الفهرس 
Effect of Electrical Neuromodulation on Over Active Bladder in Patients with Multiple Sclerosis
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Abstract
Multiple Sclerosis (MS) is a central nervous system demyelinating disease which causes different neurological manifestations. A major clinical presentation of MS is bladder and bowel problems. Neurogenic detrusor overactivity and detrusor sphincter dyssynergia are common bladder dysfunction in MS patients. Purpose: To assess and investigate the efficacy of posterior tibial nerve stimulation (PTNS) on neurogenic over active bladder (NOAB) in multiple sclerosis patients. Methods: Forty male remitting relapsing MS patients (RRMS) with moderate overactive bladder symptoms represented the sample of the study. Their ages ranged from 20 to 40 years. The Patients were assigned randomly into two equal groups; the study group (GA) was treated by a program of therapeutic exercises directed mainly for strengthening the pelvic floor muscles plus transcutaneous posterior tibial nerve stimulation while the control group (GB) was treated only by the same program of therapeutic exercises, three sessions per week for one month. The duration of each session ranged from for 45-50 minutes. Pre and post treatment evaluation was done for each patient in both groups by Overactive Bladder Symptom Score (OABSS) and urodynamics tests. The Overactive Bladder Symptom Score (OABSS) included daytime frequency, nocturia, urgency, and urgency in¬continence while the urodynamics tests included bladder capacity, maximum flow rate, bladder compliance and detrusor instability. Also, post voiding residual urine was measured by abdominal ultrasound. Results: Post treatment, a significant improvement was observed in all measured variables except the day time frequency. A significant decrease in post voiding residual urine and mean episodes number of night time frequency, urgency and urgency incontinence with significant increase in the bladder capacity, maximum flow rate and bladder compliance were detected post treatment in the study group (GA) (P<0.05). Also, there was a significant decrease in the median total OABSS and frequency distribution of the detrusor instability (P<0.05). Conclusion: Therapeutic physical therapy program has appositive effect on over active bladder symptoms. Adding PTNS to this program increase the significant effect for treatment of the OAB symptoms in MS patients