Multiple Sclerose/ Urinewegen Multiple Sclerose / Blaasproblemen 2 MS: > 90% blaasproblemen Heel lichte – zeer hinderlijke incontinentie 3 Ontbreken van zenuwgeleiding 4 Multiple Sclerose • Focale neuronale demyelinisatie • Sparen AXON • Zenuw geleidingsstoornissen 5 Neural control of the bladder •Brain •1 •Mechanoreceptors respond to •Sensory afferents bladder filling and relay afferent •Motor efferents •Pontine •Somatic efferents micturition •Central interneurons centre •4 signals to the spinal cord •2 •Sympathetic efferent signals return to bladder and relax the detrusor muscle •3 •Somatic efferents contract •1 the EUS. Urine is STORED •Urinary bladder •4 •When a threshold is reached, the PMC is activated •5 •Parasympathetic efferents •Stretch signal for the detrusor to •2 •Sacral region of •5 the spinal cord from the somatic nervous •External urethral sphincter contract •6 •If timely to urinate, signals •3 •6 EUS, external urethral sphincter; pontine Adapted from Andersson KE, et PMC, al. Pharmacological treatment of micturition centre. urinary incontinence. 3rd International Consultation on Incontinence. Monaco, June 26– 29, 2004. system relax the EUS. Urine is VOIDED 6 7 Overactieve blaas Meer dan 80% van de MS patiënten 8 Overactieve blaas Vaak en dringend moeten plassen 9 BEHANDELING Beginnende MS: oefeningen van de bekkenbodemspieren 10 BEHANDELING medicamenteus Verminderd de samentrekkingskracht van de blaas 11 Therapie (medicamenteus) • Antimuscarine middelen • Oxybutynine • Tolderodine • Solifenacine • Darifenacine • Festoterodine • Mirabegron 12 13 Therapie: Botuline Toxine 14 BEHANDELING Gevorderde MS: blaasledigingsstoornissen Teveel urine in de blaas: kans op UWI Regelmatig blaas katheteriseren / permanente blaaskatheter 15 Nieuwe ontwikkelingen •Effect van Cannabis op de blaasproblemen •Resiniferatoxin 16
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