Objective: To undertake a systematic review of the literature on peripheral neuromodulation techniques for the treatment of bladder symptoms in Parkinson’s disease (PD).

Background: Bladder symptoms are frequent in individuals with PD. Unfortunately these can be challenging to treat, with patients prone to cognitive and gait side-effects associated with anti-muscarinic medications. This has led to interest in non-pharmacological modalities of treatment. Tibial nerve stimulation (TNs) is undertaken by either percutaneous needle stimulation or via the transcutaneous route without breaking skin, which is increasingly popular. Sacral nerve modulation (SNM) involves the implantation sacral nerve electrodes coupled to a small device under the skin. Both are utilised in the specialist urology settings with an evidence base for addressing non-neurogenic bladder symptoms.

Method: A systematic review of the literature was undertaken using the MEDLINE database following PRISMA guidelines. Inclusion criteria were articles on neuromodulation techniques for bladder symptoms, at least one patient with PD and an abstract in English. Papers were assessed for study designs and outcome measures.

Results: Eighteen articles were identified, thirteen for TNS and five for SNM.  Studies consisted of populations solely concerning PD (n=10) or were included in a “neurogenic bladder” cohort (n=8). The majority of studies were case-series however four TNM randomised control trials (RCTs) were available. 16 out of 18 studies demonstrated improvement in outcome measures; most commonly daytime-urgency and frequency values from self-reported bladder diaries, followed by questionnaire scores and urodynamic assessment. For the eight studies except one where PD patients were included in an overall neurogenic bladder cohort, it was not possible to isolate outcomes specifically for the PD subgroup. Across the TNS studies, the incidence of adverse events was very low. The RCTs used different approaches to the placebo arm and all studies used varying stimulation parameters, including stimulation frequency (Hz), session duration and number of sessions per week.

Conclusion: Neuromodulation techniques may hold potential for treating bladder symptoms in the PD population and TNM in particular is well tolerated. Future high quality large-scale double blind trials are required to enhance the evidence base for TNM effectiveness and guide management policy.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/peripheral-neuromodulation-for-the-treatment-of-bladder-symptoms-associated-with-parkinsons-disease/