, Sahai A. How can we better manage drug‐resistant OAB/DO? ICI‐RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S46-S55. [DOI: 10.1002/nau.24055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/31/2019] [Accepted: 05/19/2019] [Indexed: 01/20/2023]
Affiliation(s)
| | - Brigitte Schurch
- Department of Clinical Neurosciences, Neuropsychology and Neurorehabilitation ServiceVaudois University Hospital of LausanneLausanne Switzerland
| | - Mohammad S. Rahnama'i
- Department of UrologyUniversity Hospital RWTH AachenAachen Germany
- Maastricht UniversityMaastricht The Netherlands
| | | | - Sachin Malde
- Department of UrologyGuy's Hospital & King's College School of MedicineLondon United Kingdom
| | - Vito Mancini
- Urology and Renal Transplant Unit, Ospedali RiunitiUniversity of FoggiaFoggia Italy
| | - Francoise Valentini
- Department of Physical Medicine and RehabilitationHôpital RothschildParis France
| | - Arun Sahai
- Department of UrologyGuy's Hospital & King's College School of MedicineLondon United Kingdom
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Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease. Int Neurourol J 2019; 23:211-218. [PMID: 31607100 PMCID: PMC6790817 DOI: 10.5213/inj.1938086.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/27/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms. METHODS We performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms. RESULTS We included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009). CONCLUSION DO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.
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Peyronnet B, Vurture G, Palma JA, Malacarne DR, Feigin A, Sussman RD, Biagioni MC, Palmerola R, Gilbert R, Rosenblum N, Frucht S, Kaufmann H, Nitti VW, Brucker BM. Mirabegron in patients with Parkinson disease and overactive bladder symptoms: A retrospective cohort. Parkinsonism Relat Disord 2018; 57:22-26. [PMID: 30037689 DOI: 10.1016/j.parkreldis.2018.07.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 07/15/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION This study aimed to assess the outcomes of mirabegron for the treatment of overactive bladder (OAB) symptoms in patients with Parkinson disease (PD). METHODS A retrospective study was conducted including patients with PD who received mirabegron 50 mg once daily for OAB symptoms between 2012 and 2017. The primary endpoint was clinical success defined as any improvement in overactive bladder symptoms self-assessed by the patients 6 weeks after mirabegron initiation. Secondary endpoints included number of pads per day, number of nocturia episodes and adverse events. RESULTS Fifty patients (mean 74 years old) were included. Before being treated with mirabegron, 56% had failed prior anticholinergic therapy. After 6 weeks of mirabegron 50 mg, five patients (11.4%) had a complete resolution of their OAB symptoms; 25 patients (50%) reported improvement, 23 (46%) reported no change and 2(4%) reported worsening of their OAB symptoms. The number of pads per day decreased from 1.5 to 0.9 (p = 0.01) and so did the number of nocturia episodes (from 3 to 2.6/night; p = 0.02). Only 2 adverse events were reported during mirabegron treatment (4%): one dizziness and one diaphoresis, that disappeared after mirabegron discontinuation. After a median follow-up of 19 months, 23 patients (46%) persisted on mirabegron. Persistence rates were 51.5%, 44.6% and 36.4% at 1, 2 and 3 years respectively. CONCLUSION Mirabegron has an excellent safety profile and appears to be an effective treatment for overactive bladder symptoms in patients with PD. Further prospective randomized trials are needed to properly assess mirabegron in PD patients.
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Affiliation(s)
- Benoit Peyronnet
- Department of Urology, New York University School of Medicine, New York, USA; Department of Urology, University of Rennes, Rennes, France.
| | - Gregory Vurture
- Department of Urology, New York University School of Medicine, New York, USA
| | - Jose-Alberto Palma
- Department of Neurology Dysautonomia Center, New York University School of Medicine, New York, USA
| | | | - Andrew Feigin
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Rachael D Sussman
- Department of Urology, New York University School of Medicine, New York, USA
| | - Milton C Biagioni
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Ricardo Palmerola
- Department of Urology, New York University School of Medicine, New York, USA
| | - Rebecca Gilbert
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Nirit Rosenblum
- Department of Urology, New York University School of Medicine, New York, USA
| | - Steven Frucht
- The Marlene & Paolo Fresco Institute for Parkinson's & Movement Disorders, New York University School of Medicine, New York, USA
| | - Horacio Kaufmann
- Department of Neurology Dysautonomia Center, New York University School of Medicine, New York, USA
| | - Victor W Nitti
- Department of Urology, New York University School of Medicine, New York, USA
| | - Benjamin M Brucker
- Department of Urology, New York University School of Medicine, New York, USA
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