Bladder dysfunction is one of the most disturbing symptoms of MS. The frequency of
bladder dysfunction in patients with MS is reported to be %52-97. Urinary symptoms are
among the initial symptoms in %10-15 of patients, while it is the only initial symptom in
up to %2 of patients. Patients is seen with irritative symptoms (such as frequent
urination, urgency, urinary incontinence, nocturia), obstructive symptoms (such as
difficulty in initiating urination, inability to urinate, feeling of incomplete emptying,
weak urine flow) or mixed type symptoms.In line with these symptoms, early evaluation of
MS patients in terms of urinary system, planning of appropriate treatment and regular
follow-up are extremely important in terms of preventing urinary system complications.
Pharmacotherapy and clean intermittent catheterization are the first step treatments for
lower urinary tract symptoms in multiple sclerosis. It has been reported in the
literature that electrical nerve stimulation therapy (neuromodulation methods) and
behavior change methods (pelvic floor muscle exercise, bladder training, urinary diary
keeping) are also used as a second step treatment option due to the side effects of
anticholinergic use and lack of motivation and skill in catheterization. It is reported
that neuromodulation applications are performed in MS patients and it is a reliable
method. Deep brain stimulation, transcranial magnetic stimulation, posterior tibial nerve
stimulation, sacral neuromodulation and spinal cord stimulation are generally recommended
in the treatment of bladder dysfunction, which is one of the neuromodulation methods. The
superiority of these methods to each other is debatable. In line with this information,
the aim of the study is to compare the effectiveness of different neuromodulation
techniques, transcutaneous posterior tibial nerve stimulation and repetitive transcranial
magnetic stimulation, in MS patients reporting lower urinary tract symptoms.
According to the treatment protocols of the patients to be included in the study; will be
divided into 2 groups as transcutaneous posterior tibial nerve stimulation group (8
patients) and repetitive transcranial magnetic stimulation group (8 patients). Which
method will be applied to which individual will be determined randomly. Treatment
sessions will be carried out for 5 consecutive days in 2 consecutive weeks, 1 time per
day for a total of 10 sessions. The urological parameters of the patients in all groups
will be evaluated before and after the treatment.
Statistical method(s); Statistical analysis of the data obtained from the study will be
done in the Statistical Package for the Social Sciences (SPSS) 22.0 package program. The
mean standard deviation, median, minimum and maximum values will be used to define the
data. Comparison of continuous variables between groups will be done with Mann Whitney U
test, comparison of discrete variables will be done with chi-square test. Spearman or
Pearson correlation test will be used to evaluate the correlation between variables. In
the data analysis, p < 0.05 level will be considered statistically significant.
