Videourodynamic and sphincter motor unit potential analyses in Parkinson's disease and multiple system atrophy

OBJECTIVES: Urinary dysfunction is a prominent autonomic feature in Parkinson's disease (PD) and multiple system atrophy (MSA), which is not only troublesome but also a cause of morbidity in these disorders. Recent advances in investigative uroneurology offer a better insight into the underlying pathophysiology and appropriate management for urinary dysfunction. METHODS: twenty one patients with PD (15 men, six women, mean age 64 (49-76), mean disease duration 4 years (1-8 years), median Hoehn and Yahr grade 3 (1-4), all taking 300 mg/day of levodopa (100-500 mg)) and 15 with MSA (eight men, seven women, mean age 59 (48-72), mean disease duration 3 years (0.5-6 years)) were recruited. Videourodynamic and sphincter motor unit potential analyses in the patients with PD and MSA were carried out, looking for distinguishing hallmarks that might be useful in the differential diagnosis of these two diseases. RESULTS: Urinary symptoms were found in 72% of patients with PD and in 100% with MSA. Filling phase abnormalities in the videourodynamic study included detrusor hyperreflexia in 81% of patients with PD and 56% with MSA, and uninhibited external sphincter relaxation in 33% of patients with PD and 33% of those with MSA. However, open bladder neck at the start of filling was not seen in patients with PD but was present in 53% of those with MSA, suggestive of internal sphincter denervation. Sphincter motor unit potential analysis showed neurogenic motor unit potentials in 5% of patients with PD and in 93% of those with MSA, suggestive of external sphincter denervation. On voiding, detrusor-external sphincter dyssynergia was not seen in patients with PD but was present in 47% of those with MSA. Pressure-flow analysis showed that the Abrams-Griffiths number, a grading of urethral obstruction (outflow obstruction >40), in PD (40 in women and 43 in men) was larger than that in MSA (12 in women and 28 in men). Weak detrusor in PD (66% of women and 40% of men) was less common than that in MSA (71% of women and 63% of men). Postmicturition residuals >100 ml were absent in patients with PD but were present in 47% of patients with MSA. CONCLUSION: Patients with PD had less severe urinary dysfunction with little evidence of internal or external sphincter denervation, by contrast with the common findings in MSA. The findings of postmicturition residuals >100 ml, detrusor-external sphincter dyssynergia, open bladder neck at the start of bladder filling, and neurogenic sphincter motor unit potentials are highly suggestive of MSA.     

Bladder symptoms assessed with overactive bladder questionnaire in Parkinson's disease

In Parkinson's disease (PD) the urinary dysfunction manifests primarily with symptoms of overactive bladder (OAB). The OAB questionnaire (OAB‐q) is a measure designed to assess the impact of OAB symptoms on health‐related quality of life. In this study, we quantified the urinary symptoms in a large cohort of PD patients by using the OAB‐q short form. Possible correlations between the OAB‐q and clinical features were tested. Three hundred and two PD patients were enrolled in the study. Correlations between the OAB‐q and sex, age, Unified Parkinson's Disease Rating Scale part III (UPDRS‐III), Hoehn‐Yahr (H‐Y) staging, disease duration, and treatment were analyzed. Data were compared with a large cohort of 303 age‐matched healthy subjects. The OAB‐q yielded significantly higher scores in PD patients than in healthy subjects. In the group of PD patients, all the variables tested were similar between men and women. Pearson's coefficient showed a significant correlation between mean age, disease duration, mean OAB‐q scores, UPDRS‐III scores, and H‐Y staging. A multiple linear regression analysis showed that OAB‐q values were significantly influenced by age and UPDRS‐III. No statistical correlations were found between OAB‐q scores and drug therapy or the equivalent levodopa dose, whilst the items relating to the nocturia symptoms were significantly associated with the equivalent levodopa dose. Our findings suggest that bladder dysfunction assessed by OAB‐q mainly correlates with UPDRS‐III scores for severity of motor impairment, possibly reflecting the known role of the decline in nigrostriatal dopaminergic function in bladder dysfunction associated with PD and patients' age. Our study also suggests that the OAB‐q is a simple, easily administered test that can objectively evaluate bladder function in patients with PD. © 2010 Movement Disorder Society     

Autonomic dysfunction in 3414 Parkinson's disease patients enrolled in the German Network on Parkinson's disease (KNP e.V.): the effect of ageing

We analysed non-motor symptoms (NMS) related to autonomic dysfunction in 3414 patients with Parkinson's disease (PD) enrolled in the multicentre registry of the German Competence Network on PD. Orthostatic hypotension (>20 mmHg systolic or >10 mmHg diastolic) was reported for 10% of women and 11% of men, urinary incontinence for 22% of women and 21% of men, sexual dysfunction for 8% of women and 30% of men (50% of whom reported erectile dysfunction) and sleep disturbances for 43% of women and 35% of men. Autonomic symptoms occurred in a frequency similar to severe disabling dyskinesia which was reported for 16% of women and 11% of men. A logistic regression analyses with age, sex and disease duration as covariates revealed a significant correlation of orthostatic hypotension and urinary incontinence with age and disease duration whilst sexual dysfunction was related to age only. These observations suggests that the effects of the PD process and ageing contribute to non-levodopa responsive NMS. Sleep disturbances were more common in women and a correlation was found with disease duration only supporting the notion that sleep is specifically affected in PD.     

Short-term effect of a single levodopa dose on micturition disturbance in Parkinson's disease patients with the wearing-off phenomenon.

We investigated the short-term effects of a single dose of levodopa (L-dopa) on micturition function in PD patients with wearing-off phenomenon. Eighteen PD patients who had median Hoehn and Yahr scores of 5 during the off phase and 3 during the on phase were recruited. We carried out urodynamic studies before and about 1 hour after the patients had taken 100 mg of L-dopa with dopa-decarboxylase inhibitor (DCI). After taking the L-dopa/DCI, urinary urgency and urge incontinence aggravated, whereas voiding difficulty was alleviated in all 12 patients. When compared to the baseline assessment, urodynamic study results after taking 100 mg of L-dopa/DCI showed aggravated detrusor hyperreflexia; decreased maximum bladder capacity (P = 0.006); an increased maximum Watts Factor value (P = 0.001), reflecting the detrusor power on voiding; an increased Abrams-Griffiths number (P = 0.042), reflecting urethral obstruction on voiding; decreased residual urine volume (P = 0.025); and increased static urethral closure pressure (P = 0.012). One hundred milligrams of L-dopa/DCI worsened detrusor hyperreflexia, producing worsened urinary urgency and urge incontinence during the storage (bladder-filling) phase. It also increased detrusor contractility much more than it did urethral obstruction in the voiding phase, producing overall lessening of voiding difficulty and improving voiding efficiency in our PD patients with the wearing-off phenomenon.     

Pure akinesia with low myocardial metaiodobenzylguanidine uptake

The objective of this study was to delineate the clinical features of patients with pure akinesia and a low heart versus mediastinum ratio below 2.0 in the delayed images of myocardial metaiodobenzylguanidine scintigraphy, a marker for the clinical diagnosis of Lewy body diseases. A total of 13 patients was enrolled. The clinical features of the patients were uniformly elderly (mean age, 73.7 years), a male gender preponderance (10 men and 3 women), relatively mild motor disability (mean Hoehn Yahr grade 2.4) without laterality, festinating gait (77%) and loss of postural reflex (69%), which were the most common; also observed were fair levodopa responses (70%), cognitive dysfunction in some (23%), common autonomic dysfunction (urinary urgency and frequency, 85%; constipation, 77%; and postural hypotension, 38%) and common occipital hypoperfusion (62%). These features may facilitate the clinical differential diagnosis of these patients from patients with pure akinesia due to progressive supranuclear palsy.     

Bladder and bowel dysfunction in Parkinson’s disease

Summary. Bladder dysfunction (urinary urgency/frequency) and bowel dysfunction (constipation) are common non-motor disorders in Parkinson’s disease (PD). In contrast to motor disorder, the pelvic autonomic dysfunction is often non-responsive to levodopa treatment. Brain pathology mostly accounts for the bladder dysfunction (appearance of overactivity) via altered dopamine-basal ganglia circuit, which normally suppresses the micturition reflex. In contrast, peripheral enteric pathology mostly accounts for the bowel dysfunction (slow transit and decreased phasic contraction) via altered dopamine-enteric nervous system circuit, which normally promotes the peristaltic reflex. In addition, weak strain and paradoxical anal contraction might be the results of brain pathology. Pathophysiology of the pelvic organ dysfunction in PD differs from that in multiple system atrophy; therefore it might aid the differential diagnosis. Drugs to treat bladder dysfunction in PD include anticholinergic agents. Drugs to treat bowel dysfunction in PD include dietary fibers, peripheral dopaminergic antagonists, and selective serotonergic agonists. These treatments might be beneficial not only in maximizing patients’ quality of life, but also in promoting intestinal absorption of levodopa and avoiding gastrointestinal emergency. Correspondence: Ryuji Sakakibara, Sakura Medical Center, Neurology Division, Department of Internal Medicine, Toho University, 564-1 Shimoshizu, Sakura 285-8741, Japan     

Questionnaire‐based assessment of pelvic organ dysfunction in multiple system atrophy

Multiple system atrophy (MSA) is a neurodegenerative disease characterized clinically by any combination of autonomic, cerebellar, and extrapyramidal symptoms. Autonomic symptoms are usually severe, and urinary symptoms are one of the cardinal features of MSA. Bowel dysfunction and sexual dysfunction are also common in MSA. Quality of life (QOL) in patients with MSA is severely impaired by the presence of pelvic organ dysfunction. Therefore, we aimed to examine the prevalence of pelvic organ dysfunction in patients with MSA. We recruited 256 patients with MSA seen at our neurology clinic. The mean age was 62 years. The control group comprised 158 individuals, and the mean age was 52 years. We administered a questionnaire on pelvic organ dysfunction to the MSA and control groups. The questionnaire had sections focusing on the bladder, bowel, and sexual function. Dysfunction, as described in the responses, was evaluated as normal, mild (>once a month), moderate (>once a week), or severe (>once a day). The Mann‐Whitney's U‐test was used for statistical analysis. When compared with the control group, the prevalence of pelvic organ dysfunction in the MSA group was significantly higher for urinary storage and voiding dysfunction, bowel dysfunction, and sexual dysfunction. QOL in the MSA group was therefore significantly impaired because of urinary dysfunction (70%, 76%), bowel dysfunction (40% of the men), and sexual dysfunction (26%, 45%). Pelvic organ dysfunction is common in MSA, and QOL is severely impaired in patients with MSA. © 2009 Movement Disorder Society     

Frequency and clinical correlates of retrocollis in Parkinson's disease

PurposeTo investigate the incidence of retrocollis and to determine its clinical correlates in patients with idiopathic Parkinson's disease (PD).MethodsSeventy-four patients with PD at Hoehn and Yahr stage 5 were examined for abnormal neck postures and were classified according to neck posture. Differences in age, age at PD onset, disease duration, years from PD onset to Hoehn and Yahr stage 5, cognitive state, the levodopa equivalent dose (LED) for dopaminergic drugs, and rigidity of the neck and upper and lower extremities were examined to determine the clinical correlates of abnormal neck posture. We also evaluated retrocollis in 356 patients with PD at Hoehn and Yahr stage 1, 2, 3, and 4 and 65 age matched normal controls.ResultsOf the 74 patients with PD at Hoehn and Yahr stage 5 examined, 21 (28.4%) had retrocollis, 3 (4.1%) had antecollis, and 1 (1.4%) had antecollis and torticollis. Whereas, only one patient had retrocollis in PD patients at Hoehn and Yahr stage 4 and under. Patients with antecollis were significantly younger than those with normal neck posture and retrocollis. There were no differences in age at PD onset, disease duration, sex, years from PD motor symptom onset to Hoehn and Yahr stage 5, cognitive state, or LED between patients with and without abnormal neck postures. Neck rigidity scores were significantly higher in patients with retrocollis and antecollis than in those with normal neck posture.ConclusionsRetrocollis is not rare in patients with PD at Hoehn and Yahr stage 5, and the incidence appeared to increase as axial rigidity increased.     

Therapeutic factors causing hallucination in Parkinson's disease patients, especially those given selegiline

Selegiline protects nigral dopaminergic neurons and is recommended for the treatment of patients in the early stage of Parkinson's disease (PD). We treated 112 PD patients and noted that those given selegiline had a high incidence of hallucination. Our objective was to determine which clinical therapeutic factors cause such hallucinations. The Kruskal-Wallis and chi-square test showed that in 94 patients, the severity of the hallucinations was significantly related to the duration of illness, Hoehn and Yahr stage, doses of levodopa and cabergoline, whether or not selegiline was used, and whether or not medication for constipation was required. In addition, patients who were treated with a low dose of levodopa (< or =300 mg/day), who had a low Hoehn and Yahr stage, and a short duration of illness (< or =8 years) together with a high dose of selegiline or cabergoline also tended to have hallucinations. MRI findings were not related to the incidence of hallucination. When selegiline is given to patients who have PD of long duration and a high Hoehn and Yahr stage, and who already are receiving levodopa and a dopamine agonist, the doses of levodopa and the dopamine agonists given, as well as the presence of constipation, may be related to the incidence of hallucination.     

Urinary, faecal and sexual dysfunction in patients with multiple sclerosis

The prevalence and nature of bladder and bowel dysfunction were examined in a population-based study of 221 patients with multiple sclerosis who returned postal questionnaires. This preliminary investigation was supplemented by personal review which also provided information on sexual dysfunction in 174 and laboratory and urodynamic tests in 152 participants. Thirty of 221 (14%) currently used an indwelling catheter, and 84 of the remainding190 (44%) reported symptoms of urinary dysfunction, of which the most common were urgency and frequency. Thirteen of 144 (9%) patients had biochemical evidence of renal dysfunction, and 40 of 132 (30%) had infected urine samples. Eleven of 54 patients in whom investigation of upper urinary tract was thought to be appropriate demonstrated abnormalities. Sixty-four of 221 (29%) patients had experienced faecal incontinence, and 120 of 221 (54%) were constipated. Fifty-six of 68 (82%) men and 55 of 106 (52%) women reported a deterioration in sexual activity, the commonest symptoms being erectile failure in men and fatigue in women. Received: 21 August 1998 Received in revised form: 27 April 1999 Accepted: 16 June 1999     

The effect of stage of Parkinson''s disease at the onset of levodopa therapy on development of motor complications

The aim of this study was to ascertain whether the stage of Parkinson's disease (PD) (according to the Hoehn and Yahr staging system) would affect the length of time between the introduction of levodopa therapy and appearance of levodopa-associated motor complications. Forty patients with clinically definite PD were studied. In all, clinical and therapeutic data were collected from the time of diagnosis to the time of levodopa-associated motor complications (i.e. dyskinesia, motor fluctuations). In 17 patients, levodopa could be started in Hoehn and Yahr stage I (H & Y-I; 16.2 months after the onset of PD), whilst in 13 patients levodopa could be started in H & Y-II (19.6 months after the onset of the disease) and in 10 in H & Y-III (45.1 months after the onset of PD). Cox proportional hazard regression model shows that the PD patients in whom the initial levodopa treatment was introduced at stage III develop both dyskinesias and motor fluctuations significantly earlier than the patients whose levodopa started in stage I and II of PD. The median interval to develop dyskinesias was 66, 72 and 24 months for patients in whom levodopa was introduced in stage I, II and III, respectively. These values were 64, 55 and 14 months for motor fluctuations. These findings add to the clinical arguments that favour an essential role of severity of PD at levodopa initiation as a risk factor for the development of levodopa-associated motor complications.     

Independent validation of the scales for outcomes in Parkinson’s disease‐autonomic (SCOPA‐AUT)

Background and purpose: Autonomic dysfunction is common in Parkinson’s disease (PD) and causes a great impact in health‐related quality of life (HRQL) and functional status of patients. This study is the first independent validation of the Scales for Outcomes in PD‐Autonomic (SCOPA‐AUT). Methods: In an observational, cross‐sectional study (ELEP Study), 387 PD patients were assessed using, in addition to the SCOPA‐AUT, the Hoehn and Yahr staging, SCOPA‐Motor, SCOPA‐Cognition, Cumulative Illness Rating Scale‐Geriatrics, modified Parkinson Psychosis Rating Scale, Clinical Impression of Severity Index for PD, Hospital Anxiety and Depression Scale, SCOPA‐Sleep, SCOPA‐Psychosocial, pain and fatigue visual analogue scales, and EQ‐5D. SCOPA‐AUT acceptability, internal consistency, construct validity, and precision were explored. Results: Data quality was satisfactory (97%). SCOPA‐AUT total score did not show floor or ceiling effect, and skewness was 0.40. Cronbach’s alpha coefficients ranged from 0.64 (Cardiovascular and Thermorregulatory subscales) to 0.95 (Sexual dysfunction, women). Item homogeneity index was low (0.24) for Gastrointestinal subscale. Factor analysis identified eight factors for men (68% of the variance) and seven factors for women (65% of the variance). SCOPA‐AUT correlated at a high level with specific HRQL and functional measures (r_S = 0.52–0.56). SCOPA‐AUT scores were higher for older patients, for more advanced disease, and for patients treated only with levodopa (Kruskal–Wallis test, P < 0.01). Standard error of measurement for SCOPA‐AUT subscales was 0.81 (sexual, men) – 2.26 (gastrointestinal). Conclusions: Despite its heterogeneous content, which determines some weaknesses in the psychometric attributes of its subscales, SCOPA‐AUT is an acceptable, consistent, valid and precise scale.     

Sleep disorders in Parkinson's disease.

We sought to estimate the frequency and nature of sleep disturbances in Indian Parkinson's disease (PD) patients. One hundred forty nine consecutive PD patients attending the Movement Disorders Clinic of the All India Institute of Medical Sciences, New Delhi, India and 115 age-matched healthy controls participated. After clinical evaluation, sleep assessment was done using a 23-question, validated sleep questionnaire. Mean age of PD patients and the duration of illness were 58.37 (S.D. 10.45) years and 5.7 (S.D. 3.85) years, respectively. The mean age of the controls was 56.50 (S.D. 11.45) years (P > 0.05). Sleep problems were seen in 63 (42%) PD patients compared to 12% of controls. These were: insomnia in 32%, nightmares in 32%, and excessive day time sleepiness in 15% of PD patients as compared with 5%, 5% and 6%, respectively, in controls (P < 0.025). Presence of nightmares was significantly associated with higher Hoehn and Yahr score (P < 0.002), high unified Parkinson's disease rating scale (UPDRS) Part I score (P < 0.000) and levodopa dose (P < 0.025). Excessive daytime sleepiness correlated with higher Hoehn and Yahr stage (P < 0.004), and levodopa dose (P < 0.040). The sleep latency was longer in PD patients as compared to controls (P < 0.000). Multiple logistic regression analysis showed association of sleep disturbances with UPDRS Part III, Schwab and England score, levodopa dose, rigidity score, and bradykinesia score. Sleep problems are much more common in PD patients compared to controls (P < 0.001), and correlate with increased severity of disease.     

Risk factors for progression in Parkinson's disease

Using case-control methodology, we assessed prevalence and duration of exposure to putative risk factors for rapid progression of Parkinson's disease (PD) in patients not taking levodopa or direct dopamine agonists. We identified 31 patients termed "rapidly progressive" who were stage I or II (Hoehn and Yahr) on their first visit to our center and who progressed to stage III during the study period; we pair-matched this group with 31 "slowly progressive" patients who had the same symptom duration and the same Hoehn and Yahr stage at study entry, but whose parkinsonism did not progress to stage III during the study. Only age of PD onset was associated with different rates of PD progression; older patients at PD onset progressed more rapidly than younger patients.     

Contributions of dopaminergic drugs and disease severity to daytime sleepiness in Parkinson disease

BACKGROUND: Excessive daytime somnolence is a common report among patients who have Parkinson disease (PD). The relative contributions of disease severity and of the various dopaminergic drugs are unclear. OBJECTIVE: To separate and quantify the contributions of disease markers and drug doses. METHODS: Patients seen during a 7-month period at a center for movement disorders completed the Epworth Sleepiness Scale. Treatment subgroups were compared. The relationship to sedation of age; dopaminergic drug classes and doses; Hoehn and Yahr stage; duration of disease; total score on the motor subsection of the Unified Parkinson Disease Rating Scale; and the presence or absence of dementia, depression, or hallucinations was calculated using simple and multiple regression and t tests. RESULTS: The Epworth Sleepiness Scale scores were higher among patients with PD (mean [SD], 10.8 [5.3]; n = 368) compared with patients with other neurological disorders (mean, 8.5 [5.1]; n = 243; P<.001). A model containing the Hoehn and Yahr stage, levodopa dose, and use of a dopamine agonist was the best at predicting the total score of Epworth Sleepiness Scale in patients who have PD, but accounted for only 9% of the interindividual variance. The parameter estimates (SE) corresponded to a 1.02 (0.03)-point increase per Hoehn and Yahr stage, a 0.14 (0.06)-point increase per 100-mg increase in levodopa dose over 24 hours, and a 2.33 (0.57)-point increase with use of an agonist. There was no statistically significant dose response for agonists. No statistically significant difference in sedation among the commonly used dopamine agonists was found. CONCLUSIONS: Somnolence in patients with PD, which is on average 25% higher than in other neurological diseases, is related to PD stage, levodopa dose, and the use of a dopamine agonist. However, most of the variability in sedation levels in patients with PD as well as in controls is the result of, as yet, unidentified factors.     

Mortality associated with early and late levodopa therapy initiation in Parkinson's disease

We evaluated the possible influence of early levodopa treatment on the mortality of Parkinson's disease (PD). One hundred forty-five consecutive parkinsonian patients initiated treatment with levodopa between 1970 and 1983. Ninety-eight of those started levodopa therapy 2 or more years after symptom onset, while 47 received levodopa within the 1st 2 years of the disease. At the end of follow-up, in December 1985, 49 patients had died. Mortality was 2.5 times higher among patients who delayed initiation of levodopa therapy 2 or more years than among those who initiated the therapy earlier. Age and disease severity were the most significant predictors of survival after initiation of levodopa treatment. The risk of death was 10% higher every year of age increase and was 2 and 4 times higher, respectively, for patients at Hoehn and Yahr stages II and III than for patients at Hoehn and Yahr stage I. When we controlled for the effect of age and disease severity on mortality, the cumulative death probability was no longer significantly higher among patients who delayed levodopa treatment than among patients treated within 2 years from disease onset. As far as mortality is concerned, the results show that the time of levodopa treatment initiation during PD has no influence and the drug can be introduced as soon as indicated by the severity of the disease progression.     

Genitourinary dysfunction in Parkinson's disease

Bladder dysfunction (urinary urgency/frequency) and sexual dysfunction (erectile dysfunction) are common nonmotor disorders in Parkinson's disease (PD). In contrast to motor disorders, genitourinary autonomic dysfunctions are often nonresponsive to levodopa treatment. The brain pathology causing the bladder dysfunction (appearance of overactivity) involves an altered dopamine‐basal ganglia circuit, which normally suppresses the micturition reflex. By contrast, hypothalamic dysfunction is mostly responsible for the sexual dysfunction (decrease in libido and erection) in PD, via altered dopamine‐oxytocin pathways, which normally promote libido and erection. The pathophysiology of the genitourinary dysfunction in PD differs from that in multiple system atrophy; therefore, it might aid in differential diagnosis. Anticholinergic agents are used to treat bladder dysfunction in PD, although these drugs should be used with caution particularly in elderly patients who have cognitive decline. Phosphodiesterase inhibitors are used to treat sexual dysfunction in PD. These treatments might be beneficial in maximizing the patients' quality of life. © 2010 Movement Disorder Society     

Objective sleep measures between patients with Parkinson's disease and community-based older adults

ObjectivesPrevious studies comparing objective sleep measures between patients with Parkinson's disease (PD) and control participants were limited by their small sample size. The purpose of this study was to compare objective sleep measures between large-scale cohorts of PD outpatients and community-based older adults.MethodsIn this cross-sectional study, we measured sleep parameters for 157 PD patients using an actigraph on the non-dominant wrist for six consecutive nights (95 Hoehn–Yahr stage I/II; 62 Hoehn–Yahr stage III–V). Moreover, two consecutive nights of actigraphy were performed on 1101 community-based control participants aged ≥60 years.ResultsIn multivariable analysis, sleep efficiency (SE) was significantly lower in patients with late-stage PD by 17.5% [95% confidence interval: 15.3%–19.7%] and early-stage PD by 9.4% [7.6%–11.1%] compared to the controls (67.1% and 75.3% vs. 84.6%, respectively). Similar results were observed for wake after sleep onset (WASO) and fragmentation index (FI). Total sleep time and sleep onset latency (SOL) were significantly shorter in patients with late- and early-stage PD stage compared to the controls. Among PD patients, significant association trends between advancement of individual Hoehn–Yahr stages and worsened sleep measures of SE, WASO, and FI were observed independently of age, gender, levodopa equivalent dose, and motor function parameter.ConclusionThis study demonstrated significant and quantitative differences in objective sleep quality and quantity between PD patients and control participants. Furthermore, with advancement of disease stages, objectively measured sleep quality worsened in PD patients.     

The cause and management of bladder, sexual and bowel symptoms in multiple sclerosis

Neurological control of bladder, bowel and sexual function depends on intact innervation between cerebral controlling centres and the conus of the cord. It is probably the spinal cord disease in multiple sclerosis (MS) which is the main cause of the pelvic organ dysfunctions that occur. Essential to bladder management is understanding to what extent the patient has incomplete emptying while complaining predominantly of symptoms of bladder overactivity. Anticholinergic medication can be highly effective for treatment of detrusor hyperreflexia but if incomplete emptying is also part of the problem intermittent catheterization or some other means of improving emptying will be necessary. Although there is an increasing range of treatments available for erectile failure there is still little that can be done to help women with sexual dysfunction. However, patients of both sexes are likely to welcome the opportunity to discuss their problem. The prevalence of bowel dysfunction is higher in patients with MS than in the general population and there are a number of possible pathophysiological mechanisms for both the constipation and the faecal incontinence that occur. However, there are as yet few specific effective treatments.     

Sexual function in women with advanced multiple sclerosis.

Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eight (59.6%) of the women reported decreased sexual desire. Seventeen (36.2%) reported decreased lubrication. Five (10.6%) others did not know if they lubricated or not. Eighteen women (38.3%) reported diminished orgasmic capacity and six (12.8%) others had never had an orgasm. Sensory dysfunction in the genital area was experienced by 61.7% of the women and 76.6% had weakness of the pelvic muscles. Sixty six per cent had bowel problems and 89.4% had bladder dysfunction. The changes in sexual function correlated both with neurological symptoms from the sacral segments, such as weakness of the pelvic floor and bladder and bowel dysfunction, and to other symptoms such as ataxia and vertigo as well as with age and the occurrence of amenorrhoea. A significant correlation was found between expanded disability status scale (EDSS) score and cohabitation. Problems with sexual function were reported significantly more often by women with lower EDSS scores. Most women (83%) found the interview a positive experience.