Symptomatic Treatment of MS - European Multiple Sclerosis Platform

More documents

Recommendations

Info

NEUROGENIC BOWEL DYSFUNCTION Disturbances of bowel function like constipation and/or incontinence will occur in about 70% of MS patients. Especially constipation may often worsen some other MS symptoms such as neurogenic bladder dysfunction and spasticity. The diagnosis is made by the patients´ descriptions and clinical examination. Other gastrointestinal diseases should be excluded. If constipation occurs it is of great importance to differentiate between reduced bowel motility and disturbance of rectum and bowel emptying. In some cases estimation of the colon transit time after oral administration of X-ray positive markers may be helpful. Goals of treatment are to normalize the frequency of bowel emptying and of continence and to prevent (sub)-ileus and pressure sores. SPECIFIC TREATMENT PHYSIOTHERAPY, AIDS, MEDICAL TREATMENT In a small open study biofeedback seemed to be effective in less disabled patients [Wiesel 2001]. The benefit of pelvic floor training has so far never been elucidated [Norton 2000]. Faecal incontinence in women with weak pelvic floor muscles may be ameliorated partially by electrical stimulation [Hosker 2000]. There are treatment trials providing sufficient data on the use of laxatives, drugs augmenting bowel motility, and botulinum toxin A [Wiesel 2001; DasGupta 2003]. The established guidelines are likely to be applicable also in MS patients. RECOMMENDATIONS IN CASE OF PREVAILING CONSTIPATION( � Sufficient fluid intake (1,5 – 2 L/day), nutrition rich in dietary fibre. � Physiotherapy (standing devices, motor-driven bicycles, colon massage). � Pelvic floor training for relaxation of sphincter muscles, biofeedback. � In case of hardened faeces lactulose or macrogol is recommended except if faecal incontinence is also present. � Facilitation of rectal emptying by glycerine suppositories or rectal filling with fluids. � In single cases: targeted utilisation of „reflexive emptying“ (rectal emptying simultaneously with filled bladder, use of perianal trigger points, avoidance of crude sphincter extension). � Avoidance of anticholinergic and antispastic drugs whenever possible. � In case of painful sphincter spasticity or of paradoxical sphincter-/puborectal contractions injection of low-dose botulinum toxin type A (e.g. 50 – 100 MIU Dysport). � Bowel motility augmenting drugs like metoclopramide and domperidone are of questionable efficacy. EMSP, Symptomatic Treatment of Multiple Sclerosis, December 2006 - revised in April 2008 20
IN CASE OF PREVAILING FAECAL INCONTINENCE � Regular bowel emptying every 3rd – 4th day. � Massive bowel emptying in case of pseudodiarrhoea or “overflow incontinence”. � In women with insufficient pelvic floor muscles but partially maintained sphincter control use of pelvic floor training, combination with intraanal electrical stimulation is possible. � Electromyography in patients with flaccid sphincter to rule out a peripheral neurogenic lesion. � Adaequate aids, e.g. fitted intraanal tampons especially in patients with maintained walking ability. � Meticulous skin care, prevention of pressure sores. 21 EMSP, Symptomatic Treatment of Multiple Sclerosis, December 2006 - revised in April 2008
Page 1 and 2: © EMSP, European Multiple Sclerosi
Page 3 and 4: INTRODUCTION Up to now several evid
Page 5 and 6: SPASTICITY Spasticity in MS is caus
Page 7 and 8: For a discussion of the use of botu
Page 9 and 10: DRUG TREATMENT Oral drug treatment
Page 11 and 12: MS-RELATED PAIN SYNDROMES The frequ
Page 13 and 14: Drug treatment of these pain syndro
Page 15 and 16: BLADDER SYMPTOMS Neurogenic bladder
Page 17 and 18: pressin should only be given to pat
Page 19: RECOMMENDATIONS � Exclusion of bl
Page 23 and 24: placebo [Dula 2000]. Apomorphine ma
Page 25 and 26: Antiepileptics: Primidone may be ef
Page 27 and 28: DRUG TREATMENT So far donepezil and
Page 29 and 30: RECOMMENDATIONS � Counselling as
Page 31 and 32: TRIGEMINAL NEURALGIA Drug treatment
Page 33 and 34: OCULOMOTOR SYMPTOMS During the cour
Page 35 and 36: concepts, e.g. Bobath technique, Pr
Page 37 and 38: DYSPHAGIA Estimates on the frequenc
Page 39 and 40: DRUG TREATMENT Pronounced hypersali
Page 41 and 42: REFERENCES 1. Abrams P, Amarenco G,
Page 43 and 44: injections of botulinum toxin in th
Page 45 and 46: 59. Dieterich M, Straube A, Brandt
Page 47 and 48: proposal for classification and nom
Page 49 and 50: 18. Hoverd PA, Fowler CJ (1998) Des
Page 51 and 52: 146. Lewis RW, Witherington R (1997
Page 53 and 54: 175. Multiple Sklerose - Therapie K
Page 55 and 56: 203. Prosiegel M, Heintze M, Wagner
Page 57 and 58: 232. Schwid SR, Petrie MD, McDermot
Page 59 and 60: 260. The FOOD Trial Collaboration (
Page 61 and 62: 288. Yetimalar Y, Gurgor N, Basoglu

Symptomatic Treatment of MS - European Multiple Sclerosis Platform

Create successful ePaper yourself

Delete template?

Save as template?