Functional treatments in multiple sclerosis

Courtney, Ardith; Castro-Borrero, Wanda; Davis, Scott L.; Frohman, Teresa C.; Frohman, Elliot M.

doi:10.1097/wco.0b013e328346055a

Cited by 26 publications

(15 citation statements)

References 29 publications

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“…Despite significant advances in immunomodulatory therapy, repair of existing nerve injuries is still not possible [1]. Clinical findings of the disease include fatigue, muscle spasticity, general body pain, cognitive dysfunction, depression, bladder, bowel and sexual dysfunction with a great impact on quality of life (QoL) [1][2][3]. Lower urinary tract symptoms (LUTS) are common disorders occurring in about 80 % of patients with MS [4,5].…”

Section: Introductionmentioning

confidence: 99%

“…These voiding difficulties have been shown to be related to a hypotonic and/or atonic detrusor, as well as a lack of coordination between the detrusor and urethral sphincter during voiding, also termed detrusor-sphincter dyssynergia (DSD) which often coexists with detrusor overactivity (DO) [4]. In view of the high intravesical pressure, chronic urinary retention and recurrent urinary tract infections (UTIs) are experienced by these patients, and upper urinary tract complications such as renal failure, pyelonephritis, hydronephrosis, and bladder and kidney stones have been described in 5 -10 % of patients with MS [3,7]. Further results have shown that if the DSD and chronic urinary retention are not treated, up to 50 % of patients with MS might develop the above complications [8,9].…”

Section: Introductionmentioning

confidence: 99%

“…Further results have shown that if the DSD and chronic urinary retention are not treated, up to 50 % of patients with MS might develop the above complications [8,9]. Therefore, a detailed assessment of bowel, bladder and sexual function in MS patients is mandatory in order to prevent complications and subsequent morbidities as well as to improve their QoL [1,3].…”

Section: Introductionmentioning

confidence: 99%

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Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis

et al. 2015

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“…10,11 In patients suffering from Parkinson's disease developing severe constipation, TAI has been shown to reduce constipation symptoms. 12 Evacuation disorders and incontinence may also arise after surgery for rectal cancer probably because of the loss of rectal capacity following resection, as well as possible impairment of the anorectal reflexes controlling continence. 13 TAI can improve both faecal incontinence and defecation disorders in this group.…”

Section: Introductionmentioning

confidence: 99%

Consensus review of best practice of transanal irrigation in adults

et al. 2013

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Study design: Review article. Objectives: To provide a consensus expert review of the treatment modality for transanal irrigation (TAI). Methods: A consensus group of specialists from a range of nations and disciplines who have experience in prescribing and monitoring patients using TAI worked together assimilating both the emerging literature and rapidly accruing clinical expertise. Consensus was reached by a round table discussion process, with individual members leading the article write-up in the sections where they had particular expertise. Results: Detailed trouble-shooting tips and an algorithm of care to assist professionals with patient selection, management and follow-up was developed. Conclusion: This expert review provides a practical adjunct to training for the emerging therapeutic area of TAI. Careful patient selection, directly supervised training and sustained follow-up are key to optimise outcomes with the technique. Adopting a tailored, stepped approach to care is important in the heterogeneous patient groups to whom TAI may be applied. Sponsorship: The review was financially supported by Coloplast A/S.

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“…Management of symptoms like pain, spasticity, or urinary symptoms can greatly increase a patient's quality of life and allow the patient to participate in physical therapy and regain functional independence more quickly [79][80][81][82]. A number of detailed reviews of symptom management strategies in patients with MS have been published and are worthy of study [83][84][85]. Physical and occupational therapy serve as important tools in expediting a patient's recovery after an attack and maintaining optimal functional status [86].…”

Section: Severe Relapses: Symptom Management and Rehabilitationmentioning

confidence: 99%

Therapeutic Management of Severe Relapses in Multiple Sclerosis

Bevan

Gelfand

2015

Curr Treat Options Neurol

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While not all multiple sclerosis (MS) relapses require treatment, relapses that are bothersome or that impair function should prompt consideration of timely treatment to restore function and minimize disability. Patients with suspected MS relapses should be evaluated to confirm the diagnosis, exclude other causes of neurological dysfunction, and identify potential triggers for relapse or pseudo-relapse, such as urinary tract infections, fever, or metabolic derangements. The diagnosis of an MS relapse is clinical, but MRI may be useful for confirmation and to evaluate for multifocal disease activity. High-dose oral or intravenous glucocorticoids, with or without an oral taper, are first-line therapy for MS relapses. Adrenocorticotropic hormone (ACTH) provides an alternative to glucocorticoid treatment but is currently much more expensive and does not have proven superiority. If the acute neurological deficits remain severe after steroid treatment, and particularly if there is persistent abnormal contrast-enhancement of the symptomatic lesion on repeat MRI, plasma exchange (PLEX) should be considered as an acute rescue therapy for relapse. In exceptional cases, particularly fulminant or tumefactive disease that fails to improve following treatment with steroids and PLEX, cytoxic agents such as cyclophosphamide or B cell-depleting regimens such as rituximab may be considered, although risk must be carefully weighed and the kinetics of such regimens indicate that they probably serve more to accelerate remission of disease activity than as an immediate relapse remedy. A single dose of natalizumab given as acute therapy for MS relapse was shown not to improve clinical outcomes in a randomized controlled trial. Attention to symptom management and promotion of neurorehabilitation are important aspects of MS relapse care. Neuroprotective and neuroreparative therapies remain under investigation, but are likely to become important complementary elements of relapse therapy in the future. Relapses serve as important indicators of MS disease activity. In the context of the emerging treatment paradigm of targeting freedom from evidence of MS disease activity, relapses should prompt consideration of transitioning to a disease-modifying treatment that may offer better efficacy.

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Functional treatments in multiple sclerosis

Cited by 26 publications

References 29 publications

Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis

Sacral neuromodulation: an effective treatment for lower urinary tract symptoms in multiple sclerosis

Consensus review of best practice of transanal irrigation in adults

Therapeutic Management of Severe Relapses in Multiple Sclerosis

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