Percutaneous tibial nerve stimulation in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: a historically controlled study

Abstract

Background: Percutaneous tibial nerve stimulation (PTNS) is widely used in the treatment of neurogenic detrusor overactivity (NDO) in multiple sclerosis (MS); however, controlled studies are still lacking. Objective: To assess effectiveness of PTNS in MS patients with NDO unresponsive to pharmacological and behavioural therapies. Methods: MS patients with NDO were enrolled. Inclusion criteria were NDO not responding to pharmacological and behavioural therapies. Exclusion criteria were the presence of relevant comorbidities and urinary tract infections. Patients were evaluated using 3-day bladder diaries and validated questionnaires at baseline, after 4 weeks of educational therapy and after 12 PTNS sessions. The primary outcome measure was the percentage of patients considered responders after the behavioural therapy and after the PTNS in a historical controlled fashion (definition of ‘responder’ was reduction ⩾50% of urgency episodes). Results: A total of 33 patients (26 women, 7 men) were enrolled. Two patients dropped out for reasons not related to the protocol. Two out of 31 patients (6.5%) and 21/29 (72.4%) were considered responders at visits 1 and 2, respectively. In PTNS responders, a statistically significant improvement in both bladder diary results and standardized questionnaire scores was recorded, compared with that obtained with behavioural therapy alone. No serious adverse events were reported. Conclusion: This historically controlled study suggests that PTNS may be effective in improving NDO in MS patients.

Posterior Tibial Nerve Stimulation for the Treatment of Detrusor Overactivity in Multiple Sclerosis Patients: A Narrative Review

“…Overall, 89% of patients reported a treatment satisfaction level of at least 70% and a significant improvement in QoL questionnaires. The patients did not report adverse events [21].…”

“…A transcutaneous adhesive contact electrode is placed posteriorly to the medial malleolus on the sole of the foot on the same leg. A low-voltage (9 V) electrical stimulator is connected to both the adhesive electrode and the needle (Figure 1) [21]. Utilizing a fixed frequency of 20 Hz and a pulse width of 200 ms, the stimulation current (ranging from 0 to 10 mA) is gradually increased until a motor response concurs with either the big toe's plantar flexion or the "fan-shaped" opening of all toes.…”

“…In most cases, the motor response is accompanied by a light tingling sensation in the sole of the foot. PTNS is a minimally invasive neuromodulation technique that has demonstrated efficacy in treating patients with neurogenic DO unresponsive to conventional medical therapy [21]. Despite its proven effectiveness, the precise mechanism underlying PTNS remains incompletely understood.…”

“…These depolarized fibers probably inhibit preganglionic bladder motor neurons in the spinal cord [24]. Danisman et al reported that the mast cell population in the bladder PTNS is a minimally invasive neuromodulation technique that has demonstrated efficacy in treating patients with neurogenic DO unresponsive to conventional medical therapy [21]. Despite its proven effectiveness, the precise mechanism underlying PTNS remains incompletely understood.…”

“…Thus, patients experiencing mental health challenges may not be optimal candidates for PTNS therapy. The notable effectiveness of PTNS, coupled with its favorable patient tolerance, underscores the advantages of employing this treatment either independently or alongside other rehabilitation programs to address neurogenic bladder dysfunction in MS patients [21,31,39,40].…”