Abstract
The central and peripheral motor pathways serving striated sphincter muscle function were studied using cortical and lumbar transcutaneous electrical stimulation, pudendal nerve stimulation and sphincter electromyography in 23 patients with multiple sclerosis (MS), and sphincter disturbance, including incontinence of urine or faeces, urinary voiding dysfunction, or constipation. The central motor conduction time was significantly increased in the MS group compared to controls (p less than 0.05). Damage to both the upper and lower motor neuron pathways can contribute to sphincter disturbance in MS. The latter may be due to coexisting pathology or to involvement of the conus medullaris by MS.
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- Bartram C. I., Turnbull G. K., Lennard-Jones J. E. Evacuation proctography: an investigation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol. 1988;13(1):72–80. doi: 10.1007/BF01889028. [DOI] [PubMed] [Google Scholar]
- Blaivas J. G. The neurophysiology of micturition: a clinical study of 550 patients. J Urol. 1982 May;127(5):958–963. doi: 10.1016/s0022-5347(17)54147-6. [DOI] [PubMed] [Google Scholar]
- Cowan J. M., Rothwell J. C., Dick J. P., Thompson P. D., Day B. L., Marsden C. D. Abnormalities in central motor pathway conduction in multiple sclerosis. Lancet. 1984 Aug 11;2(8398):304–307. doi: 10.1016/s0140-6736(84)92683-7. [DOI] [PubMed] [Google Scholar]
- FLOYD W. F., WALLS E. W. Electromyography of the sphincter ani externus in man. J Physiol. 1953 Dec 29;122(3):599–609. doi: 10.1113/jphysiol.1953.sp005024. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Fowler C. J., Kirby R. S., Harrison M. J., Milroy E. J., Turner-Warwick R. Individual motor unit analysis in the diagnosis of disorders of urethral sphincter innervation. J Neurol Neurosurg Psychiatry. 1984 Jun;47(6):637–641. doi: 10.1136/jnnp.47.6.637. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Glick M. E., Meshkinpour H., Haldeman S., Bhatia N. N., Bradley W. E. Colonic dysfunction in multiple sclerosis. Gastroenterology. 1982 Nov;83(5):1002–1007. [PubMed] [Google Scholar]
- Henry M. M., Simson J. N. Results of postanal repair: a retrospective study. Br J Surg. 1985 Sep;72 (Suppl):S17–S19. doi: 10.1002/bjs.1800721312. [DOI] [PubMed] [Google Scholar]
- Henry M. M., Snooks S. J., Barnes P. R., Swash M. Investigation of disorders of the anorectum and colon. Ann R Coll Surg Engl. 1985 Nov;67(6):355–360. [PMC free article] [PubMed] [Google Scholar]
- Holstege G., Tan J. Supraspinal control of motoneurons innervating the striated muscles of the pelvic floor including urethral and anal sphincters in the cat. Brain. 1987 Oct;110(Pt 5):1323–1344. doi: 10.1093/brain/110.5.1323. [DOI] [PubMed] [Google Scholar]
- Ingram D. A., Thompson A. J., Swash M. Central motor conduction in multiple sclerosis: evaluation of abnormalities revealed by transcutaneous magnetic stimulation of the brain. J Neurol Neurosurg Psychiatry. 1988 Apr;51(4):487–494. doi: 10.1136/jnnp.51.4.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
- KURTZKE J. F. FURTHER NOTES ON DISABILITY EVALUATION IN MULTIPLE SCLEROSIS, WITH SCALE MODIFICATIONS. Neurology. 1965 Jul;15:654–661. doi: 10.1212/wnl.15.7.654. [DOI] [PubMed] [Google Scholar]
- Kamm M. A., Hawley P. R., Lennard-Jones J. E. Lateral division of the puborectalis muscle in the management of severe constipation. Br J Surg. 1988 Jul;75(7):661–663. doi: 10.1002/bjs.1800750713. [DOI] [PubMed] [Google Scholar]
- Kiff E. S., Swash M. Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence. Br J Surg. 1984 Aug;71(8):614–616. doi: 10.1002/bjs.1800710817. [DOI] [PubMed] [Google Scholar]
- MILLER H., SIMPSON C. A., YEATES W. K. BLADDER DYSFUNCTION IN MULTIPLE SCLEROSIS. Br Med J. 1965 May 15;1(5445):1265–1269. doi: 10.1136/bmj.1.5445.1265. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Maertens de Noordhout A., Rothwell J. C., Thompson P. D., Day B. L., Marsden C. D. Percutaneous electrical stimulation of lumbosacral roots in man. J Neurol Neurosurg Psychiatry. 1988 Feb;51(2):174–181. doi: 10.1136/jnnp.51.2.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Mathers S. E., Kempster P. A., Swash M., Lees A. J. Constipation and paradoxical puborectalis contraction in anismus and Parkinson's disease: a dystonic phenomenon? J Neurol Neurosurg Psychiatry. 1988 Dec;51(12):1503–1507. doi: 10.1136/jnnp.51.12.1503. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Merton P. A., Hill D. K., Morton H. B., Marsden C. D. Scope of a technique for electrical stimulation of human brain, spinal cord, and muscle. Lancet. 1982 Sep 11;2(8298):597–600. doi: 10.1016/s0140-6736(82)90670-5. [DOI] [PubMed] [Google Scholar]
- Mills K. R., Murray N. M. Corticospinal tract conduction time in multiple sclerosis. Ann Neurol. 1985 Nov;18(5):601–605. doi: 10.1002/ana.410180514. [DOI] [PubMed] [Google Scholar]
- NATHAN P. W., SMITH M. C. Spinal pathways subserving defaecation and sensation from the lower bowel. J Neurol Neurosurg Psychiatry. 1953 Nov;16(4):245–256. doi: 10.1136/jnnp.16.4.245. [DOI] [PMC free article] [PubMed] [Google Scholar]
- NATHAN P. W., SMITH M. C. The centrifugal pathway for micturition within the spinal cord. J Neurol Neurosurg Psychiatry. 1958 Aug;21(3):177–189. doi: 10.1136/jnnp.21.3.177. [DOI] [PMC free article] [PubMed] [Google Scholar]
- NATHAN P. W., SMITH M. C. The centripetal pathway from the bladder and urethra within the spinal cord. J Neurol Neurosurg Psychiatry. 1951 Nov;14(4):262–280. doi: 10.1136/jnnp.14.4.262. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nakagawa S. Onuf's nucleus of the sacral cord in a South American monkey (Saimiri): its location and bilateral cortical input from area 4. Brain Res. 1980 Jun 9;191(2):337–344. doi: 10.1016/0006-8993(80)91285-8. [DOI] [PubMed] [Google Scholar]
- Neill M. E., Parks A. G., Swash M. Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse. Br J Surg. 1981 Aug;68(8):531–536. doi: 10.1002/bjs.1800680804. [DOI] [PubMed] [Google Scholar]
- Neill M. E., Swash M. Increased motor unit fibre density in the external anal sphincter muscle in ano-rectal incontinence: a single fibre EMG study. J Neurol Neurosurg Psychiatry. 1980 Apr;43(4):343–347. doi: 10.1136/jnnp.43.4.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Snooks S. J., Swash M. Motor conduction velocity in the human spinal cord: slowed conduction in multiple sclerosis and radiation myelopathy. J Neurol Neurosurg Psychiatry. 1985 Nov;48(11):1135–1139. doi: 10.1136/jnnp.48.11.1135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Swash M., Snooks S. J., Chalmers D. H. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol. 1987 May;44(5):504–508. doi: 10.1001/archneur.1987.00520170034018. [DOI] [PubMed] [Google Scholar]
- Swash M., Snooks S. J. Slowed motor conduction in lumbosacral nerve roots in cauda equina lesions: a new diagnostic technique. J Neurol Neurosurg Psychiatry. 1986 Jul;49(7):808–816. doi: 10.1136/jnnp.49.7.808. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Taylor M. C., Bradley W. E., Bhatia N., Glick M., Haldeman S. The conus demyelination syndrome in multiple sclerosis. Acta Neurol Scand. 1984 Feb;69(2):80–89. doi: 10.1111/j.1600-0404.1984.tb07783.x. [DOI] [PubMed] [Google Scholar]
- Weber J., Grise P., Roquebert M., Hellot M. F., Mihout B., Samson M., Beuret-Blanquart F., Pasquis P., Denis P. Radiopaque markers transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction. Dis Colon Rectum. 1987 Feb;30(2):95–100. doi: 10.1007/BF02554940. [DOI] [PubMed] [Google Scholar]