Dorsal Column Stimulation in Multiple Sclerosis: Effects on Bladder, Leg Blood Flow and Peptides

Abstract

9 patients with bladder disorder secondary to multiple sclerosis (MS) were treated by dorsal column stimulation (DCS). Detailed urodynamic tests were performed and leg blood flow was assessed on repeated occasions. Cerebrospinal fluid (CSF) met-enkephalin levels were estimated before and during DCS. The chief effect of DCS was improved urinary flow associated with reduced sphincter tone and lessened detrusor instability maximal at the 6th or 7th day of continuous stimulation. Considerable fluctuation in leg blood flow occurred unrelated to activation of the stimulator. No obvious change in CSF met-enkephalin levels took place, but it is suspected that the mode of action of DCS in via certain peptide hormones.

Management of lower urinary tract dysfunction in multiple sclerosis: A systematic review and Turkish consensus report

“…Open‐label epidural continuous spinal cord stimulation, intravaginal electrical, and epidural dorsal column stimulation trials in small numbers of patients with MS and NDO demonstrated some symptomatic improvements of various degrees, but long‐term results were not satisfactory . Another study compared transcutaneous electrical nerve stimulation and epidural spinal cord stimulation and concluded that transcutaneous electrical stimulation might predict the success of cord stimulation…”

Electrical Stimulation in Multiple Sclerosis

“…[7] observed improvement in urinary function in 14 of 19 patients postoperatively. Even in a later report [6], they state that 'significant improvement in flow rate and urethral sphincter pressure was recorded in about two thirds' of 15 patients.…”

Neuromodulation: Spinal cord and peripheral nerve stimulation

“…Although Tonelli et al [12] observed increases in ␤-endorphin and ␤-lipotropin in the cerebrospinal fluid (CSF) after SCS, it did not occur in all patients. Other studies have shown that levels of endogenous opioids in the CSF were not increased by stimulation of the spinal cord [13]. There is some experimental evidence that substance P and serotonin may be involved.…”

“…There are nine percutaneous electrodes and nine plate-type electrodes approved for epidural implantation. The electrodes differ in contacts available for stimulation (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16), contact length (range of 3 to 6 mm), contact spacing (6 to 12 mm), and contact configuration (6). Electrodes with four contacts in a series enable 65 anode-cathode combinations including monopolar combinations [23].…”