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Lower urinary tract dysfunction in acute disseminated encephalomyelitis

Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Indiaj.panicker{at}ion.ucl.ac.uk

D Nagaraja

Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India

JME Kovoor

Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India

KPS Nair

Department of Psychiatric and Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bangalore, India

DK Subbakrishna

Department of Biostatistics, National Institute of Mental Health and Neurosciences Bangalore, India

Background

Lower urinary tract dysfunction (LUTD) in multiple sclerosis has been well documented. However, its occurrence and outcome in acute disseminated encephalomyelitis (ADEM) has only been variably reported.

Objective

To evaluate LUTD in ADEM, correlation with other neurological deficits, and outcome.

Methods

Patients with ADEM having significant LUTD were evaluated. LUTD was evaluated by symptom analysis, ultrasonography, and urodynamics. Storage symptoms were managed using antimuscarinics and significant voiding dysfunction by catheterization.

Results

Of 61 patients, 20 (33%) had LUTD. Voiding dysfunction was more common and 16 patients were in urinary retention. Cystometry demonstrated detrusor overactivity in four patients and underactivity in four patients. Incontinence was reported more often in patients with frontoparietal white matter changes in MR imaging. LUTD was found to be associated with occurrence of paraparesis or tetraparesis, though did not predict functional outcome at discharge. At 3 months follow up, five patients continued to have LUTD and urgency and hesitancy were commonest symptoms.

Conclusion

LUTD is common in ADEM, especially in patients with lower limb pyramidal involvement and its causes multifactorial. Presence of LUTD does not influence the functional outcome of patients with ADEM. Recovery may be incomplete and symptoms may persist even after recovery of other neurological deficits.

Key Words: ADEM • bladder • cystometry • incontinence • lower urinary tract dysfunction • micturition disturbances • outcome

This version was published on September 1, 2009

Multiple Sclerosis, Vol. 15, No. 9, 1118-1122 (2009)
DOI: 10.1177/1352458509106614


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