Urodynamic and Neurophysiological Evaluation in Parkinson's Disease and Multiple System Atrophy

Abstract

Aims-To determine whether Parkinson's disease and multiple system atrophy each has a distinct pattern of micturition abnormalities and whether a urodynamic evaluation could be useful in the differential diagnosis between the two diseases. Methods-Sixty two patients (30 with Parkinson's disease and 32 with multiple system atrophy) underwent a complete urodynamic evaluation and neurophysiological testing. Results-Of the parkinsonian patients 36-6% had normal micturition findings with normal bladder sensitivity; 26-7% had delayed or incomplete pelvic floor relaxation; 26-7% had hyperreflexia with vesicosphincteric synergy; and 10% had hyperreflexia with vesicosphincteric synergy associated with incomplete pelvic floor relaxation. Parkinsonian patients with a normal urodynamic pattern had significantly less severe disease and a shorter duration of disease in years than those who had abnormal patterns. Patients with hyperreflexia had significantly higher severity of disease. All the patients with multiple system atrophy had hyperreflexia with synergy. Two urodynamic patterns were identified: hyperreflexia with vesicosphincteric synergy (90-6% of patients), and hyperreflexia with vesicosphincteric synergy and incomplete pelvic floor relaxation (in 9.4%). Hyperreflexia with synergy correlated neither with the severity nor with the duration of disease. Sphincter EMG analysis showed that all the parkinsonian patients had normal sphincter EMG whereas 24 of the 32 patients with multiple system atrophy had neurogenic signs.

Bladder, Bowel, and Sexual Dysfunction in Parkinson's Disease

“…Therefore, DO can be the major contributing factor to overactive bladder in PD. There is also a correlation between DO and stage of disease [ 55 ].…”

“…Pressure-flow analysis [ 10 , 59 , 60 ] of the voiding phase in PD has shown weak detrusor activity during voiding (40% of men; 66% of women) [ 56 ]. There is a correlation between a weak detrusor and the stage of the disease [ 55 ]. A subset of PD patients had DO during storage but weak detrusor activity in voiding.…”

“…Anal function at the resting state is measured by anal manometry and analysis of the external sphincter motor unit potentials. At the resting state, the anal pressure of PD patients is low or normal [ 160 , 171 ]. The resting anal pressure may reflect sympathetic innervation in the internal anal sphincter, since lesions or anaesthetic blocks at T12-L3 (where the sympathetic PGN is located) substantially lessen the anal pressure [ 172 ].…”

“…The resting anal pressure may reflect sympathetic innervation in the internal anal sphincter, since lesions or anaesthetic blocks at T12-L3 (where the sympathetic PGN is located) substantially lessen the anal pressure [ 172 ]. Similarly, PD patients have low [ 173 ] or normal [ 160 , 171 ] anal pressure increase on squeezing. However, neurogenic changes in motor unit potentials of the external sphincter muscles occur in only 0–15% of PD patients [ 174 , 175 ].…”

Autonomic Dysfunctions in Parkinson’s Disease: Prevalence, Clinical Characteristics, Potential Diagnostic Markers, and Treatment

“…If the symptoms are caused by detrusor inactivity, it is very important to reduce or stop the use of cholinergic receptor antagonists. And levodopa is used for delayed relaxation of urethral sphincter [ 81 ]. If the above measures do not work, symptomatic treatment including urethral catheterization should be considered [ 82 ].…”