Raffaele Nardone1, Viviana Versace2, Luca Sebastianelli2, Francesco Brigo3, Stefan Golaszewski4, Monica Christova5, Leopold Saltuari6, Eugen Trinka7. 1. Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Spinal Cord Injury and Tissue Regeneration Center, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria. Electronic address: raffaele.nardone@asbmeran-o.it. 2. Department of Neurorehabilitation, Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy. 3. Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neuroscience, Biomedicine and Movement Science, University of Verona, Italy. 4. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Karl Landsteiner Institut für Neurorehabilitation und Raumfahrtneurologie, Salzburg, Austria. 5. Otto Loewi Research Center, Physiology Section, Medical University of Graz, Graz, Austria; Department of Physiotherapy, University of Applied Sciences FH-Joanneum, Austria. 6. Department of Neurorehabilitation, Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy; Department of Neurology, Hochzirl Hospital, Zirl, Austria. 7. Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria; Centre for Cognitive Neurosciences Salzburg, Salzburg, Austria; University for Medical Informatics and Health Technology, UMIT, Hall in Tirol, Austria.
Abstract
OBJECTIVE: We aimed at assessing the usefulness of motor evoked potentials (MEPs) for exploring the integrity of striated sphincters and pelvic floor motor innervation in normal subjects and of repetitive transcranial magnetic stimulation TMS (rTMS) in patients with neurogenic bladder dysfunction. METHODS: A systematic literature search was conducted using PubMed and Embase. RESULTS: We identified, reviewed and discussed 11 articles matching the inclusion criteria. CONCLUSIONS: The assessment of MEPs could represent a useful tool in the investigation of patients with urologic disorders. High frequency rTMS can improve detrusor contraction and/or urethral sphincter relaxation in patients with multiple sclerosis and bladder dysfunction. Low frequency (LF) rTMS seems to be an effective treatment of neurogenic lower urinary tract dysfunctions in subjects with Parkinson's disease and possibly other neurodegenerative disorders. Furthermore, rTMS might have the potential to restore bladder and bowel sphincter function after incomplete spinal cord injury. LF rTMS could also relieve some symptoms of bladder pain syndrome and chronic pelvic pain. SIGNIFICANCE: The clinical applicability of MEPs appears to be questionable, since a poor reproducibility was detected for all pelvic floor muscles. The use of rTMS in this field is emerging and the results of a few preliminary studies should be replicated in controlled, randomized studies with larger sample sizes.
OBJECTIVE: We aimed at assessing the usefulness of motor evoked potentials (MEPs) for exploring the integrity of striated sphincters and pelvic floor motor innervation in normal subjects and of repetitive transcranial magnetic stimulation TMS (rTMS) in patients with neurogenic bladder dysfunction. METHODS: A systematic literature search was conducted using PubMed and Embase. RESULTS: We identified, reviewed and discussed 11 articles matching the inclusion criteria. CONCLUSIONS: The assessment of MEPs could represent a useful tool in the investigation of patients with urologic disorders. High frequency rTMS can improve detrusor contraction and/or urethral sphincter relaxation in patients with multiple sclerosis and bladder dysfunction. Low frequency (LF) rTMS seems to be an effective treatment of neurogenic lower urinary tract dysfunctions in subjects with Parkinson's disease and possibly other neurodegenerative disorders. Furthermore, rTMS might have the potential to restore bladder and bowel sphincter function after incomplete spinal cord injury. LF rTMS could also relieve some symptoms of bladder pain syndrome and chronic pelvic pain. SIGNIFICANCE: The clinical applicability of MEPs appears to be questionable, since a poor reproducibility was detected for all pelvic floor muscles. The use of rTMS in this field is emerging and the results of a few preliminary studies should be replicated in controlled, randomized studies with larger sample sizes.