Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0677481 (urinary frequency)
 1,126 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A Japanese woman, aged 42, was admitted because of paroxysmal attacks consisting of paresthesia of the left face, tremor in the right hand, epigastric pain and urinary incontinence. A year prior to the admission, she noticed some difficulty in writing, dysarthria and unsteadiness of walking. These symptoms had been persistent since then. At the end of March, 1991, these symptoms rapidly worsened, and she fell down frequently. She also experienced pain behind both eyes, numbness in her left fingers and toe, urinary frequency and the above-mentioned attacks. Neurological examination disclosed bilateral internuclear ophthalmoplegia and upbeating nystagmus on upward gaze, titubation in the head, scanning speech, dysmetria in all limbs, exaggerated reflexes in jaw and both legs, bilateral extensor plantar reflexes and ankle clonus. SEP showed delayed cortical response with stimulation of the median nerves bilaterally and of the right posterior tibial nerve. P40 was absent with the left posterior tibial nerve stimulation. VEP was normal. T2-weighted image of MRI showed multiple high intensity areas located around the third ventricle, crus cerebri and the right upper part of the pons. The diagnosis of multiple sclerosis was made. Each paroxysmal attack started with numbness in the left face and burning sensation in the neck. Almost simultaneously tremor in the right hand began. The surface EMG showed the rhythmic contractions in the dorsal hand muscles and wrist extensors at a frequency of 6-7 Hz, and sometimes it revealed synchronized contractions of finger flexors and the dorsal hand muscles. A few seconds later she felt painful sensation in the epigastric region, and the tremor gradually increased in its intensity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of multiple sclerosis with paroxysmal attacks of facial paresthesia, unilateral hand tremor, epigastric pain and urinary incontinence]. 162 36

A hundred patients with multiple sclerosis and urinary disorders were examined clinically and by gas or water cystometry. Particular attention was paid to abnormalities in the voiding need sensation. These abnormalities can best be studied by cystometry combined with urethral striated sphincter electromyography. When the sequence of the three degrees of need (usual need, pressing need and urgent need) is respected, there is a good correlation between the progression of the voiding need during the filling phase of the cystometry and during the detrusor action. When there is interference with the sequence of these three degrees of the voiding need, especially the absence of the sensation normally contemporaneous with the detrusor action or immediately preceding it, there is exaggeration of either the hyperactivity or the hypoactivity of the bladder, and this aggravates vesical sensitivity: premature contraction of the detrusor muscle eliminates the first two degrees (usual need and pressing need), while progressive distension of the detrusor muscle eliminates all three stages. As the multiple sclerosis evolves a stage is reached at which there are functional mictional disorders exclusively connected with the interference with the degrees of voiding need pollakiuria and urgency.
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PMID:[Abnormalities of the sensation of the need to urinate in multiple sclerosis. Clinical and urodynamic study. Apropos of 100 cases]. 398 70

Comprehensive treatment, including pharmacotherapy, rehabilitation, psychotherapy and ultrasound stimulation of the lymphatic system by the method of Seltzer is given to multiple sclerosis patients at the hospital department for these patients. In the first year of treatment three courses of ultrasound sessions are given with 24 sessions in each course, in the second year two such courses are given, and in the following years one course is given yearly. The present material comprised 45 patients after 7 or 8 courses of treatment in the hospital. The neurological status of each patient was evaluated before the first course and after the last one using a score scale containing the most important clinical parameters. Is was found that these therapeutic methods had only a negligible effect on paresis of the extremities, but it seems that they influenced favourably eye signs, particularly nystagmus, and cerebellar tremor. The greatest improvement was obtained in sphincter disturbances, especially in pollakiuria and urinary incontinence. The effect of ultrasound alone on the obtained results could not have been assessed. Investigations would be necessary for this purpose which are not done in this hospital.
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PMID:[Complex treatment of patients with multiple sclerosis]. 664 25

In eleven patients with acute disseminated encephalomyelitis (ADEM), micturitional histories taken during the acute stage revealed that nine were in a state of urinary retention, and the other two had urinary frequency and urge incontinence together with difficulty in voiding. After the follow-up period of 3 to 38 months seven of nine patients with retention became able to urinate, but five of them had difficulty in voiding and four of them developed urinary frequency or urge incontinence. Two patients had urinary retention even after 26 and 38 months from the onset. Ten patients underwent urodynamic studies and disclosed detrusor hyperreflexia in six, low compliance bladder in two, atonic cystometrogram in one and detrusor-sphincter dyssynergia in two patients. Motor unit analysis of the external sphincter revealed polyphasic neurogenic changes is one of four patients. The results were compared with our previous findings in multiple sclerosis (MS), and we found that micturitional disturbance in ADEM seemed to be as common and as severe as in MS. Supranuclear as well as nuclear types of pelvic and pudendal nerve dysfunction seemed to be responsible for micturitional disturbance in our patients with ADEM. Micturitional disturbance seemed to be related to the pyramidal tract involvement, and probably reflecting the severity of spinal cord lesions.
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PMID:Micturitional disturbance in acute disseminated encephalomyelitis (ADEM). 891 71

The aim of this study was to investigate the efficacy and tolerance of capsaicin, a neurotoxin for C-fiber afferents, applied intravesically in the treatment of detrusor hyperreflexia. Eleven male and nine female patients who had spinal cord lesions caused by multiple sclerosis (12) or trauma (eight) resulting in detrusor hyperreflexia with urge incontinence and pollakiuria were randomized to receive one intravesical instillation of either 30 mg capsaicin in 100 ml 30% ethanol or 100 ml 30% ethanol alone. The patients were evaluated clinically (voiding diary) and urodynamically (maximum cystometric capacity, maximum detrusor pressure, first and normal desire to void) before and 30 days after the instillation. On day 30, the 10 patients who received capsaicin had significant decreases in 24-h voiding frequency from 9.3+/-6.1 to 6.7+/-3.8 (P=0.016) and leakages from 3.9+/-1.6 to 0.6+/-0.8 (P=0.0008); their maximum cystometric capacity increased from 169+/-68 to 299+/-96 ml (P=0.01) and maximum detrusor pressure decreased from 77+/-24 to 53+/-27 cm H2O. There were no significant changes in the control group. In seven subjects in each group, instillation triggered immediate side effects (suprapubic pain, sensory urgency, flushes, hematuria, autonomic hyperreflexia) that resolved within 2 weeks. Intravesical capsaicin significantly improves clinical and urodynamic parameters of detrusor hyperreflexia in spinal cord-injured patients. Side effects are frequent, tolerable, and identical to those induced by 30% ethanol alone.
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PMID:Capsaicin and neurogenic detrusor hyperreflexia: a double-blind placebo-controlled study in 20 patients with spinal cord lesions. 977 14

Although primarily used for treatment of stress incontinence, pelvic floor rehabilitation has been reported to have some value in the treatment of detrusor instability and urgency. In neurogenic bladder dysfunction due to Multiple Sclerosis, many authors have suggested the possible use of pelvic floor rehabilitation as a treatment modality. Therefore, we designed an open prospective trial to look at the possible role of pelvic floor rehabilitation in voiding dysfunction due to MS, concentrating upon the clinical and neurological parameters in relation to the outcome. A new scoring system for pelvic floor dysfunction is introduced. Thirty female patients were evaluated. In 25, the strength of the pelvic floor was significantly improved after one month (p < 0.001). In all patients but one the endurance score improved significantly (p < 0.001) as did the exhaustibility score (p = 0.01). The relaxation score on the other hand did not show any significant evolution despite intensive training. Cystometric findings after one month did not significantly differ from the initial cystometric findings. There was a significant increase in the mean functional bladder capacity as read from the voiding charts from 173.8 cc +/- 53.9 cc to 208.5 cc +/- 57.6 cc (p = 0.005). Also the mean urinary frequency decreased significantly from 12.7 +/- 3.6 to 9.1 +/- 2.6 (p < 0.01) as did the mean number of daily incontinent episodes from 2.8 +/- 1.3 to 1.5 +/- 1.5 (p < 0.01). Pelvic floor rehabiltation has a place in the treatment of MS patients with a low Kurtzke score and without pelvic floor spasticity.
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PMID:Pelvic floor rehabilitation in multiple sclerosis. 1021 95

The majority of patients with multiple sclerosis (MS) develop troublesome lower urinary tract symptoms (LUTS). Anecdotal reports suggest that cannabis may alleviate LUTS, and cannabinoid receptors in the bladder and nervous system are potential pharmacological targets. In an open trial we evaluated the safety, tolerability, dose range, and efficacy of two whole-plant extracts of Cannabis sativa in patients with advanced MS and refractory LUTS. Patients took extracts containing delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD; 2.5 mg of each per spray) for eight weeks followed by THC-only (2.5 mg THC per spray) for a further eight weeks, and then into a long-term extension. Assessments included urinary frequency and volume charts, incontinence pad weights, cystometry and visual analogue scales for secondary troublesome symptoms. Twenty-one patients were recruited and data from 15 were evaluated. Urinary urgency, the number and volume of incontinence episodes, frequency and nocturia all decreased significantly following treatment (P <0.05, Wilcoxon's signed rank test). However, daily total voided, catheterized and urinary incontinence pad weights also decreased significantly on both extracts. Patient self-assessment of pain, spasticity and quality of sleep improved significantly (P <0.05, Wilcoxon's signed rank test) with pain improvement continuing up to median of 35 weeks. There were few troublesome side effects, suggesting that cannabis-based medicinal extracts are a safe and effective treatment for urinary and other problems in patients with advanced MS.
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PMID:An open-label pilot study of cannabis-based extracts for bladder dysfunction in advanced multiple sclerosis. 1575 66

Urination disorders occur in 80% patients with multiple sclerosis (MS). Most common of them is detrusor-sphincter dyssynergia (DSD). Alpha1-adrenoblockers can relax the neck of the urinary bladder (UB) and urethral sphincters, thus eliminating dynamic obstruction, reducing resistance to urine flow and facilitating voiding. Our study assessed feasibility of using a selective alpha1A/D-adrenoblocker tamsulosin in MS-associated DSD. The choice of this alpha-adrenoblocker was based on its high safety profile in relation to cardiovascular system. The trial enrolled 28 patients (20 females and 8 males) with verified diagnosis of DSD. They were given tamsulosin (omnik) in a dose 0.4 mg/day (1 capsule) for 2 months. To the end of the trial quality of life raised in 96% patients. Occurrence of pollakiuria, number of imperative micturate urges diminished, the IPSS score decreased by 54%, QL index improved by 58%. There was also a decrease in the volume of the residual urine, amplitude of involuntary detrusor contractions, an increase in maximal volumic speed of urine flow, cystometric volume of the UB, mean urine volume in urination. Side effects were not registered. Thus, tamsulosin has a positive effect in voiding disorders in the presence of DSD associated with MS. This considerably improves quality of life of MS patients.
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PMID:[Tamsulosin in the treatment of detrusor-sphincter dyssynergia of the urinary bladder in patients with multiple sclerosis]. 1545 55

Chancellor MB, Anderson RU, Boone TB: Pharmacotherapy for neurogenic detrusor overactivity. Am J Phys Med Rehabil 2006;85:536-545. Patients with neurogenic detrusor overactivity are a heterogeneous group with voiding dysfunction secondary to neurologic injury or disease. The neurogenic detrusor overactivity syndrome, which may include urinary frequency, urgency, and incontinence, frequently contributes to a loss of independence, or even institutionalization. Urodynamic assessment provides the best method of quantifying and classifying neurogenic detrusor overactivity dysfunction in patients with primary diagnoses as diverse as Parkinson's disease, cerebral palsy, multiple sclerosis, spinal cord injury, and spina bifida. For many patients, management of urinary symptoms includes pharmacotherapy with an anticholinergic agent. Several novel approaches to managing neurogenic detrusor overactivity, including intravesical instillation of anticholinergic agents, vanilloids, and neurotoxins, are being investigated. For most patients, however, flexible dosing with an anticholinergic agent, with clean intermittent catheterization when indicated, has been shown to reduce the risks of urologic complications, improve levels of continence, and enhance patient quality of life in both children and adults.
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PMID:Pharmacotherapy for neurogenic detrusor overactivity. 1671 24

Multiple sclerosis (MS) is often diagnosed among women of childbearing age. This article reviews how MS affects pregnancy and provides information for health care providers who care for women with this disorder. Women with MS need to be informed regarding how the disease will affect their reproductive health. The disease itself does not usually have a negative impact on fertility or pregnancy, although some studies indicate that women with MS have a slightly increased risk for having small-for-gestational-age newborns. Some of the common MS symptoms such as fatigue, urinary frequency, constipation, and mood changes are similar to pregnancy-related symptoms. Mode of birth and anesthesia choices are similar to those for women without MS. Immunomodulatory therapy for MS needs to be discontinued before conception because most of the medications are still under investigation with regard to safety during pregnancy or have adverse effects on pregnancy. Relapse rates are increased for up to 6 months in the postpartum period. Breast feeding does not appear to increase the risk of postpartum relapses. All hormonal contraception can be used by women with MS. Some studies suggest that estrogen may have protective effects against disease progression.
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PMID:Pregnancy and multiple sclerosis. 2132 49


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