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.
Department of Neurorehabilitation, Hospital of Vipiteno, and Research Department for Neurorehabilitation South Tyrol, Bolzano, Italy.
Clin Neurophysiol. 2019 Nov;130(11):2032-2037. doi: 10.1016/j.clinph.2019.08.020. Epub 2019 Sep 3.
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.
A systematic literature search was conducted using PubMed and Embase.
We identified, reviewed and discussed 11 articles matching the inclusion criteria.
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.
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.
我们旨在评估运动诱发电位 (MEPs) 在探索正常受试者横纹括约肌和盆底运动神经支配完整性以及重复经颅磁刺激 (rTMS) 在神经源性膀胱功能障碍患者中的作用。
使用 PubMed 和 Embase 进行系统文献检索。
我们确定、审查和讨论了符合纳入标准的 11 篇文章。
MEPs 的评估可能是泌尿科疾病患者检查的有用工具。高频 rTMS 可改善多发性硬化症和膀胱功能障碍患者的逼尿肌收缩和/或尿道括约肌松弛。低频 (LF) rTMS 似乎是帕金森病等其他神经退行性疾病患者治疗神经源性下尿路功能障碍的有效方法。此外，rTMS 可能有潜力在不完全性脊髓损伤后恢复膀胱和肠道括约肌功能。LF rTMS 还可以缓解膀胱疼痛综合征和慢性骨盆疼痛的一些症状。
MEPs 的临床适用性似乎值得怀疑，因为所有盆底肌肉的可重复性都很差。rTMS 在该领域的应用正在出现，少数初步研究的结果应在具有更大样本量的对照、随机研究中复制。
