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Campetella M, Marino F, Gavi F, Gandi C, Ragonese M, Coluzzi S, Racioppi M, Sacco E, Bientinesi R. Classification and management of sexual dysfunctions in multiple sclerosis patients: A review of current literature. Urologia 2023; 90:605-610. [PMID: 37387303 DOI: 10.1177/03915603231183751] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Multiple sclerosis (MS) is the most frequent neurological disease in young adults, with the greatest incidence between age of 30 and 35 years. Sexual dysfunctions (SDs) are frequent, but are often underestimated in patients with MS, and can have a significantly high impact on patient's quality of life. Aim of this review is to summarize sexual dysfunctions in male and female MS patients and to illustrate current and emerging therapeutic options for treatment.
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Affiliation(s)
- Marco Campetella
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Filippo Marino
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Filippo Gavi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Carlo Gandi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Mauro Ragonese
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Simone Coluzzi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Marco Racioppi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Emilio Sacco
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Riccardo Bientinesi
- Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
- Università Cattolica del Sacro Cuore, Roma, Italy
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Afshar B, Amini L, Hasani M, Jahanfar S, Massood Nabavi S. The most effective sexual function and dysfunction interventions in individuals with multiple sclerosis: A systematic review and meta-analysis. Int J Reprod Biomed 2022; 20:241-254. [PMID: 35822180 PMCID: PMC9260072 DOI: 10.18502/ijrm.v20i4.10897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 06/09/2021] [Accepted: 10/06/2021] [Indexed: 11/24/2022] Open
Abstract
Background Sexual dysfunction has many factors in multiple sclerosis, but there is no reliable treatment for this challenge. Objective Determining effective sexual function or dysfunction interventions in individuals with multiple sclerosis. Materials and Methods To find the relevant published interventional studies that at least had an English abstract or in Persian, we searched International Statistical Institute, PubMed, Scopus, Cochrane, Medline, PsycINFO, EMBASE, CINAHL, and Google Scholar from January 1990 to June 2021. The results were analyzed using RevMan 5.3 software. The p < 0.05 was considered significant. Results Out of 568 articles, 41 were included after deleting the duplicate and irrelevant articles. Studies were divided into 2 groups of sexual function (n = 27) and dysfunction (n = 14). Interventions in each category have 4 subgroups: psychoeducational, exercise and rehabilitation, and medical and multi-type interventions. For improving sexual function, more than half of psychoeducational interventions showed a significant improvement after interventions (p = 0.0003). In sexual dysfunction studies, most of the interventions (n = 13/14) had improved at least one subscale of sexual dysfunction. Medical interventions were effective on men's sexual dysfunction, and psychoeducational interventions had been more effective in women's sexual dysfunction. Conclusion Psychoeducational and medical interventions are the commonest effective interventions. The psychoeducational studies conducted specifically on women had a positive impact, and only 4 articles with medical interventions were specifically targeted at men, which had a positive effect.
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Affiliation(s)
- Bahare Afshar
- Student Research Committee, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Amini
- Nursing Care Research Center (NCRC), Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Hasani
- Department of Midwifery, School of Nursing and Midwifery, Lorestan University of Medical Sciences, Khoramabad, Iran
| | - Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, USA
| | - Seyed Massood Nabavi
- Department of Regenerative Biomedicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Department of Brain and Cognitive Sciences, Cell Science Research Center, Royan Institute for Stem Cell, Tehran, Iran
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Prevalence of dysphagia in a consecutive cohort of subjects with MS using fibre-optic endoscopy. Neurol Sci 2019; 41:1075-1079. [DOI: 10.1007/s10072-019-04198-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023]
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Bernardes D, Oliveira ALR. Comprehensive catwalk gait analysis in a chronic model of multiple sclerosis subjected to treadmill exercise training. BMC Neurol 2017; 17:160. [PMID: 28830377 PMCID: PMC5568395 DOI: 10.1186/s12883-017-0941-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 08/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a demyelinating disease with a wide range of symptoms including walking impairment and neuropathic pain mainly represented by mechanical allodynia. Noteworthy, exercise preconditioning may affect both walking impairment and mechanical allodynia. Most of MS symptoms can be reproduced in the animal model named experimental autoimmune encephalomyelitis (EAE). Usually, neurological deficits of EAE are recorded using a clinical scale based on the development of disease severity that characterizes tail and limb paralysis. Following paralysis recovery, subtle motor alterations and even mechanical allodynia investigation are difficult to record, representing sequels of peak disease. The aim of the present study was to investigate the walking dysfunction by the catwalk system (CT) in exercised and non-exercised C57BL/6 mice submitted to EAE with MOG35-55 up to 42 days post-induction (dpi). METHODS Twenty-four C57BL/6 female mice were randomly assigned to unexercised (n = 12) or exercised (n = 12) groups. The MOG35-55 induced EAE model has been performed at the beginning of the fifth week of the physical exercise training protocol. In order to characterize the gait parameters, we used the CT system software version XT 10.1 (Noldus Inc., The Netherlands) from a basal time point (before induction) to 42 days post induction (dpi). Statistical analyses were performed with GraphPad Prisma 4.0 software. RESULTS Data show dynamic gait changes in EAE mice including differential front (FP) and hind paw (HP) contact latency. Such findings are hypothesized as related to an attempt to maintain balance and posture similar to what has been observed in patients with MS. Importantly, pre-exercised mice show differences in the mentioned gait compensation, particularly at the propulsion sub-phase of HP stand. Besides, we observed reduced intensity of the paw prints as well as reduced print area in EAE subjects, suggestive of a development of chronic mechanical allodynia in spite of being previously exercised. CONCLUSIONS Our data suggest that Catwalk system is a useful tool to investigate subtle motor impairment and mechanical allodynia at chronic time points of the EAE model, improving the functional investigation of gait abnormalities and demyelination sequelae.
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Affiliation(s)
- Danielle Bernardes
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Rua Monteiro Lobato, 255, Campinas, Sao Paulo 13.083-862 Brazil
| | - Alexandre Leite Rodrigues Oliveira
- Department of Structural and Functional Biology, Institute of Biology, University of Campinas, Rua Monteiro Lobato, 255, Campinas, Sao Paulo 13.083-862 Brazil
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The effectiveness of the Permission, Limited Information, Specific suggestions, Intensive Therapy (PLISSIT) model based sexual counseling on the sexual function of women with Multiple Sclerosis who are sexually active. Mult Scler Relat Disord 2016; 8:113-9. [PMID: 27456885 DOI: 10.1016/j.msard.2016.05.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 04/27/2016] [Accepted: 05/08/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study was conducted to evaluate the effectiveness of sexual counseling based on the Permission, Limited Information, Specific Suggestion, Intensive Therapy (PLISSIT) model on the Sexual Dysfunction (SD) of married sexually active women who suffer from Multiple Sclerosis (MS). This is the first sexual intervention applied by a midwife as a health professional on MS patients in Iran where the cultural and religious limitations are important challenging issues. STUDY DESIGN This randomized clinical trial was carried out in Iranian Community of Support for MS Patients in Tehran, Iran. The participating women who had a definite diagnosis of MS and SD, Expanded Disability Status Scale (EDSS) scores <7, and aged 18-55 years were randomly assigned to experimental (EG, n=43) and control group (CG, n=45). Participants in the EG group received 4 weekly sexual counseling sessions based on the PLISSIT model (90-120min per session). MAIN OUTCOME MEASURES Sexual function was assessed three times (before the intervention, and 2 months and 3 months after the intervention) using the Female Sexual Function Index (FSFI). Chi-square test, Fisher's exact test, and Repeated Measures ANOVA were employed to analyze the data. RESULTS The mean total FSFI score of the women in EG improved at 2 and 3 months after the intervention when it was compared with the FSFI score before the intervention (p<0.05). There was no significant difference in the total FSFI score when the data of 3 evaluations was compared in CG. A significant increase in the mean score of 6 subgroups was seen in EG (p<0.05) but not in CG. CONCLUSION According to this study, utilizing the PLISSIT model as a framework for sexual counseling can improve sexual function in women who are sexually active and suffer from SD due to MS.
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Pintér A, Cseh D, Sárközi A, Illigens BM, Siepmann T. Autonomic Dysregulation in Multiple Sclerosis. Int J Mol Sci 2015; 16:16920-52. [PMID: 26213927 PMCID: PMC4581177 DOI: 10.3390/ijms160816920] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 07/13/2015] [Accepted: 07/20/2015] [Indexed: 02/07/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic, progressive central neurological disease characterized by inflammation and demyelination. In patients with MS, dysregulation of the autonomic nervous system may present with various clinical symptoms including sweating abnormalities, urinary dysfunction, orthostatic dysregulation, gastrointestinal symptoms, and sexual dysfunction. These autonomic disturbances reduce the quality of life of affected patients and constitute a clinical challenge to the physician due to variability of clinical presentation and inconsistent data on diagnosis and treatment. Early diagnosis and initiation of individualized interdisciplinary and multimodal strategies is beneficial in the management of autonomic dysfunction in MS. This review summarizes the current literature on the most prevalent aspects of autonomic dysfunction in MS and provides reference to underlying pathophysiological mechanisms as well as means of diagnosis and treatment.
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Affiliation(s)
- Alexandra Pintér
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
| | - Domonkos Cseh
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Adrienn Sárközi
- Institute of Human Physiology and Clinical Experimental Research, Faculty of Medicine, Semmelweis University, Budapest 1085, Hungary.
| | - Ben M Illigens
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Timo Siepmann
- Center for Clinical Research and Management Education, Division of Health Care Sciences, Dresden International University, Dresden 01067, Germany.
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
- Department of Psychotherapy and Psychosomatic Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden 01307, Germany.
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Fazil PA, Ali SM, Zaboli M, Shah SR. Multiple Sclerosis Like Condition in a Patient of Hepatitis C after Treatment with Interferon Alpha: A Case Report. J Clin Diagn Res 2015; 9:OD14-5. [PMID: 26155513 DOI: 10.7860/jcdr/2015/12588.5962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 03/29/2015] [Indexed: 11/24/2022]
Abstract
Hepatitis C virus affects millions of people around the world. The primary therapy comprises of interferon alpha and ribavarin. The most common side effects of this treatment include flu like symptoms and psychiatric issues. One of the rare complications of the combined therapy is the development of demyelinating lesions in the central nervous system. Our case report presents a 35-year-old man who was a known case of Hepatitis C presenting to us with altered level of consciousness and decreased vision. He had been treated as per the standard therapy for Hepatitis C infection with interferon alpha and ribavarin. During the course of this therapy, he developed significant loss of vision. This was in fact due to serious and rare complication of the treatment which was demonstrated on the MRI as demyelinating lesions in the deep periventricular white matter bilaterally. Visual Evoked Potential study was performed which concluded bilateral dysfunction of the optic pathway. The treatment of Hepatitis C with interferon alpha and ribavarin may present with a wide array of adverse effects which includes a rare complication of central nervous system demyelination as well. Research suggests that early treatment of Multiple Sclerosis (MS) is beneficial in the long run with a better prognosis and minimal changes on MRI of the patient. Therefore this complication of the treatment should be kept in mind as one of the main differential diagnosis. By finding the extent of the inflammation, and consequently doing an MRI alongside a lumbar puncture, can serve to diagnose a rare condition mimicking multiple sclerosis while treating with interferon alpha.
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Affiliation(s)
- Pyar Ali Fazil
- Associate Professor, Department of Medicine, Dow University of Health Sciences (DUHS) , Karachi, Pakistan
| | - Syed Mustafa Ali
- House Officer, Department of Medicine, Dow University of Health Sciences (DUHS) , Karachi, Pakistan
| | - Mustafa Zaboli
- House Officer, Department of Medicine, Dow University of Health Sciences (DUHS) , Karachi, Pakistan
| | - Syed Raza Shah
- Medical Student, Department of Medicine, Dow University of Health Sciences (DUHS) , Karachi, Pakistan
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ShayestehAzar M, Kariminasab MH, Saravi MS, Abedini M, Fazli M, Hashemi SA, Abdizadeh P. A Survey of Severity and Distribution of Musculoskeletal Pain in Multiple Sclerosis Patients; a Cross-Sectional Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2015; 3:114-8. [PMID: 26110178 PMCID: PMC4468621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 02/01/2015] [Indexed: 11/02/2022]
Abstract
BACKGROUND Pain, a common phenomenon in multiple sclerosis (MS) patients, is associated with many symptoms and problems. AIM To investigation severity and distribution of musculoskeletal pain in MS patients. METHODS In this cross-sectional study, 115 members of the Mazandaran MS Association with confirmed MS were randomly selected to participate in the study. The patients were asked to fill out Numerical Rating Score and Nodric questionnaires, respectively. The data was analyzed by SPSS ver. 16 software. RESULTS The mean age of the participants was 30.43±5.86 years and 88 cases (76.5%) were female. The mean disease duration was 26.34±24.32 months and 87.8% of the cases were experiencing pain at the time of study. The mean pain severity was 3.75±2.25 and worst pain experienced was 5.73±2.12. The most common pain sites were: the knees (55.7%), wrist (43.5%), and neck (41.7%). Women experience higher prevalence of shoulder, upper back, and ankle pain (P<0.05). In 62 cases (53.91%) MS interfered with daily functioning at least for a time. The prevalence of upper back and neck pain was higher in cases with a shorter disease duration (P<0.05). CONCLUSIONS Pain was very common in patients with MS and not relevant to sex or age. In the majority of the cases more than 1 limb was involved and the prevalence of pain in the lower limbs was higher, especially in the knees. In females, the prevalence of pain in the shoulders, upper back, and ankle was higher compared to males. Also, neck and upper-back pain were found in the early stages of the disease.
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Prévinaire J, Lecourt G, Soler J, Denys P. Sexual disorders in men with multiple sclerosis: Evaluation and management. Ann Phys Rehabil Med 2014; 57:329-336. [DOI: 10.1016/j.rehab.2014.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 10/25/2022]
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Tanasescu R, Constantinescu CS. Pharmacokinetic evaluation of nabiximols for the treatment of multiple sclerosis pain. Expert Opin Drug Metab Toxicol 2013; 9:1219-28. [PMID: 23621668 DOI: 10.1517/17425255.2013.795542] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Pain associated with multiple sclerosis (MS) is frequent, and frequently not alleviated by currently available drugs. Nabiximols is a combination of two plant cannabinoids administered via an oromucosal pump spray and approved in Canada for the treatment of intractable central neuropathic pain due to MS and intractable cancer pain. Nabiximols exerts its analgesic effects through its interaction with the endocannabinoid system to modulate pain transmission via pain networks. AREAS COVERED This review examines the characteristics of nabiximols, its pharmacokinetic properties and data on efficacy and tolerability in MS-related neuropathic pain. The authors, furthermore, provide information on the pharmacology and clinical data of nabiximols as neuropathic analgesic in MS. EXPERT OPINION Nabiximols is an appropriate therapy for pain patients who tend to be particularly resistant to pharmacological interventions. Its action depends on not only the local constellation of the endocannabinoid system signalling, but also the particular functional status of pain pathways and on the specific mechanism of neuropathic pain. It is therefore justifiable that further studies are initiated which aim to define the best responder profile and which explore the full potential of nabiximols in MS-related pain.
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Affiliation(s)
- Radu Tanasescu
- University of Nottingham, Academic Division of Clinical Neurology, Queen's Medical Centre, Nottingham, UK. b
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Adamec I, Bach I, Barušić AK, Mišmaš A, Habek M. Assessment of prevalence and pathological response to orthostatic provocation in patients with multiple sclerosis. J Neurol Sci 2012; 324:80-3. [PMID: 23127354 DOI: 10.1016/j.jns.2012.10.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 09/15/2012] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of pathologic response to orthostatic challenge in patients with relapsing remitting multiple sclerosis (RRMS) and the difference of the response in patients in relapse and remission. PATIENTS AND METHODS We included 112 RRMS patients; group 1 included 53 patients in a relapse and group 2, 59 patients in remission. The head up tilt table test was used to provoke an orthostatic reaction. RESULTS 71 (63%) patients (60.4% and 66% of relapse and remission subjects respectively) had a pathological response to orthostatic provocation. Syncope was found in 9 (17%) patients in group 1 compared to 22 (37.3%) in group 2 (p=0.014). Postural orthostatic tachycardia syndrome (POTS) was found in 17 (32%) patients in group 1 compared to 4 (6.8%) in group 2 (p=0.001). There was a significantly negative correlation between the Expanded Disability Status Scale (EDSS) and POTS (-0.201; p=0.034) and a positive correlation between the EDSS and syncope (0.190; p=0.044). CONCLUSION The prevalence of distinct types of orthostatic autonomic dysfunction in different phases of RRMS seems to be in direct correlation with the EDSS. Furthermore, certain autonomic dysfunctions of orthostasis, more specifically syncope and POTS, tend to be increased in remission and relapse respectively.
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Affiliation(s)
- Ivan Adamec
- University Hospital Center Zagreb, Department of Neurology, Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia
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