Clare J. Fowler

Intravesical capsaicin as a treatment for refractory detrusor hyperreflexia: A dual center study with long-term followup

PURPOSEnWe described the long-term outcome of intravesical capsaicin instillations in patients with urinary incontinence and compared its efficacy in 2 similar populations of patients with multiple sclerosis in a dual center study.nnnMATERIALS AND METHODSnDuring 5 years 79 patients with intractable urinary incontinence have been treated with intravesical capsaicin. The majority of patients had spinal cord disease due to multiple sclerosis but 4 were neurologically normal. Cystometry was performed before and 4 to 6 weeks after intravesical instillation of 1 to 2 mmol./l. of capsaicin in 30% ethanol in saline. Instillations of vehicle (30% ethanol in saline) alone were carried out in 5 patients.nnnRESULTSnIn patients with phasic detrusor hyperreflexia complete continence was achieved in 44%, satisfactory improvement occurred in 36% and treatment failed in 20%. Clinical benefit from a single instillation lasted 3 to 6 months and was repeated in some patients with similar improvement. Capsaicin was ineffective in patients with poor bladder compliance and in neurologically normal patients with sensory urgency and detrusor instability. There was no clinical or urodynamic improvement in patients treated with vehicle alone. There have been no long-term complications.nnnCONCLUSIONSnOur study shows that repeated instillations of intravesical capsaicin are effective in treatment of patients with detrusor hyperreflexia due to spinal cord disease and that effectiveness of the treatment persists at least 3 to 5 years.

Value of sphincter electromyography in the diagnosis of multiple system atrophy.

It is clinically important, to distinguish between idiopathic Parkinsons disease (IPD) and multiple system atrophy (MSA) not only because of the implications for prognosis but also because urinary incontinence is often an early troublesome feature of MSA and by making the correct neurological diagnosis inappropriate urological surgery may be avoided. Onufs nucleus in the sacral cord is the location of the anterior horn cells innervating the sphincters, and it is among central nervous system sites affected by neuronal cell loss in MSA but not in IPD. A systematic analysis of motor units recorded from the sphincter looking for changes of chronic reinnervation has therefore been used to distinguish between these conditions. Sphincter electromyography (EMG) was carried out in 126 patients with suspected MSA with review of their case notes up to 2 years later. Of those in whom a diagnosis of MSA was made, 82% had had an abnormal sphincter EMG.

Sphincter electromyography in diagnosis of multiple system atrophy: technical issues.

Possible technical reasons for the controversy over the role of sphincter electromyography (EMG) in the diagnosis of multiple system atrophy (MSA) were analyzed. In a review of the literature, a high sensitivity (>60%) was found reported in 11 studies that included late components, and no value of the test was found in 4 studies that excluded them. This was also corroborated in a pilot study of 5 patients with probable MSA. With late components included, the mean motor unit potential (MUP) duration was prolonged in all 4 patients with an adequate single‐MUP analysis sample and, with late components excluded, in 2 of 5 patients on multi‐MUP analysis. At least in diagnostic EMG of MSA patients, late components should be included in the measurement of MUP duration. Muscle Nerve 2003

Pelvic Organ Dysfunction in Neurological Disease: Clinical Management and Rehabilitation

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: Neurological control of sexual function in health and disease

© Cambridge University Press 2010. The neurology of human sexual responses is poorly understood, not only because it is a highly complex process involving much of the nervous system, but also because in comparison to the extent to which research has been carried out in experimental animals, humans have been relatively little studied. Whereas in animals the central and peripheral nervous system control of penile erection and copulatory behavior have been intensively examined, our knowledge about human function and the brain is based mainly on a synthesis of observations of reported abnormalities resulting from disease [1]. Now, however, functional brain imaging data have begun to complement those data. Homology between primates and rodents has been shown for many aspects of sexual responses but there remains much that is unknown about the more complex human processes, especially the neurological determinants of sexual desire. After defining the various phases of the human sexual cycle, this chapter outlines the roles of the subcortical and cortical regions, spinal connections and peripheral innervation involved in those phases, with reference to the experimental animal literature and mention of the dysfunctions that can result from neurological disease at each level. Findings from recent functional imaging experiments are discussed in the context of the role of the cortical regions in human neurological control of sexual function.

Pelvic Organ Dysfunction in Neurological Disease: Index

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: Pelvic Organ Dysfunction in Neurological Disease

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: Contents

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.

Pelvic Organ Dysfunction in Neurological Disease: List of contributors

Foreword Preface List of contributors Part I. Neurologic Control of Pelvic Organ Functions: 1. Neurological control of the bladder in health and disease Derek J. Griffiths and Apostolos Apostolidis 2. Neurological control of the bowel in health and disease Prateesh M. Trivedi and Derek J. Griffiths 3. Neurological control of sexual function in health and disease Clare J. Fowler, Jalesh N. Panicker and Rajesh B. Kavia Part II. Evaluation and Management: 4. Approach and evaluation of neurogenic bladder dysfunction Jalesh N. Panicker, Vinay Kalsi and Marianne de Seze 5. General measures and non-pharmacological approaches Jeanette Haslam, Gwen Gonzales and Collette Haslam 6. Neurogenic bladder dysfunction: pharmacological interventional approaches Apostolos Apostolidis, Soumendra Datta, Xavier Game and Shahid Khan 7. Neurogenic bladder dysfunction: surgical interventional approaches Xavier Game, Thomas M. Kessler, Suzy Elneil and Rizwan Hamid 8. Approach and evaluation of neurogenic bowel dysfunction Klaus Krogh 9. Neurogenic bowel management Maureen Coggrave and Anton Emmanuel 10. Evaluation and management of neurogenic sexual dysfunction Charlotte Chaliha, Catherine M. Dalton, Sohier Elneil and Thomas M. Kessler Part III. Specific Conditions: 11. Cortical and subcortical disorders Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 12. Parkinsons disease Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 13. Multiple system atrophy Ryuji Sakakibara, Clare J. Fowler and Takamichi Hattori 14. Multiple sclerosis and other non-compressive myelopathies Catherine M. Dalton, Giuseppi Preziosi, Shahid Khan and Marianne de Seze 15. Spinal cord injury Xavier Game and Rizwan Hamid 16. Spina bifida and tethered cord syndrome Thomas M. Kessler and Gustav Kiss 17. Pelvic organ dysfunction following cauda equina damage Simon Podnar and Clare J. Fowler 18. Neuromuscular disorders Jalesh N. Panicker and Hadi Manji 19. Urinary retention Jalesh N. Panicker, Ranan DasGupta, Sohier Elneil and Clare J. Fowler Appendices: Appendix 1. Management algorithms Appendix 2. Surveys and questionnaires Index.