Valiquette G, Herbert J, Maede-D'Alisera P
Department of Medicine, Multiple Sclerosis Comprehensive Care Center, West Haverstraw, NY, USA.
Arch Neurol. 1996 Dec;53(12):1270-5. doi: 10.1001/archneur.1996.00550120082020.
Neurogenic bladder affects up to 80% of patients with multiple sclerosis (MS) and, in 50% of these patients, it is a significant cause of disability. The current management of neurogenic bladder, based on fluid restriction, anticholinergic agents, intermittent self-catheterization, and, in some cases, surgical intervention, often fails to relieve all symptoms. Furthermore, anticholinergic drugs have significant adverse effects and may be medically contraindicated. Nocturia is a particularly disabling symptom of neurogenic bladder; by disrupting sleep patterns, it aggravates the chronic fatigue of MS, imposes serious demands on caregivers, and can lead to institutionalization. To evaluate a novel approach to the symptomatic management of nocturia in patients with MS, we have conducted a trial of desmopressin acetate (1-desamino-8-D-arginine vasopressin), a synthetic analogue of antidiuretic hormone.
To evaluate the efficacy and short-term safety of desmopressin therapy in the symptomatic treatment of nocturia in patients with MS.
Seventeen patients were enrolled in a double-blind, crossover trial of desmopressin administered at bedtime. Patients with both relapsing-remitting and chronic-progressive forms of MS were admitted. Night time voiding diaries were maintained for the 6 weeks of the trial; similarly, serum electrolyte levels and plasma osmolality were measured twice weekly and urinalyses and urine cultures were performed weekly during the trial.
Desmopressin reduced the percentage of nights with nocturia in patients from 97% to 66%. The average number of episodes of nocturia per night in patients decreased from 2.35 to 1.09 and the maximum hours of sleep uninterrupted by nocturia increased from 3.74 to 5.77. These results were highly significant. Four of the 17 patients discontinued participation in the study after developing asymptomatic or minimally symptomatic hyponatremia.
Desmopressin was found effective; no tolerance and only minimal adverse effects have been observed. Our results suggest that desmopressin, either alone or in combination with other therapeutic modalities, is effective in the symptomatic management of nocturia in patients with MS. The only adverse effect attributed to desmopressin was hyponatremia, which occurred in 4 of 17 patients and appeared to be dose related.
神经源性膀胱影响多达80%的多发性硬化症（MS）患者，其中50%的患者，神经源性膀胱是致残的重要原因。目前神经源性膀胱的治疗方法包括限液、使用抗胆碱能药物、间歇性自我导尿，在某些情况下还包括手术干预，但往往无法缓解所有症状。此外，抗胆碱能药物有显著的不良反应，在医学上可能存在禁忌。夜尿症是神经源性膀胱特别致残的症状；它扰乱睡眠模式，加重MS患者的慢性疲劳，给护理人员带来沉重负担，并可能导致患者需要专人护理。为了评估一种治疗MS患者夜尿症症状的新方法，我们进行了一项醋酸去氨加压素（1-去氨基-8-D-精氨酸血管加压素）的试验，醋酸去氨加压素是抗利尿激素的合成类似物。
评估去氨加压素治疗MS患者夜尿症症状的疗效和短期安全性。
17名患者参加了一项在睡前服用去氨加压素的双盲交叉试验。复发缓解型和慢性进展型MS患者均纳入试验。在试验的6周内记录夜间排尿日记；同样，在试验期间每周测量两次血清电解质水平和血浆渗透压，每周进行尿液分析和尿培养。
去氨加压素使患者有夜尿的夜晚百分比从97%降至66%。患者每晚夜尿发作的平均次数从2.35次降至1.09次，无夜尿干扰的最长睡眠时间从3.74小时增加到5.77小时。这些结果非常显著。17名患者中有4名在出现无症状或症状轻微的低钠血症后停止参与研究。
发现去氨加压素有效；未观察到耐受性，且不良反应极小。我们的结果表明，去氨加压素单独使用或与其他治疗方式联合使用，对MS患者夜尿症症状的治疗有效。去氨加压素唯一的不良反应是低钠血症，17名患者中有4名出现，且似乎与剂量有关。
