The aim of the present study was to describe co-activity patterns of the striated urethral wall muscle and the pelvic floor muscles (PFM) during contraction of outer pelvic muscles. Six healthy nulliparous physical education students, mean age 19.5 years (19-21) participated in the study. Concentric needle EMG and a Dantec amplifier were used for registrations. EMG activity was continuously recorded with the participants lying in a supine position. EMG was recorded during relaxation, contraction of the PFM, valsalva maneuver, coughing, hip adductor contraction, gluteal muscle contraction, backward tilting of the pelvis, and sit-ups. The procedure was performed with the needle in the striated muscle of the anterior wall of the urethra and then repeated with the needle set lateral to the urethra in the PFM. The results showed that the striated urethral wall muscle was contracted synergistically during PFM, hip adductor, and gluteal muscle contraction, but not during abdominal contraction. Both hip adduction, gluteal muscle, and abdominal muscle contraction gave synergistic contraction of the PFM. Thus the urethral wall striated muscle and the PFM react differently during abdominal contraction.

In this Danish‐Norwegian randomized double‐blind parallel‐group multicentre study, we compared the therapeutic response of slow‐release Madopar HBS® to standard Madopar® in 134 de novo patients with idiopathic Parkinson's disease during a 5‐year period. The drugs were dosed according to the individual need of the patients. The Webster, NUDS, UPDRS and Hoehn & Yahr scales were used for evaluation of symptoms. Addition of a morning dose of standard Madopar 62.5 mg was allowed after 6 months. Bromocriptine could be administered but not Selegiline. Sixty‐five patients got Madopar HBS and 69 standard Madopar. Surprisingly, no differences were found as to the mean daily levodopa dose, the mean number of daily doses or the use of and doses of bromocriptine. Unexpectedly, we found a trend towards a more frequent use of a morning dose of standard Madopar in the group treated with the standard formulation. No differences were observed in the occurrence of motor fluctuations or dyskinesia, the incidence of which was relatively low. Sustained‐release Madopar (HBS) thus proved to be as effective as standard Madopar in the long‐term treatment of de novo parkinsonian patients, but the drug showed no advantage in postponing or reducing the long‐term levodopa treatment problems.

The anti-spastic effect of a new drug, tizanidine, was compared with that of baclofen in a double-blind clinical trial; 40 seriously handicapped patients with multiple sclerosis (MS) were randomly allocated treatment with one or the other drug for a 6-week period. The antispastic effect was evaluated by clinical criteria. The optimal daily dose of both drugs varied considerably from patient to patient, and was on the average 23 mg for Tizanidin and 59 mg for baclofen. To the extent an antispastic effect was observed, the 2 drugs appeared to be equally effective when given at a 1:2 ratio (mg tizanidine: mg baclofen). Side effects of both drugs were sleepiness, muscular weakness and dry mouth. Tizanidine had a mild depressive effect on blood pressure. Sudden withdrawal of both drugs was accompanied by a transient relative increase of spasticity in approximately half the patients. There were no other changes suggesting physical or psychological dependence. The present study underscores that neither baclofen nor tizanidine are ideal antispastic drugs, and emphasize the need for further research.

Authors from Oslo report the difficult problem of urinary incontinence after a stroke, with impaired awareness of the need to void. In this interesting paper they compared it to urge urinary incontinence, and felt that it probably reflects greater brain damage. They also found that there were various urodynamic patterns associated with the condition. OBJECTIVE To describe a clinical subtype of urinary incontinence (UI) after a stroke, i.e. with impaired awareness of the need to void (IA‐UI), and to compare it to urge UI after a stroke for the risk factors and medium‐term outcome. PATIENTS AND METHODS In a consecutive sample of 315 hospitalized stroke patients who were clinically stable and able to communicate, 65 with UI were identified (27 urge UI, 38 IA‐UI). All had a comprehensive clinical assessment and cerebral computed tomography (CT). Cysto‐urethrometry was performed in seven patients with IA‐UI. RESULTS Of the 38 patients with IA‐UI, 16 were partially aware of leakage, but not of bladder fullness; the remaining 22 denied leakage. Patients with IA‐UI were more functionally impaired (P = 0.001), had more visible new CT lesions (24 of 38 vs 10 of 27, P = 0.04) and less frontal lobe involvement (seven of 24 vs seven of 10, P = 0.05) than those with urge UI. Ten of 12 patients with parietal lobe involvement denied leakage; no particular lesion pattern was found in those with partial awareness. Two patients had normal cysto‐urethrometry, four showed terminal detrusor overactivity, and one had an incompetent urethral closure mechanism. In all, bladder sensation was reduced or absent. Only two of the surviving patients had regained continence after 1 year, whereas half of those with urge UI had become continent. CONCLUSION IA‐UI after a stroke differs from urge UI in clinical and prognostic respects, and probably reflects greater brain damage. It might explain the prognostic importance of stroke‐related UI. There are various urodynamic patterns. Patients with better preserved insight might benefit from early awareness training and even from additional medical treatment if bladder overactivity is present; this needs further investigation.