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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 盧星華 | 以Gabapentin治療神經因性膀胱過動症 | 2006/12/21 下午 04:52:59 | 0 |
| 原 文 | 題 目 | Gabapentin treatment of neurogenic overactive bladder. |
| 作 者 | Antonio, Carbone. Giovanni, Palleschi. Conte, Antonella. Gino, Bova. Elisa, Iacovelli. Chiara, Marini Bettolo. Antonio, Pastore. Maurizio, Inghilleri. | |
| 出 處 | Clinical Neuropharmacology | |
| 出版日期 | 2006 | |
| 評 論 |
膀胱逼尿肌過度活動(Detrusor overativity)是使病患產生膀胱過動症(Overative Bladder)症狀的主要原因，症狀以急尿、頻尿為主，非常困擾著病患。 許多藥物被用來治療神經因性逼尿肌過度活動，但是結果並不如預期的好。這可能是因為對其病理生理層面的了解不足所致。最近許多研究認為膀胱內的接受器，膀胱傳入神經活性及脊隨神經反射中心之活動，均與膀胱逼尿肌收縮有密切相關。 本篇文章出自Clinical Neuropharmacology醫學期刊，由義大利羅馬大學神經科學學系Dr. Antonio評估，gabapentin藥物用於治療神經因性逼尿肌過度活動的效果，此種藥物原來是一種抗癲癇藥物及治療神經疼痛的藥物。此一研究共收集了60位病患，以症狀評分、排尿日誌及尿流動力學檢查評估其療效。結果症狀評分及排尿日誌顯示，其刺激性症狀明顯改善，IPSS評分治療後由14.8降為8.8 ，尿流動力學檢查顯示其逼尿肌過度活動情形顯著減少，其first desire to void由121.25±25.9 ml增加為140.19±35.2 ml(p=0.021)，其maximum cystometric capacity由342±99 ml增加為430±98 ml(p=0.05)。 本文提供神經因性逼尿肌過度活動之另一治療新選擇，藉由調控膀胱之傳入神經活性及薦椎神經反射中心而達到治療的目標。希望有助於突破此種疾病治療之瓶頸。 |
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| abstract | Detrusor overactivity is a well-recognized and distressing medical condition affecting both men and women, with a significant prevalence in the population and with a higher incidence rate in people older than 70 years. This pathological condition is characterized by irritative symptoms: urinary urgency, with or without incontinence, and urinary frequency, often seriously compromising the quality of life of the people who have it. The complaint of these symptoms is defined by the International Continence Society (www.continet.org) as "overactive bladder." Many neurological patients experience irritative symptoms of the lower urinary tract related to their disease, and this condition drastically limits their social life. Various drugs have been introduced in therapy protocols to treat neurogenic detrusor overactivity; however, in many cases, the outcomes of these treatments have proven to be unsatisfactory. This fact is probably related to the incomplete understanding of the pathophysiological aspects of detrusor overactivity. Recent studies suggest the possible role in the detrusor overactivity pathogenesis of bladder receptors, afferent pathways, and spinal cord interneurons; consequently, the modulation of bladder receptor and/or spinal cord centers activity has been proposed as a possible approach to control involuntary detrusor contractions, using drugs capable of acting on bladder afferent pathways.The aim of this study was to evaluate the efficacy of gabapentin, an anticonvulsive agent used by neurologists in the treatment of epilepsy and neurogenic pain, in the treatment of detrusor overactivity of neurogenic origin. METHODS: Sixteen patients affected by neurogenic overactive bladder were enrolled in the study. The clinical outcomes were assessed by symptomatic score evaluations, voiding diary, and urodynamic test before and after 31 days of gabapentin treatment. RESULTS: The preliminary results showed significant modifications of urodynamic indexes, particularly of the detrusor overactivity, whereas the symptomatic score evaluation and the voiding diary data demonstrated a significant lowering of the irritative symptoms. Furthermore, we did not record significant adverse effects and no patient interrupted the drug treatment. CONCLUSIONS: These data support the rationale that detrusor overactivity may be controlled by modulating the afferent input from the bladder and the excitability of the sacral reflex center and suggest a novel method to treat overactive bladder patients. | |
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