Search

Background Sexual function can be altered in patients by many neurological disorders affecting the cerebrum, the brain stem, the spinal cord, the spinal roots or the peripheral nerves. It can also be prominently affected in patients with an underlying undiagnosed neurological disease. Traditionally, practising neurologists have not paid much attention to sexual dysfunction in their patients, partly because therapeutic possibilities were scant. Sexual dysfunction, however, is observed in many neurological disorders, and may arise as a primary neurogenic disorder. Although not as obviously limiting as, for instance, paresis and pain, it is most disruptive for patients' lives. With emerging awareness of the primary importance of quality of life as the most important indicator of good patient management, and with the advent of more effective treatment of sexual dysfunction, it is no longer acceptable to ignore this very important dimension of life. In this review we will present the anatomical and physiological basis of the sexual response, the clinical approach to patients with sexual dysfunction, the characteristics of symptoms in neurological disorders, how to take a case history, diagnostic procedures and the treatment possibilities. [ABSTRACT FROM AUTHOR]

Motor end plate jitter was studied by single fibre EMG in the orbicularis oculi muscle of eight patients with facioscapulohumeral dystrophy activated by extramuscular nerve stimulation. The jitter was found to be slightly larger in comparison with the normal controls, although still within the normal limits in each patient. The findings are considered to indicate absence of any significant neuromuscular transmission disturbance, inflammatory or regenerative process, or reinnervation in progress. There was no evidence of muscle fibre conduction abnormality even in very weak muscle. [ABSTRACT FROM AUTHOR]

Responses in the external anal and urethral sphincters as well as in the bulbocavernosus muscle have been evoked by supramaximal electrical stimulation of the penis (or clitoris), perineum and the peri-anal region and recorded electromyographically in 82 male subjects 5 to 73 years old and in nine female subjects 18 to 55 years old, who had no systemic diseases or demonstrable sacral nervous system lesion. On perineal stimulation (including the penis or clitoris) reflex responses with a typical latency of 33 ms and which exhibit no habituation were obtained in all muscles examined. Stimulation of the peri-anal region gave habituating reflex responses with a typical latency of 55 ms in all muscles examined. On perineal, and sometimes also peri-anal stimulation, stable short latency responses with typical latencies of 5 and 13 ms were recorded; both were considered to be direct responses. The different evoked muscle responses obtained by stimulation in the perineal and peri-anal region have to be distinguished when the bulbocavernosus and anal reflexes are recorded for evaluation of sacral nervous system lesions. [ABSTRACT FROM AUTHOR]

Copyright of Archives of Gynecology & Obstetrics is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

EMG of pelvic floor muscles, single fibre EMG of external anal sphincter and both bulbocavernosus and anal reflexes were investigated in 31 men without sacral nervous system lesions and in 12 patients with neurogenic erectile impotence, of whom one had slight loss of sensitivity to pinprick in the lower sacral dermatomes. EMG and single fibre EMG abnormalities have been found concomitantly in eight patients and six of these had also prolonged bulbocavernosus reflex latencies. In two patients the prolonged bulbocavernosus reflex latency was the only abnormality. Single fibre EMG of anal sphincter muscle seems to be superfluous in routine evaluation of sacral nervous system lesions. [ABSTRACT FROM AUTHOR]

Prolonged-release fampridine (fampridine PR) is a potassium channel blocker that improves conductivity of signal on demyelinated axons in central nervous system. Fampridine PR has been approved to improve speed of walking in patients with multiple sclerosis. This statement provides a brief summary of data on fampridine PR and recommendations on practical use of the medication in clinical practice, prediction, and evaluation of response to treatment and patient management., (© 2013 Blackwell Publishing Ltd.)

For more than two decades Mini-Mental State Examination (MMSE) has been adapted to the Slovenian language as 'Kratek preizkus spoznavnih sposobnosti' (KPSS). In this study, we evaluated the influences of age and education on the KPSS score, looking for the cut-off point with the optimal ratio of sensitivity (SE) and specificity (SP) to support the use of the KPSS as a screening tool. During the years 2000-03 we examined 258 Slovenian volunteers. Volunteers were divided in two groups based on clinical criteria. A total of 189 were healthy, aged from 45 to 96 years, 69 were demented patients aged from 46 to 91 years, of both sexes, all different levels of education and different degrees of dementia. Median value, SE, SP, positive predictive power and negative predictive power were calculated at cut-off points 23/24, 24/25, 25/26 and 26/27. Younger age and higher education (at least 10 years of education) were each associated with higher KPSS scores. The Slovenian modification of the MMSE demonstrates an optimal cut-off score at 25/26 points for screening dementia in the Slovenian population, due to the best SP (75%)/SE (73%) ratio. The cut-off level 26/27 is recommended for screening highly educated persons.

Multiple system atrophy (MSA) is a degenerative disease manifesting a combination of parkinsonism, cerebellar, pyramidal, and autonomic (including urinary, sexual and anorectal) dysfunction. It is pathomorphologically defined, but lacks a definitive clinical diagnostic test. In patients with probable MSA, abnormal sphincter EMG, as compared to control subjects, has been found in the majority of patients in all the different forms of the disease in most studies, including patients who, as yet, have no urological or anorectal problems. Patients with Parkinson's disease (PD) as a rule do not show marked sphincter EMG abnormalities in the first five years of the disease. Thus, abnormal spontaneous activity or marked motor unit potential changes in sphincter muscles are helpful in distinguishing MSA from PD in the first five years after the onset of symptoms and signs, and from pure autonomic failure, as well as from cerebellar ataxias, if other causes for sphincter denervation have been ruled out. EMG does not distinguish MSA from progressive supranuclear palsy. How early in the course of MSA these abnormalities become significant enough to support diagnosis remains to be established by prospective studies.

Objective: To investigate the effects of cauda equina lesions on sexual function in men., Methods: Sexual function was investigated in 46 men with long standing cauda equina/conus medullaris lesions. All had clinical and radiological findings supporting the diagnosis. The validated Slovene translation of the international index of erectile function (IIEF) was used. The responses were scored and sexual dysfunction categorised as absent, mild, moderate, or severe. The number of patients receiving help for sexual dysfunction was noted. Neurological examination of the trunk and lower limbs, electromyographic (EMG) evaluation of the sacral reflex, and quantitative EMG of the external anal sphincter muscles were done., Results: Severe sexual dysfunction was reported by 35% of patients, moderate dysfunction by 24%, and slight dysfunction by 26%; normal sexual function was reported by 15%. Orgasmic function was slightly more impaired than erectile function, and sexual desire slightly less. The patients' age, but no findings on clinical neurological or EMG examination, correlated with sexual function. Only five men had received medical attention for sexual dysfunction., Conclusions: There is significant sexual impairment in men with lesions of the cauda equina or conus medullaris. This is poorly correlated with neurological and EMG findings and has received insufficient medical attention.

The external anal sphincter (EAS) has continuously active low-threshold and recruitable high-threshold motor units (MUs), the latter being 'larger'. On performing concentric needle electromyography (EMG) of the EAS, the high-threshold MUs seemed to reveal more neuropathic changes than the low-threshold MUs. To verify this hypothesis, low- and high-threshold motor unit potentials (MUPs) were compared in patients with neuropathic EAS and controls. Fifteen subjects without pelvic disorders and 29 patients with sequela after cauda equina lesions were studied. In patients, only muscles ipsilateral to severe perianal sensory loss were included. MUPs were sampled using multi-MUP analysis during relaxation ('low-threshold'), and on activation ('high-threshold' MUs). MUP parameters of low- and high-threshold MUs from controls and patients were compared, as was the sensitivity and specificity with which MUPs were classified as normal or pathological (using discriminant analysis). MUP changes due to reinnervation, and the sensitivity and specificity in classifying MUPs as normal or pathological were not significantly different between the low- and high-threshold MUPs. Stronger activation of EAS does not improve discrimination between neuropathic and normal MUPs. New EMG techniques for sampling sphincter MUPs at higher activation levels would seem not to yield additional information.

Clinical neurophysiological tests have been introduced for the sacral neuromuscular system to aid with diagnosis of neurogenic conditions involving the lower urinary tract, anorectal and sexual dysfunction. The tests have, however, the potential to be of value in different interventions outside of the neurophysiological laboratory. EMG monitoring can be used for exact application of botulinum toxin by the relatively non-invasive transcutaneous approach in treatment of male detrusor sphincter dyssynergia. Checking for compound muscle action potentials of the external anal sphincter is proposed as the best method for exact placement of wire electrodes close to the 3rd sacral roots in treating lower urinary tract dysfunction by 'neuromodulation'. Presently the most established use of clinical neurophysiological techniques--outside the laboratory--as related to the sacral neuromuscular system is in the operating theatre. These tests have been introduced to identify relevant structures, for instance pudendal afferents within dorsal sacral roots, which should be spared during rhizotomy procedures for treatment of spasticity. Modified techniques are used intraoperatively to monitor the integrity of the lower sacral reflex arc (the bulbocavernosus reflex) or the lower sacral afferents throughout the spinal cord (pudendal SEP). Clinical neurophysiological tests are expected to become established in several interventions involving the sacral neuromuscular system.

Multiple system atrophy (MSA) is a degenerative disease manifesting a combination of parkinsonism, cerebellar, pyramidal, and autonomic (including urinary, sexual, and anorectal) dysfunction. It is pathomorphologically defined, but lacks a definitive clinical diagnostic test. Sphincter electromyography (EMG), reflecting Onuf's nucleus degeneration, has been proposed as a helpful test; its value has been reevaluated by a critical review of the literature. In patients with probable MSA, abnormal sphincter EMG, as compared to control subjects, has been found in the majority of patients in all the different forms of the disease in most studies, including patients who, as yet, have no urological or anorectal problems. The prevalence of abnormalities in the early stages of MSA is as yet unclear. Patients with Parkinson's disease (PD) as a rule do not show severe sphincter EMG abnormalities in the early stage of the disease. Anal sphincter EMG abnormalities (abnormal spontaneous activity or motor unit potential changes three standard deviations above valid control data) distinguish MSA from PD in the first 5 years after the onset of symptoms and signs, and from pure autonomic failure, as well as from cerebellar ataxias, if other causes for sphincter denervation have been ruled out. With such criteria, the sensitivity of the method is, however, low. EMG does not distinguish MSA from progressive supranuclear palsy. Future studies should use standardized anal sphincter EMG to better compare results from different centers and precisely define the sensitivity and specificity of the method., (Copyright 2001 Movement Disorder Society.)

Objective: To evaluate the mobility of the vesical neck during coughing and valsalva in healthy nulliparous volunteers and to test the reliability of the technique applied., Design: Clinical observational study., Setting: Department of Obstetrics and Gynaecology, Cantonal Hospital Lucerne, Switzerland., Population: Thirty-nine nulliparous volunteers., Methods: Vesical neck motion was assessed with perineal ultrasound. Intra-abdominal pressure was controlled for with an intrarectal probe. Intra-rater reliability was evaluated., Results: Vesical neck mobility was significantly lower during coughing (8 mm, SD 4 mm) than during valsalva (15 mm, SD 10 mm) (P < 0.005). Between individuals mobility varied from 4 mm to 32 mm during coughing and from 2 mm to 31 mm during valsalva. Test-retest-studies showed a maximum difference between to tests during coughing of 4 mm and during valsalva of 5 mm., Conclusion: The bladder neck is mobile in normal continent women and bladder neck mobility is lower during coughing than during Valsalva.

Clinical neurophysiologic examination of the pelvic floor is performed worldwide, but there is no consensus on the choice of tests, nor on technical details of individual methods. Standardized methods are, however, necessary to obtain their valid application in different laboratories for the purpose of collection of normative data, comparison of patient data and organization of multi-center studies. It is proposed that in patients with suspected "lower motor neuron" type lesions concentric needle electromyography (CNEMG) is the most informative test to detect pelvic floor denervation/reinnervation, and the external anal sphincter (EAS) muscle is the most appropriate muscle to be examined (either in isolation-when a selective lesion is suspected-or in addition to examination of other muscles). An algorithm consisting of standardized tests including a standardized approach to CNEMG examination of the EAS is presented. The proposed electrophysiologic assessment consists of a computer-assisted analysis of denervation and reinnervation features of the CNEMG signal, a qualitative assessment of reflex and voluntary activation of EAS motor units, and of electrical (or mechanical) elicitation of the bulbocavernosus reflex in those patients in whom manual anogenital stimulation failed to elicit a robust response in the EAS. The proposed protocol could serve as a basis for further studies on validity, sensitivity and specificity of electrophysiologic assessment in patients with different types of "lower motor neuron" involvement of pelvic floor muscles and sacral dysfunction., (Copyright 2001 Wiley-Liss, Inc.)