“An increasing number of MSers under my care with poor and intractable bladder problems are finding that posterior tibial nerve stimulation (PTNS) helpful. This treatment is not a panacea for bladder dysfunction, but helps reduce symptoms. How does it work? I wish I knew. I suspect it modulates neuronal pathways that control the bladder in a similar way that TENS (transcutaneous electrical nerve stimulation) works for pain. This is the so called gating mechanism. The treatment also works in fecal incontinence, which cannot be overlooked. PTNS is generally a low-risk procedure, with the most common side-effects due to the placement of the needle electrode. These include minor bleeding, pain and some skin irritation. The study below is in keeping with the published literature.”
“Please note that bladder problems in MSers are very common and often an indicator symptom of spinal cord damage. The reason why the bladder is so frequently involved in MS is due to the fact that the neuronal pathways that control bladder function are quite long and hence more likely to be affected with time.”
“Bladder dysfunction is another example of end-organ damage; this is usually the spinal cord. Wouldn’t it be wonderful if we could prevent MSers developing bladder dysfunction? One way would be for neurologists and healthcare systems to adopt early treat-2-target paradigm of NEDA. The latter is the best way to prevent early damage.”
“PTNS is a treatment for MSers that I need to be add to my tube map.”
Epub: Zecca et al. Motor and sensory responses after percutaneous tibial nerve stimulation in multiple sclerosis patients with lower urinary tract symptoms treated in daily practice. Eur J Neurol. 2014 Jan. doi: 10.1111/ene.12339.
BACKGROUND AND PURPOSE: Posterior tibial nerve stimulation (PTNS) is an effective treatment option for lower urinary tract symptoms (LUTS) in MSers.
METHODS: MSers and LUTS unresponsive to medical treatment received PTNS for 12 weeks after saline urodynamics to evaluate the prevalence of motor, sensory and combined responses during PTNS and to determine whether the type of response can predict treatment outcome. LUTS were also assessed using a 3-day bladder diary, patient perception of bladder condition (PPBC) questionnaire, patient perception of intensity of urgency scale (PPIUS), Kings Health QOL questionnaire (KHQ) and Overactive Bladder Questionnaire (OAB-q) before and after treatment. MSers were considered as “responders” if they reported an improvement >50% in their LUTS according to the PPBC. Sensory, motor and combined sensory/motor responses were compared between responders and non-responders.
RESULTS: Eighty-three MSers were included. 61% (51/83) of patients were responders. Sensory, motor and combined sensory/motor responses were found in 64% (53/83), 6% (5/83) and 30% (25/83) of patients respectively. A sensory response alone, or in combination with a motor response, was better associated with a successful outcome than the presence of a motor response alone (P = 0.001).
CONCLUSIONS: A sensory response, either alone or in combination with a motor response, is more frequent and seems to be better associated with a successful outcome of PTNS than motor response alone.