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Sysoev Y, Bazhenova E, Shkorbatova P, Kovalev G, Labetov I, Merkulyeva N, Shkarupa D, Musienko P. Functional mapping of the lower urinary tract by epidural electrical stimulation of the spinal cord in decerebrated cat model. Sci Rep 2024; 14:9654. [PMID: 38670988 PMCID: PMC11053135 DOI: 10.1038/s41598-024-54209-3] [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: 08/15/2023] [Accepted: 02/09/2024] [Indexed: 04/28/2024] Open
Abstract
Several neurologic diseases including spinal cord injury, Parkinson's disease or multiple sclerosis are accompanied by disturbances of the lower urinary tract functions. Clinical data indicates that chronic spinal cord stimulation can improve not only motor function but also ability to store urine and control micturition. Decoding the spinal mechanisms that regulate the functioning of detrusor (Detr) and external urethral sphincter (EUS) muscles is essential for effective neuromodulation therapy in patients with disturbances of micturition. In the present work we performed a mapping of Detr and EUS activity by applying epidural electrical stimulation (EES) at different levels of the spinal cord in decerebrated cat model. The study was performed in 5 adult male cats, evoked potentials were generated by EES aiming to recruit various spinal pathways responsible for LUT and hindlimbs control. Recruitment of Detr occurred mainly with stimulation of the lower thoracic and upper lumbar spinal cord (T13-L1 spinal segments). Responses in the EUS, in general, occurred with stimulation of all the studied sites of the spinal cord, however, a pronounced specificity was noted for the lower lumbar/upper sacral sections (L7-S1 spinal segments). These features were confirmed by comparing the normalized values of the slope angles used to approximate the recruitment curve data by the linear regression method. Thus, these findings are in accordance with our previous data obtained in rats and could be used for development of novel site-specific neuromodulation therapeutic approaches.
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Affiliation(s)
- Yuriy Sysoev
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
- Department of Neuroscience, Sirius University of Science and Technology, Sirius, Russia, 354340
- Department of Pharmacology and Clinical Pharmacology, Saint-Petersburg State Chemical Pharmaceutical University, Saint-Petersburg, Russia
| | - Elena Bazhenova
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Polina Shkorbatova
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
- Department of Neuroscience, Sirius University of Science and Technology, Sirius, Russia, 354340
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Gleb Kovalev
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Ivan Labetov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Natalia Merkulyeva
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Dmitry Shkarupa
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russia
| | - Pavel Musienko
- Department of Neuroscience, Sirius University of Science and Technology, Sirius, Russia, 354340.
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.
- Life Improvement by Future Technologies Center "LIFT", Moscow, Russia, 143025.
- Center for Biomedical Engineering, National University of Science and Technology "MISIS", Moscow, Russia, 119049.
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Palma JA, Thijs RD. Non-Pharmacological Treatment of Autonomic Dysfunction in Parkinson's Disease and Other Synucleinopathies. JOURNAL OF PARKINSON'S DISEASE 2023:JPD230173. [PMID: 37694308 DOI: 10.3233/jpd-230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Symptoms of autonomic dysfunction are prevalent and can be very debilitating, reducing the quality of life in patients with Parkinson's disease (PD) and other synucleinopathies such as dementia with Lewy bodies and multiple system atrophy. Non-pharmacological therapies are key to effective management and are frequently used alone in patients with mild autonomic symptoms, or in combination with pharmacological therapies in patients with moderate and severe symptoms. This article focuses on non-pharmacological approaches. Our objective was to review the non-drug and non-surgical approaches to treating autonomic symptoms in patients with PD and other synucleinopathies, focusing on cardiovascular, gastrointestinal, and genitourinary autonomic dysfunction. Evidence supporting the effectiveness of non-pharmacological treatment for the management of neurogenic orthostatic hypotension, supine hypertension, constipation, and bladder and sexual dysfunction is available. High-quality prospective trials are scarce, yet some non-pharmacological interventions (e.g., physical counter maneuvers) can be evaluated relatively quickly on an individual basis and often seem effective. The emerging variety of clinical presentations advocates for a stepwise, individualized, and non-pharmacological approach for the management of autonomic symptoms. Often, the first step is to reduce or discontinue drugs that cause or aggravate autonomic symptoms followed by lifestyle measures. While non-pharmacological and non-surgical treatments are available and, in many cases, effective to improve symptoms of autonomic dysfunction in PD and other synucleinopathies, they are often overlooked. Large randomized trials testing and comparing non-pharmacological approaches are warranted.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands
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Cheng B, Huang S, Huang Q, Zhou Z, Bao Y. The efficacy and safety of medication for treating overactive bladder in patients with Parkinson's disease: a meta-analysis and systematic review of randomized double-blind placebo-controlled trials. Int Urogynecol J 2023; 34:2207-2216. [PMID: 37052644 DOI: 10.1007/s00192-023-05528-y] [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: 10/17/2022] [Accepted: 03/10/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The goal of this meta-analysis was to determine the efficacy and safety of medication for treating overactive bladder (OAB) in patients with Parkinson's disease (PD). METHODS Papers containing predefined key terms were searched in the PubMed, Embase, Web of Science, and Cochrane Library databases up to December 2021 to collect randomized double-blind placebo-controlled trials (RCTs). The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. Two reviewers independently assessed the risk of bias using the modified Jadad scale and Cochrane risk-of-bias tool. The GRADEpro GDT was employed to evaluate the strength of evidence based on the findings of this meta-analysis. RESULTS We eventually included four RCTs involving 313 patients (163 patients in the medication group and 150 patients in the placebo group). Of these, the therapeutic agent in two RCTs was mirabegron (121 and 106 patients and controls, respectively, representing 3/4 -2/3 of the patients). The results showed that the number of micturition episodes per 24 h (MD -1.33; 95% CI -2.30 to -0.36; p = 0.007), the number of nocturia episodes per 24 h (MD -0.33; 95% CI -0.58 to -0.08; p = 0.009) and the number of urinary incontinence episodes per 24 h (MD -0.72; 95% CI -1.32 to -0.12; p = 0.02) were significantly lower in the medication group than in the placebo group. The OAB symptom score (MD -2.84; 95% CI -4.67 to -1.00; p = 0.002) and quality of life score (MD 15.15; 95% CI 12.33 to 17.96; p < 0.0001) of the medication group were significantly improved compared with those of the placebo group. However, no significant difference in the daily frequency of urinary urgency episodes was identified between the medication group and the placebo group (MD -0.79; 95% CI -1.71 to 0.14; p = 0.09). There were no significant differences between the two groups in terms of drug-related adverse events (OR 1.69; 95% CI 0.41 to 6.99; p = 0.47), especially in PD patients receiving mirabegron therapy. CONCLUSIONS Medication was effective for OAB symptoms in patients with PD, and patients tolerated adverse events well.
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Affiliation(s)
- Bo Cheng
- Department of Urology, Tengzhou Central People's Hospital, Tengzhou, 277500, China
| | - Shuangfeng Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100070, China
| | | | - Zhongbao Zhou
- Department of Urology, Beijing TianTan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Yiping Bao
- Department of Urology, Yantai Yuhuangding Hospital, Qingdao University, Yantai, Shandong, China.
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Topoliova K, Harsanyi S, Danisovic L, Ziaran S. Tissue Engineering and Stem Cell Therapy in Neurogenic Bladder Dysfunction: Current and Future Perspectives. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1416. [PMID: 37629705 PMCID: PMC10456466 DOI: 10.3390/medicina59081416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023]
Abstract
Tissue engineering (TE) is a rapidly evolving biomedical discipline that can play an important role in treating neurogenic bladder dysfunction and compensating for current conventional options' shortcomings. This review aims to analyze the current status of preclinical and clinical trials and discuss what could be expected in the future based on the current state of the art. Although most preclinical studies provide promising results on the effectiveness of TE and stem cell therapies, the main limitations are mainly the very slow translation of preclinical trials to clinical trials, lack of quality research on neurogenic preconditions of neurogenic bladder dysfunction outside of the spinal cord injury and varying therapeutic methods of the existing research that lacks a standardized approach.
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Affiliation(s)
- Katarina Topoliova
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 833 05 Bratislava, Slovakia
| | - Stefan Harsanyi
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 811 08 Bratislava, Slovakia
| | - Lubos Danisovic
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Institute of Medical Biology, Genetics and Clinical Genetics, Faculty of Medicine, Comenius University in Bratislava, Sasinkova 4, 811 08 Bratislava, Slovakia
- Regenmed Ltd., Medena 29, 811 02 Bratislava, Slovakia
| | - Stanislav Ziaran
- National Institute of Rheumatic Diseases, Nabrezie I. Krasku 4, 921 12 Piestany, Slovakia; (K.T.); (S.H.); (S.Z.)
- Department of Urology, Faculty of Medicine, Comenius University in Bratislava, Limbova 5, 833 05 Bratislava, Slovakia
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Marra JM, de Castro Vieira PV, de Senna Migueletto AM, de Oliveira LFA, de Souza ECF, Marquini GV. Neurogenic Disorders and the Lower Urinary Tract Dysfunction: Proposed Approach for the Gynecologist. Reprod Sci 2023; 30:2087-2091. [PMID: 36973580 DOI: 10.1007/s43032-023-01213-z] [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: 08/18/2022] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The scenario of the patient with neuropathies, which are related to urinary disorders, impacts the quality of life. Symptoms can lead to social isolation, impair activities of daily living, and shorten life expectancy. This study aims to make a practical and integrative review of current recommendations for the urogynecological approach of patients with neuropathy and urinary dysfunction. METHODS The authors searched for data on combinations of the terms "lower urinary tract symptoms" AND "neurogenic voiding dysfunction" from January 2012 to January 2022 in the following scientific databases: PUBMED, MEDLINE, EMBASE, and The Cochrane Library. INCLUSION CRITERIA randomized clinical trials, protocols from specialized societies and articles before that period, and according to clinical relevance. EXCLUSION CRITERIA case series or reports, expert opinions not endorsed by medical societies in the area. RESULTS From the 25 studies mentioned, 09 studies were selected according to pre-established criteria and qualitative analysis of relevance. The authors add 2 references for relevance in the area of urogynecology and neurological diseases. According to the selected scientific references, the main neuropathies that can cause urinary dysfunction are CNS injuries such as stroke, spinal cord injury, meningomyelocele, and amyotrophic lateral sclerosis. Ten steps below were compiled to facilitate the gynecological approach, according to the researched literature. CONCLUSION It is important for the medical assistant to pay close attention to careful anamnesis and post-emptying urinary residual volume. The treatment in general addresses greater fluid intake, maneuvers to favor bladder emptying, medications, and/or intermittent self-catheterization. The approach of a multidisciplinary team can make a difference in the patient's prognosis and quality of life.
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Affiliation(s)
- Juliana Marques Marra
- Urogynecology and Gynecological Perioperative Care Sector From Federal University of Uberlândia, Av Amazonas, 1595, Campus Umuarama, Uberlândia, Minas Gerais, 38411000, Brazil
| | - Paulo Vitor de Castro Vieira
- Urogynecology and Gynecological Perioperative Care Sector From Federal University of Uberlândia, Av Amazonas, 1595, Campus Umuarama, Uberlândia, Minas Gerais, 38411000, Brazil
| | - Anna Maria de Senna Migueletto
- Urogynecology and Gynecological Perioperative Care Sector From Federal University of Uberlândia, Av Amazonas, 1595, Campus Umuarama, Uberlândia, Minas Gerais, 38411000, Brazil
| | - Luis Flavio Araujo de Oliveira
- Urogynecology and Gynecological Perioperative Care Sector From Federal University of Uberlândia, Av Amazonas, 1595, Campus Umuarama, Uberlândia, Minas Gerais, 38411000, Brazil
| | - Eduardo Carneiro Fabrício de Souza
- Urogynecology and Gynecological Perioperative Care Sector From Federal University of Uberlândia, Av Amazonas, 1595, Campus Umuarama, Uberlândia, Minas Gerais, 38411000, Brazil
| | - Gisele Vissoci Marquini
- Urogynecology and Gynecological Perioperative Care Sector From Federal University of Uberlândia, Av Amazonas, 1595, Campus Umuarama, Uberlândia, Minas Gerais, 38411000, Brazil.
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Ma L, Mu Y, Li X, Zhang M, An W, Zeng F. Expression of transforming growth factor-β1 and autophagy markers in the bladder of rats with neurogenic lower urinary tract injury. Spinal Cord 2023; 61:154-159. [PMID: 36319684 DOI: 10.1038/s41393-022-00866-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study was conducted to explore the expression of transforming growth factor-beta 1 (TGF-β1) and its correlation with autophagy markers in the bladder of rats with neurogenic lower urinary tract dysfunction (NLUTD) post spinal cord injury (SCI). STUDY DESIGN A total of 36 male Wistar rats were randomly divided into the SCI group and control group. Rats in the SCI group were subjected to T10-T11 spinal cord transection. At day 1, 4, and 7, 6 rats were euthanized daily and the Basso, Beattie and Bresnahan score (BBB score), post-void residual (PVR), urinary bladder function score (UBFS) and bladder weight were assessed. The expression TGF-β1 and autophagy markers were evaluated by immunofluorescence staining, Western bolt, and qRT-PCR. SETTING A total of 36 male Wistar rats were randomly divided into the SCI group and control group, with three time points in each group. PARTICIPANTS Not applicable. RESULTS SCI modeling impaired the motor function of the hind limbs and the bladder function of rats. NLUTD muscle exhibited a punctated immunostaining pattern for LC3, suggesting the accumulation of autophagosomes. Our results further indicated that compared with the control group, the expression levels of TGF-β1 and LC3 were increased, while the level of P62 was decreased after SCI modeling. CONCLUSION TGF-β1 was significantly increased in SCI rats with NLUTD and was correlated with autophagy markers LC3 and p62.
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Affiliation(s)
- Lili Ma
- Department of Rehabilitation Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Avenue, Jinan, 250033, Shandong, China.,Department of Neurology, Zibo Central Hospital, No. 54, Gongqingtuan West Road, Zibo, 255036, Shandong, China
| | - Ying Mu
- Department of Intensive Care Medicine, Zhangdian People's Hospital, No. 63, Jinjing Road, Zibo, 255036, Shandong, China
| | - Xiangqing Li
- Department of Neurology, Zibo Central Hospital, No. 54, Gongqingtuan West Road, Zibo, 255036, Shandong, China
| | - Ming Zhang
- Department of Rehabilitation Medicine, Zibo Central Hospital, No. 54, Gongqingtuan West Road, Zibo, 255036, Shandong, China
| | - Wenhan An
- Department of Rehabilitation Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Avenue, Jinan, 250033, Shandong, China
| | - Fanshuo Zeng
- Department of Rehabilitation Medicine, the Second Hospital, Cheeloo College of Medicine, Shandong University, No. 247 Beiyuan Avenue, Jinan, 250033, Shandong, China.
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Sadeghmousavi S, Soltani Khaboushan A, Jafarnezhad-Ansariha F, Nejad-Gashti R, Farsi M, Esmaeil-Pour R, Alijani M, Majidi Zolbin M, Niknejad H, Kajbafzadeh AM. The role of spinal cord tractography in detecting lesions following selective bladder afferent and efferent fibers: A novel method for induction of neurogenic lower urinary tract dysfunction in rabbit. Neurourol Urodyn 2022; 41:1539-1552. [PMID: 35842827 DOI: 10.1002/nau.25009] [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: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neurogenic lower urinary tract dysfunction (NLUTD), a challenging disorder, is defined by lack of bladder control due to the abnormalities in neural pathways and can be classified based on the location of lesions within the nervous system, thus investigating the neural pathways can help us to know the site of the lesion and specify the class of the NLUTD. Diffusion Tensor Imaging (DTI) tractography, a noninvasive advanced imaging method, is capable of detecting central nervous system pathologies, even if routine magnetic resonance imaging shows no abnormality. Accordingly, tractography is an ideal technique to evaluate patients with NLUTD and visualize the pathology site within the spine. This study aimed to introduce a novel method of spinal cord injury (SCI) to establish NLUTD in the rabbit and to investigate the potential of tractography in tracing neural tracts of the spinal cord in an induced NLUTD animal model. MATERIALS AND METHODS An animal model of NLUTD was induced through cauterization of the spinal cord at the level T12-L1 in 12 rabbits. Then rabbits were assessed via DTI, urodynamic studies (UDS), voiding cystourethrogram (VCUG), and pathology assessments using antineurofilament 200 (NF200) antibody, anti-S100, anti-Smooth Muscle Actin, anti-Myogenin, and anti-MyoD1. RESULTS The tractography visualized lesions within spinal cord fibers. DTI parameters including fractional anisotropy (FA) value and tract density were significantly decreased (FA: p-value = 0.01, Tract density: p-value = 0.05) after injury. The mean diffusivity (MD) was insignificantly increased compared to before the injury. Also, the results of UDS and pathology assessments corroborated that applying SCI and the establishment of the NLUTD model was completely successful. CONCLUSION In the present study, we investigated the auxiliary role of tractography in detecting the spinal cord lesions in the novel established rabbit model of NLUTD. The introduced method of NLUTD induction was without the leg's neurological deficit, easily applicable, low-cost, and was accompanied by minimal surgical preparation and a satisfactory survival rate in comparison with other SCI animal models.
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Affiliation(s)
- Shaghayegh Sadeghmousavi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Soltani Khaboushan
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fahimeh Jafarnezhad-Ansariha
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Nejad-Gashti
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farsi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Esmaeil-Pour
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alijani
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Majidi Zolbin
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Childern's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Ali MU, Fong KNK, Kannan P, Bello UM, Kranz GS. Effects of nonsurgical, minimally or noninvasive therapies for urinary incontinence due to neurogenic bladder: a systematic review and meta-analysis. Ther Adv Chronic Dis 2022; 13:20406223211063059. [PMID: 35321402 PMCID: PMC8935404 DOI: 10.1177/20406223211063059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022] Open
Abstract
Objective: To determine the effects of nonsurgical, minimally or noninvasive therapies on urge urinary incontinence (UUI) symptoms and quality of life (QoL) in individuals with neurogenic bladder (NGB). Data Sources: Cochrane library, EMBASE, MEDLINE, PEDro, Scopus, and Web of Science databases were searched from inception to September 2021. Review Methods: Randomized controlled trials that compared therapies such as intravaginal electrical stimulation (IVES), transcutaneous electrical nerve stimulation (TENS), neuromuscular electrical stimulation (NMES), transcutaneous tibial nerve stimulation (TTNS), pelvic floor muscle training (PFMT), and behavioural therapy (BT) to control were included. Study screening, data extraction, and study quality assessments were performed by two independent authors. Results: Fourteen trials with 804 participants were included in the study after screening of 4281 potentially relevant articles. Meta-analyses revealed a significant effect of electrical stimulation on UUI due to multiple sclerosis (standardized mean difference (SMD): −0.614; 95% confidence interval (CI): −1.023, −0.206; p = 0.003) and stroke (SMD: −2.639; 95% CI: −3.804, −1.474; p = 0.000). The pooled analyses of TTNS (weighted mean difference (WMD): −12.406; 95% CI: −16.015, −8.797; p = 0.000) and BT (WMD: −9.117; 95% CI: −14.746, −3.487; p = 0.002) revealed significant effects of these interventions on QoL in people with Parkinson’s disease. However, meta-analyses revealed nonsignificant effects for PFMT (WMD: −0.751; 95% CI: −2.426, 0.924; p = 0.380) and BT (WMD: −0.597; 95% CI: −1.278, 0.083; p = 0.085) on UUI due to Parkinson’s disease. Conclusions: Our meta-analyses found electrical stimulation to be beneficial for improving the symptoms of UUI among people with multiple sclerosis and those with stroke. Our review also revealed that TTNS and BT might improve QoL for people with NGB due to Parkinson’s disease, although the effects of PFMT and BT on UUI warrant further investigation.
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Affiliation(s)
- Mohammed Usman Ali
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Medical Rehabilitation (Physiotherapy), University of Maiduguri, Maiduguri, Nigeria
| | - Kenneth Nai-Kuen Fong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Priya Kannan
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Umar Muhammad Bello
- Centre for Eye and Vision Research (CEVR) Limited, Hong Kong, China; Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Physiotherapy, Yobe State University Teaching Hospital, Damaturu, Nigeria
| | - Georg S. Kranz
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Moussa M, Chakra MA, Dabboucy B, Fares Y, Dellis A, Papatsoris A. The safety and effectiveness of mirabegron in Parkinson's disease patients with overactive bladder: a randomized controlled trial. Scand J Urol 2021; 56:66-72. [PMID: 34672847 DOI: 10.1080/21681805.2021.1990994] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the safety and effectiveness of mirabegron in patients with PD complaining of overactive bladder (OAB). PATIENTS AND METHODS From January 2017 to November 2020, we performed a prospective randomized, double-blind, placebo-controlled trial that enrolled PD patients with symptoms of OAB. The total duration of the study was 13 weeks, comprising a 1-week screening period and a 12-week treatment period. A total of 110 patients were randomized in one of two groups: treatment group (mirabegron 50 mg) or placebo group. The primary outcomes of our study were the change from baseline in OAB symptom score (OABSS) and the overactive bladder questionnaire short form (OAB-q SF) score. The secondary outcomes were the change from baseline in the mean number of micturitions/24 hours, the mean number of urgency episodes/24 hours, the mean number of urgency incontinence episodes/24 hours and the mean number of nocturia episodes/night, volume voided/micturition (ml) as recorded on a 3-day bladder diary. Safety assessments included adverse events, electrocardiogram, QT corrected for heart rate using Fridericia's correction (QTcF) interval and blood pressure and pulse rate measurements. RESULTS There was a significant improvement in the primary outcome and secondary outcome measures in the treatment group compared to the placebo group. Adverse events were mild and the same in the two groups. The cardiovascular safety profile was high. This study is limited by its sample size and its short follow-up period. CONCLUSIONS Mirabegron is a promising drug to control OAB symptoms in patients with PD with an excellent safety profile.
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Affiliation(s)
- Mohamad Moussa
- Urology Department, Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon
| | - Mohamad Abou Chakra
- Faculty of Medicine, Urology Department, Lebanese University, Beirut, Lebanon
| | - Baraa Dabboucy
- Department of Neurosurgery, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Department of Neurosurgery, Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Athanasios Dellis
- Department of Urology/General Surgery, Areteion Hospital, Athens, Greece
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens, Athens, Greece
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10
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Kohler M, Schwarz J, Saxer S. Promoting urinary continence with nonpharmacological interventions in Parkinson's disease. Pflege 2021; 35:33-40. [PMID: 34645330 DOI: 10.1024/1012-5302/a000845] [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: 11/19/2022]
Abstract
Background: The evidence of nonpharmacological interventions promoting urinary continence in Parkinson's disease is low and rehabilitation nurses do not give it a high priority. Aim: To examine the effects of a urinary incontinence management program on continence and quality of life in persons with Parkinson's disease in inpatient rehabilitation. The acceptance of the intervention and the knowledge of the nurses were also of interest. Methods: A nonrandomized experimental study was conducted. The data collection commenced with a control group followed by an intervention group. A structured urinary incontinence management was performed in the intervention phase. This includes incontinence assessment, care planning, individual interventions, discharge planning, and telephone support at home. Results: Urinary continence and quality of life were enhanced in both groups; however, improvements were higher in the intervention group but the differences were not significant. Knowledge of the nurses about urinary incontinence improved during the study duration. The acceptance of the intervention was high. Conclusions: A structured urinary continence management may improve urinary continence in persons suffering from Parkinson's disease. In clinical practice it is important to perform a detailed assessment to identify problems regarding urinary incontinence.
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Affiliation(s)
- Myrta Kohler
- Eastern Switzerland University of Applied Sciences, St. Gallen
| | - Jürg Schwarz
- Lucerne University of Applied Sciences and Arts, Lucerne
| | - Susi Saxer
- Eastern Switzerland University of Applied Sciences, St. Gallen
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11
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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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12
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Review of Current Neurogenic Bladder Best Practices and International Guidelines. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00622-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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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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14
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Stem Cell Therapy for Neurogenic Bladder Dysfunction in Rodent Models: A Systematic Review. Int Neurourol J 2020; 24:241-257. [PMID: 33017895 PMCID: PMC7538284 DOI: 10.5213/inj.2040058.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Neurogenic bladder dysfunction (NGB) has an impact on the quality of life, which made it an important research subject in preclinical studies. The present review investigates the effect of stem cell (SC) therapy on bladder functional recovery after the onset of spinal cord injury (SCI), multiple sclerosis (MS), Parkinson disease (PD), and stroke in rodent models. METHODS All experiments evaluated the regenerative potential of SC on the management of NGB in rodent models up to June 2019, were included. From 1,189 relevant publications, 20 studies met our inclusion criteria of which 15 were conducted on SCI, 2 on PD, 2 on stroke, and 1 on MS in the rodent models. We conducted a meta-analysis on SCI experiments and for other neurological diseases, detailed urodynamic findings were reported. RESULTS The common SC sources used for therapeutical purposes were neural progenitor cells, bone marrow mesenchymal SCs, human amniotic fluid SCs, and human umbilical cord blood SCs. There was a significant improvement of micturition pressure in both contusion and transaction SCI models 4 and 8 weeks post-SC transplantation. Residual urine volume, micturition volume, and bladder capacity were improved 28 days after SC transplantation only in the transaction model of SCI. Nonvoiding contraction recovered only in 56 days post-cell transplantation in the contusion model. CONCLUSION Partial bladder recovery has been evident after SC therapy in SCI models. Due to limitations in the number of studies in other neurological diseases, additional studies are necessary to confirm the detailed mechanism for bladder recovery.
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15
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Sysoev Y, Bazhenova E, Lyakhovetskii V, Kovalev G, Shkorbatova P, Islamova R, Pavlova N, Gorskii O, Merkulyeva N, Shkarupa D, Musienko P. Site-Specific Neuromodulation of Detrusor and External Urethral Sphincter by Epidural Spinal Cord Stimulation. Front Syst Neurosci 2020; 14:47. [PMID: 32774243 PMCID: PMC7387722 DOI: 10.3389/fnsys.2020.00047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
Impairments of the lower urinary tract function including urine storage and voiding are widely spread among patients with spinal cord injuries. The management of such patients includes bladder catheterization, surgical and pharmacological approaches, which reduce the morbidity from urinary tract-related complications. However, to date, there is no effective treatment of neurogenic bladder and restoration of urinary function. In the present study, we examined neuromodulation of detrusor (Detr) and external urethral sphincter by epidural electrical stimulation (EES) of lumbar and sacral regions of the spinal cord in chronic rats. To our knowledge, it is the first chronic study where detrusor and external urethral sphincter signals were recorded simultaneously to monitor their neuromodulation by site-specific spinal cord stimulation (SCS). The data obtained demonstrate that activation of detrusor muscle mainly occurs during the stimulation of the upper lumbar (L1) and lower lumbar (L5-L6) spinal segments whereas external urethral sphincter was activated predominantly by sacral stimulation. These findings can be used for the development of neurorehabilitation strategies based on spinal cord epidural stimulation for autonomic function recovery after severe spinal cord injury (SCI).
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Affiliation(s)
- Yuriy Sysoev
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Department of Pharmacology and Clinical Pharmacology, Saint-Petersburg State Chemical Pharmaceutical University, Saint-Petersburg, Russia
| | - Elena Bazhenova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Vsevolod Lyakhovetskii
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Gleb Kovalev
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Polina Shkorbatova
- Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Regina Islamova
- Institute of Chemistry, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Natalia Pavlova
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia
| | - Oleg Gorskii
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Natalia Merkulyeva
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
| | - Dmitry Shkarupa
- Clinic of High Medical Technology named after N.I. Pirogov St. Petersburg State University, Saint-Petersburg, Russia
| | - Pavel Musienko
- Institute of Translational Biomedicine, Saint-Petersburg State University, Saint-Petersburg, Russia.,Pavlov Institute of Physiology, Russian Academy of Sciences (RAS), Saint-Petersburg, Russia.,Granov Russian Research Center of Radiology and Surgical Technologies, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia.,Saint-Petersburg State Research Institute of Phthisiopulmonology, Ministry of Healthcare of the Russian Federation, Saint-Petersburg, Russia
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16
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Mostafaei H, Shariat SF, Salehi-Pourmehr H, Janisch F, Mori K, Quhal F, Hajebrahimi S. The clinical pharmacology of the medical treatment for overactive bladder in adults. Expert Rev Clin Pharmacol 2020; 13:707-720. [PMID: 32500759 DOI: 10.1080/17512433.2020.1779056] [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: 02/09/2023]
Abstract
INTRODUCTION Overactive bladder is a prevalent symptom complex that affects the patient's quality of life. Any disruption between the neuronal micturition pathway can lead to bladder overactivity. Neurogenic causes, myogenic causes, aging, bladder outlet obstruction, sex, and psychological factors are some of the factors contributing to bladder overactivity. The complaint of any symptoms of OAB, which is highly prevalent and affects overall QOL, often needs therapeutic interventions. When conservative therapy methods fail, the addition of medications is recommended. The most commonly used agents for the treatment of OAB are antimuscarinic drugs. New classes of drugs, such as beta-3 agonists, have enriched our pharmacologic armamentarium. AREAS COVERED In this review, with a special focus on oral pharmacological treatments, we discussed the definition, etiology, symptoms, diagnosis, and management of OAB. EXPERT OPINION OAB is a multifactorial condition with every patient presenting with a different collection of symptoms and signs. Medical therapies should be given in conjunction with behavioral therapies. Using high or low doses, flexible doses, and stopping or changing the medications are interchangeable strategies based on the level of treatment efficacy and patient satisfaction.
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Affiliation(s)
- Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, 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, University of Texas Southwestern Medical Center , Dallas, TX, USA.,Department of Urology, Second Faculty of Medicine, Charles University , Prague, Czech Republic.,Department of Urology, Weill Cornell Medical College , New York, NY, USA.,Karl Landsteiner Institute of Urology and Andrology , Vienna, Austria.,Department of Urology, University of Jordan , Amman, Jordan
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran.,Student Research Committee, Tabriz University of Medical Sciences , Tabriz, Iran
| | - Florian Janisch
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, Medical University of Hamburg , Hamburg, Germany
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,Department of Urology, The Jikei University School of Medicine , Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna , Vienna, Austria.,King Fahad Specialist Hospital-Dammam , Saudi Arabia
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences , Tabriz, Iran
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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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18
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Gomes CM, de Bessa J, Bruschini H. Letter to the Editor. Neurourol Urodyn 2019; 38:1184. [PMID: 30859613 DOI: 10.1002/nau.23962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 01/18/2019] [Indexed: 11/08/2022]
Affiliation(s)
- Cristiano M Gomes
- Division of Urology, Medical School, Sao Paulo University, Sao Paulo, SP, Brazil
| | - Jose de Bessa
- Division of Urology, Medical School, Sao Paulo University, Sao Paulo, SP, Brazil.,Department of Surgery, Medical School, State University of Feira de Santana, Feira de Santana, Brazil
| | - Homero Bruschini
- Division of Urology, Medical School, Sao Paulo University, Sao Paulo, SP, Brazil
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