Treatment hope for urinary incontinence with multiple sclerosis or spinal cord injury
Two new treatments — cannabinoids and botulinum toxin — have been shown to have some clinical benefit in treating urinary incontinence related to multiple sclerosis or spinal cord injury.
The cannabinoid data come from the Medical Research Council-funded CAMS
(cannabinoids in multiple sclerosis) trial. The main trial, assessing
effects on spasticity, was published last year (PJ, November
15, 2003, p672). The investigators have now reported data from a sub-study
assessing
whether treatment has any effect on lower urinary tract symptoms, a common
problem in patients with longstanding multiple sclerosis. They report
a significant reduction in urge incontinence episodes in the cannabinoid
group compared with placebo, but no changes in quality of life measures.
The botulinum study was a placebo-controlled European trial in 59 patients
with incontinence caused by neurogenic detrusor overactivity associated
with multiple sclerosis or
spinal cord injury.
Treatment involved a single treatment of botulinum toxin type A (Botox)
or placebo, given as 30 injections into the detrusor muscle. Patients
were followed up for 24 weeks. There was a rapid and sustained reduction
in incontinence episodes in the botulinum-treated patients, and low incidence
of side
effects. Urodynamic tests also showed
improvements in bladder function.
Both studies were reported at the International
Continence Society conference
in Paris at the end of August. |
The
Pharmaceutical Journal
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