Objective: to verify if a treatment protocol for neuropathic pain (NP) with Transcranial Direct Current Stimulation Supervised Remotely (tDCS-RS) has improved bladder function in individuals with Spinal Cord Injury (SCI). Case report: Three adults (1 woman and 2 men, mean age 52 ± 4 years) from the Specialized Rehabilitation Center/SDI (Santos Dumont Institute) with NP and Neurogenic Bladder (NB) associated with incomplete (SCI) participated in the study. They have paraplegia with a neurological level between T2 and T5/ AIS B or D according to the American Spinal Injury Impairment Scale. They all move independently in wheelchairs and undergo intermittent bladder catheterization associated with anticholinergic treatment. The protocol consisted of intensive treatment to reduce NP at home with remotely supervised anodic tDCS in 10 applications (20 min/day, 5 times/week). Changes in Neurogenic Lower Urinary Tract Dysfunction (NLUTD) were assessed using the Neurogenic Bladder Symptom Score (NBSS) before and after intensive treatment. Participants signed a written informed consent form approved by SDI’s Research Ethics Committee under registration number: CAAE 69887123.8.0000.0129. Results: There was a slight decrease in the arithmetic mean of the total NBSS score of the 3 volunteers after intervention with remotely supervised tDCS and (pre 36.3; post 35.6). The incontinence domain of 2 volunteers decreased by 1 point after intervention and remained the same in the third. Quality of life decreased for 1 volunteer (pre 3; post 4) and there was no change in the others. Conclusion: The findings of this study are inconclusive, however, tDCS has great potential as adjuvant therapy in the treatment of neurogenic bladder in spinal cord injury. Further studies with greater methodological rigor are suggested.

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Remotely Supervised Transcranial Direct Current Stimulation for the Treatment of Neurogenic Bladder in Spinal Cord Injury: Case Series

  • M. C. Paiva,
  • J. T. M. da Costa,
  • E. R. S. Serafini,
  • A. S. Santos,
  • F. G. Mourão,
  • U. M. Silva,
  • A. G. D. de Campos,
  • V. S. Rodrigues,
  • M. T. S. de Lima,
  • F. S. Fiorin,
  • L. L. Lisboa,
  • D. D. Rodriguez,
  • C. C. Espírito-Santo

摘要

Objective: to verify if a treatment protocol for neuropathic pain (NP) with Transcranial Direct Current Stimulation Supervised Remotely (tDCS-RS) has improved bladder function in individuals with Spinal Cord Injury (SCI). Case report: Three adults (1 woman and 2 men, mean age 52 ± 4 years) from the Specialized Rehabilitation Center/SDI (Santos Dumont Institute) with NP and Neurogenic Bladder (NB) associated with incomplete (SCI) participated in the study. They have paraplegia with a neurological level between T2 and T5/ AIS B or D according to the American Spinal Injury Impairment Scale. They all move independently in wheelchairs and undergo intermittent bladder catheterization associated with anticholinergic treatment. The protocol consisted of intensive treatment to reduce NP at home with remotely supervised anodic tDCS in 10 applications (20 min/day, 5 times/week). Changes in Neurogenic Lower Urinary Tract Dysfunction (NLUTD) were assessed using the Neurogenic Bladder Symptom Score (NBSS) before and after intensive treatment. Participants signed a written informed consent form approved by SDI’s Research Ethics Committee under registration number: CAAE 69887123.8.0000.0129. Results: There was a slight decrease in the arithmetic mean of the total NBSS score of the 3 volunteers after intervention with remotely supervised tDCS and (pre 36.3; post 35.6). The incontinence domain of 2 volunteers decreased by 1 point after intervention and remained the same in the third. Quality of life decreased for 1 volunteer (pre 3; post 4) and there was no change in the others. Conclusion: The findings of this study are inconclusive, however, tDCS has great potential as adjuvant therapy in the treatment of neurogenic bladder in spinal cord injury. Further studies with greater methodological rigor are suggested.