Effects of pelvic floor muscle training applied with telerehabilitation in patients with multiple sclerosis having lower urinary track symptoms: A randomized controlled trial

In this study, the researchers aimed to investigate the effects of pelvic floor muscle training (PFMT) applied with telerehabilitation on urinary symptoms, quality of life, and subjective perception of improvement and satisfaction in multiple sclerosis (MS) patients having lower urinary tract symptoms. Patients were randomly divided into PFMT (n:21) and control (n:21) groups. The PFMT group received PFMT via telerehabilitation for 8 weeks and lifestyle advice, while the control group received only lifestyle advice. Although lifestyle advice alone was not effective, PFMT applied with telerehabilitation was an effective method in the management of lower urinary tract symptoms in MS patients. PFMT applied with telerehabilitation can be considered as an alternative method.

Current and emerging treatment options for premature ejaculation

Premature ejaculation (PE) is a prevalent male sexual dysfunction. Current standard treatment regimens include behavioural therapies, topical anaesthetics, dapoxetine and other selective serotonin reuptake inhibitors (SSRIs). Most of the pharmacotherapeutic options target neurotransmitters (such as serotonin and oxytocin) that have a role in the ejaculation mechanism. However, these treatments are mildly effective and only provide a temporary delay in the ejaculation latency time, and PE recurs when the treatment is stopped. Thus, a treatment for PE is urgently needed and research is ongoing to find the ideal PE therapy. The efficacy and safety of topical anaesthetics and SSRIs in delaying ejaculation have been confirmed in many well-designed controlled trials. Both preclinical and clinical studies on new-generation SSRIs are ongoing. Moreover, promising results came from clinical trials in which the efficacy of on-demand PE therapies targeting neurotransmitters other than serotonin, such as α1-adrenoceptor antagonists and oxytocin antagonists, was assessed. Surgical intervention and neuromodulation have been proposed as potential treatment options for PE; however, current PE guidelines do not recommend these treatments owing to safety concerns.

Effects of transcutaneous tibial nerve stimulation on females with overactive bladder syndrome in multiple sclerosis a protocol for a systematic review and meta-analysis

Background

Overactive bladder (OAB) is a problem that increasingly affects adults and the elderly, especially women. It may affect quality of life, ability to participate and overall wellbeing. Transcutaneous tibial nerve stimulation (TTNS) is a form of neuromodulation involving the use of electrical impulses to address urinary symptoms. There are many randomized controlled trials that have shown that TTNS is effective at treating overactive bladder. In recent years, TTNS has gained increasing attention for this condition. But its effect in females remains controversial and evidence is lacking. Therefore, the main purpose of this study will be to systematically evaluate the effect of TTNS on females with OAB in Multiple sclerosis (MS) by conducting a systematic review and meta-analysis, and also to provide a reference for the application of TTNS in OAB.

Methods

A systematic review of eligible articles will be conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive search of the literature will be conducted in PubMed, Web of Science, The Cochrane Library, Chinese National Knowledge Infrastructure Database (CNKI), Wanfang Data, Weipu Electronics, and other databases. We will include randomized controlled trials about TTNS in females with OAB in MS. Two reviewers will screen titles, abstracts, and full texts independently. We will use a hierarchy of recommended assessment, development, and assessment methods to assess the overall certainty of the evidence and report findings accordingly. Endnote X9 will be used to select the studies and Review Manager V.5.4 (Cochrane Collaboration) will be used to conduct the meta-analysis. The mean difference or standard deviation with 95% confidence interval (CI) will be used in the computation of continuous variables to synthesize data.

Results

The results will provide evidence for judging whether TTNS is effective in females with OAB and MS.

Conclusion

This study will provide reliable evidence for the effect of TTNS in female patients with OAB and MS.

Trial registration

Systematic review registration: PROSPERO CRD42021256861.

Pelvic Floor Dysfunctions and Their Rehabilitation in Multiple Sclerosis

Urinary, bowel, and sexual dysfunctions are the most frequent and disabling pelvic floor (PF) disorders in patients with multiple sclerosis (MS). PF dysfunction negatively impacts the performance of daily living activities, walking, and the physical dimension of quality of life (QoL) in people with MS. Patient-reported outcomes on sphincteric functioning could be useful to detect PF disorders and their impact on patients’ lives. PF rehabilitation proposed by Kegel is based on a series of regularly repeated exercises for “the functional restoration of the perineal muscles”. Over time, various therapeutic modalities have been added to PF muscles exercises, through the application of physical or instrumental techniques, such as intravaginal neuromuscular electrical stimulation, electromyographic biofeedback, transcutaneous tibial nerve stimulation. PF rehabilitation has been applied in MS treatment, with improvements of lower urinary tract symptoms severity, QoL, level of anxiety and depression, and sexual dysfunction. This review aims to examine the different PF disorders in MS to evaluate the application of PF rehabilitation in MS and to highlight its advantages and limits, suggesting a multidisciplinary management of PF disorders, with a well-deserved space reserved for PF rehabilitation.

Evaluating the effects of transcutaneous tibial nerve stimulation or pelvic floor muscle training on sexual dysfunction in female multiple sclerosis patients reporting overactive bladder

AIMS

Sexual dysfunction (SD) is common in female patients with multiple sclerosis (MS) reporting overactive bladder (OAB) symptoms. The aim of the study was to evaluate the effects of transcutaneous tibial nerve stimulation (TTNS) and pelvic floor muscle training (PFMT) with biofeedback on SD in female patients with MS reporting OAB symptoms.

METHODS

Patients with overactive bladder and SD were allocated to receive TTNS or PFMT daily. Overactive bladder symptoms, sexual functions, and sexual quality of life were assessed at baseline and 6^th weeks. Female Sexual Function Index (FSFI), Overactive Bladder Questionnaire (OABv-8), and Sexual Quality of Life-Female (SQoL-F) questionnaires were used.

RESULTS

Thirty patients (TTNS = 10, PFMT = 20) were included in the study. Compared to baseline, total FSFIOABv-8, and SQoL-F scores improved in both TTNS (p = 0.005, p = 0.011, p = 0.444, respectively) and PFMT (p = 0.002, p = 0.001, p = 0.001, respectively) groups. Between-group comparisons did not show any significant differences.

CONCLUSION

This study demonstrates the efficacy of both TTNS and PFMT for improving sexual function in female MS patients with OAB symptoms, but did not show superiority of any particular method. Further studies are required to investigate the differences between these two non-invasive methods.

Neural implant for the treatment of multiple sclerosis

The methods used to treat various neurological diseases are evolving. The facilities provided by the technology have led to creation of new treatment opportunities. Neuromodulation is one of these important methods. By definition, the neuromodulation is a change in neural activity which occurs by stimulating a specific area of nervous system. The mentioned stimulation can be electrical, magnetic, or chemical. This method is used in various diseases, such as stroke, Parkinson's, Alzheimer's, and amyotrophic lateral sclerosis (ALS). Multiple sclerosis (MS) is no exception in this regard and methods including the neurofeedback and transcranial magnetic stimulation (TMS) are used to treat various complications of the MS. One aspect of neuromodulation is the use of neural implant, which is applied nowadays, especially in the Parkinson's disease, and the use of microchips and prostheses to treat various symptoms in different neurological diseases has received significant attention. Although neural implant has been exploited to improve the symptoms of MS, they appear to have much greater potential to improve the condition of patients with MS. It seems that more attention to the symptoms of MS, on the one hand, and a new approach to the pathogenesis of this disease and considering it as a connectomopathy, on the other hand, can provide new opportunities for application of this method in the treatment of MS.