Combined antimuscarinics for treatment of neurogenic overactive bladder.

Antimuscarinic drugs are the first line pharmacotherapy for overactive bladder, but they are not always effective to achieve complete continence. Nevertheless in some patients urodynamic investigations reveal insufficient effects with continuing incontinence events even with dose optimization. The aim of this study is to evaluate the effect of association of Oxybutynin chloride, Trospium chloride and Solifenacin succinate administered orally for a minimum of 12 weeks in subjects with suprasacral spinal cord injury with urge-incontinence, urodynamic–proven neurogenic detrusor overactivity dysfunction and detrusor-external sphincter dyssynergia to improve level of continence, reduce the risks of urologic complications and enhance QOL. This study was a randomized, double blind, controlled, balanced-parallel-groups investigation of orally administed Oxybutynin in addition to Trospium chloride in the first group and Oxybutynin in addition to Solifenacin in the other group. A total of 12 patients with neurogenic detrusor overactivity and clean intermittent catheterization were allocated into two treatment groups: 5 mg tablet of Oxibutinin and 20 mg tablet of Trospium Chloride were administered respectively 3 times a day and 4 times a day in the first group (Group A). 5 mg tablet of Oxibutinin and 10 mg tablet of Solifenacin were administered respective 3 times a day and once daily in the second group (Group B). In both group of patients we found a significant decrease in incontinence episodes, with an improvement of bladder compliance, bladder capacity and volume voided. Side effects were higher in patients of group B, but in generally well tolerated. In conclusion, a combined antimuscarinic treatment might be a right option for patients affected by neurogenic bladder refractory to previous antimuscarinic monotherapy, and might slow down or delay other more invasive treatments.

[Effects of noise on cortical mechanisms involved in the development of linguistic sounds]. / Effetti del rumore sui meccanismi corticali di elaborazione dei suoni linguistici.

So far studies about noise effects on speech perception have been focused on the development of hearing loss and other related pathologies. However, behavioral findings indicate that speech perception and intelligibility are disrupted in presence of noise in certain clinical groups in a way that is unpredictable on the basis of the audiogram performed in silence. This observation suggests that even soft noise can modify the cerebral mechanisms underlying speech information processing. Confirming the behavioral results, electric and magnetic brain measurements showed that noise presented to healthy subjects decreases the amplitude and increases the latency of brain responses to speech sounds. Recently, further experimental data allowed us to have a deeper knowledge of the neural mechanisms interventing in difficult listening conditions. In particolar, speech sounds presented in noisy background evoke bioelectric responses in neural populations located in the right cerebral hemisphere, that otherwise would not be activated. These findings can in future contribute to unveal new aspects of the noise pathology and its assessment in an early pre-clinical stage.

Urodynamic evaluation of 12 ataxic subjects: neurophysiopathologic considerations.

Twelve ataxic subjects (seven with Friedreich's heredo-ataxia and five with a cerebellar vascular or traumatic lesion) were examined by way of urodynamic evaluation. The results explain the role the cerebellum plays in the modulation of the micturition reflex and confirm the importance of bilateral encephalic damage in causing vesico-sphincteral malfunctioning and the important role of the lateral myelon cords in transporting bladder proprioceptive sensitivity.