The Effect of Sacral Nerve Modulation on Cerebral Evoked Potential Latency in Fecal Incontinence and Constipation

Giani, Iacopo; Novelli, Eugenio; Martina, S.; Clerico, Giuseppe; Luc, A. Realis; Trompetto, Mario; Malaguti, S.; Nicholls, John; Ganio, Ezio

doi:10.1097/sla.0b013e3182196ff4

Cited by 56 publications

(54 citation statements)

References 21 publications

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“…This is supported by evidence of altered motility in the right side of the colon during SNS [11,12]. Furthermore, SNS alters cerebral evoked potentials and reduces the overall corticoanal excitability during rectal distension [9,24]. Thus, modulation through afferent nerve fibres may be an important part of the mode of action of SNS for IBS.…”

Section: Discussionmentioning

confidence: 93%

“…Based on results from the same patient group, we have previously reported that SNS alleviates IBS specific symptoms including pain, bloating, diarrhoea, constipation and satiety and that the effect lasts at least one year [7]. In patients with faecal incontinence, the percutaneuos nerve evaluation test alters rectal sensation to distension [9,24,25]. Most IBS patients have visceral hypersensitivity [26,27] and abnormal engagement of CNS regions associated with emotional arousal and endogenous pain modulation has been documented during rectal distension [28].…”

Section: Discussionmentioning

confidence: 99%

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A randomised, controlled study of small intestinal motility in patients treated with sacral nerve stimulation for irritable bowel syndrome

et al. 2014

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BackgroundIrritable bowel syndrome (IBS) is among the most common gastrointestinal disorders worldwide. In selected patients with severe diarrhoea-predominant or mixed IBS subtypes sacral nerve stimulation (SNS) alleviates IBS-specific symptoms and improves quality of life. The mode of action, however, remains unknown. The present study aimed to evaluate the effect of SNS on small intestinal motility in IBS patients.MethodsTwenty patients treated with SNS for severe diarrhoea-predominant or mixed IBS were included in a randomised, controlled, crossover study. The neurostimulator was turned ON or OFF for the first one month and then to the opposite setting for the next month. Gastrointestinal transit patterns were investigated with the Motility Tracking System-1 (MTS-1) at the end of each the ON and OFF period. Primary endpoint was change in the velocity of the magnetic pill within the small intestine. Statistical testing was performed with Wilcoxon’s rank sum test and Fisher’s exact test.ResultsThe median velocity of the magnetic pill through the small intestine in the fasting state was not significantly different between periods with and without SNS (Group ON-OFF: median change 0 m/h (range -1.07, 0.63), Group OFF-ON: median change 0.27 m/h (range -0.59, 1.12)) (p = 0.25). Neither, was the median velocity of the magnetic pill through the small intestine in the postprandial state significantly different between periods with and without SNS (Group ON-OFF: median change -0.13 m/h (range -0.46, 0.23), Group OFF-ON: median change 0.015 m/h (range -0.48, 0.59)) (p = 0.14).ConclusionEven though SNS may reduce symptoms of diarrhoea-predominant and mixed IBS, it has no detectable effect on small intestinal transit patterns.Trial registrationClinical.trials.gov, (NCT00919672).

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

A randomised, controlled study of small intestinal motility in patients treated with sacral nerve stimulation for irritable bowel syndrome

et al. 2014

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“…3. FIQL score changes before and after the treatment higher perception of afferent information (36,37). However, no anorectal physiological changes are consistently observed from PTNS and SNS (38).…”

Section: Discussionmentioning

confidence: 97%

Transcutaneous tibial nerve stimulation for the treatment of faecal incontinence: results of a prospective study

Stundiene¹,

Žeromskas²,

Valantinas³

2014

AML

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Background. Transcutaneous tibial nerve stimulation is a simple, non-invasive treatment, which can be used to treat faecal incontinence. Optimal treatment regimen is not known and various stimulation regimens are used in different centers. The aim of this prospective study was to evaluate the efficacy of twice weekly transcutaneous tibial nerve stimulation for faecal incontinence patients, who have failed to respond to maximal conservative treatment. Material and methods. Twenty patients with faecal incontinence resistant to maximal conservative therapy were treated with transcutaneous posterior tibial nerve stimulation twice a week for six weeks. The number of the bowel movements per two weeks and the Cleveland Clinic Florida Feacal Incontinence Score were assessed before and after the treatment. The quality of life was estimated using the Faecal Incontinence Quality of Life questionnaire and the Gastrointestinal Quality of Life Index. Results. Effect was seen in 55% of patients. Two-week faecal incontinence episodes decreased from median 4 (2–84) to 2 (0–56) (p = 0.002). The mean Cleveland Clinic Florida Faecal Incontinence score improved from 10.9 ± 4.34 to 7.8 ± 3.96 (p = 0.002). The quality of life improved significantly after the treatment. The therapy was well tolerated and no participant experienced any adverse event. Conclusions. Transcutaneous tibial nerve stimulation twice a week for 6 weeks may be efficacious in patients with faecal incontinence, who have failed to respond to maximal conservative treatments.

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“…3 The results of this trial confirmed the salutary effects of the therapy as had been repeatedly demonstrated in European and Australian trials. [4][5][6][7][8] The other alternatives for the treatment of FI including traditional overlapping sphincteroplasty, 9 graciloplasty, 10-14 artificial bowel sphincter 15-16 and stoma construction will all continue to play roles in our therapeutic algorithms. In addition, some recent studies have demonstrated reasonable results with injectables 17-18 although limited long term data are available to recommend their use.…”

mentioning

confidence: 99%

Sacral Nerve Stimulation

Wexner¹

2011

Annals of Surgery

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Letters to the Editor 18. Michelsen HB, Maeda Y, Lundby L, et al. Retention test in sacral nerve stimulation for fecal incontinence. Dis Colon Rectum. 2009;52(11): 1864-1868. 19. Rosen HR, Urbarz C, Holzer B, et al. Sacral nerve stimulation as a treatment for fecal incontinence. Gastroenterology. 2001;121(3):536-541. 20. Michelsen HB, Christensen P, Krogh K, et al. Sacral nerve stimulation for faecal incontinence alters colorectal transport. Br J Surg. 2008;95(6):779-784. 21. Blok BF, Groen J, Bosch JL, et al. Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators. BJU Int. 2006;98(6):1238-1243. 22. Braun PM, Baezner H, Seif C, et al. Alterations of cortical electrical activity in patients with sacral neuromodulator. Eur Urol. 2002;41(5):562-566; discussion 566-567. 23. Dasgupta R, Critchley HD, Dolan RJ, et al.Changes in brain activity following sacral neuromodulation for urinary retention.

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The Effect of Sacral Nerve Modulation on Cerebral Evoked Potential Latency in Fecal Incontinence and Constipation

Abstract: Measurement of P40 latency of SEP at baseline and at 1 month of SNM at a frequency of 40 Hz may help to predict the outcome of SNM and thus influence the decision for permanent implantation for patients with incontinence and constipation.

Cited by 56 publications

References 21 publications

A randomised, controlled study of small intestinal motility in patients treated with sacral nerve stimulation for irritable bowel syndrome

A randomised, controlled study of small intestinal motility in patients treated with sacral nerve stimulation for irritable bowel syndrome

Transcutaneous tibial nerve stimulation for the treatment of faecal incontinence: results of a prospective study

Sacral Nerve Stimulation

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