In multiple sclerosis bladder, urgency and incontinence with incomplete emptying are common. The neuro-muscular system loses coordination as the nerves decrease their strength of activation. Urodynamic studies disclose early bladder contractions. During voiding, these are not sustained and produce incomplete evacuation. The sympathetic - parasympathetic systems also demonstrate impaired sensory-motor coordination. Regional sympathetic systems up-regulate as somatic input decreases. Sympathetic detrusor afferents are activated by stretch receptors enter the spine at T10 to L2. Activation of large cutaneous and segmental muscle stretch sensory fibers activate local reflexes and inhibit micturition (guarding reflex). Repetitive activation of these somatic sensory nerves entering at the same level as the sympathetics, reduces the hyper- sensitivity of the sympathetic arm of the micturition reflex. Electrical stimulation of motor and cutaneous sensory input at T10 to L2 spinal root levels is shown in this study to inhibit overactive bladder of multiple sclerosis.

Methodology:
13 patients with chronic progressive MS (6 female, 7 male) ages 28 to 59 all with lower extremity weakness and spasticity applied the repetitive stimulation for 20 min two to three times per week for four weeks. All had previously applied the same pattern of stimulation to the quadriceps and hamstrings without reduction of incontinence. All stimuli intensities produced abdominal and medial thigh muscle twitch.

Results:
Application of the same pattern of stimulation to the skin and muscles of the T10 to L2 dermatomes produced a dramatic reduction in urgency and incontinence in eleven of the 13 patients (5 female, 6 male). None noted discomfort from the stimulation, nor were there any undesired side effects. Quantified measures included # hrs. between urgency. (1.75 vs 4.5) Number of incontinent voids per 24hrs during the daytime (3.6 vs 0.8) and at night (1.4 vs 0.8). The volume of continent voids (small, med., large) also increased. Additional Findings: Of the six males with erectile dysfunction, five of them regained tumescense capability that lasted for many months after the program Follow-up: All patients slowly reverted back to pre treatment incontinence levels after four to six weeks without additional treatment. All were able to regain control within one or two sessions after resuming the above treatment.

Conclusions:
Surface patterned muscle stimulation applied to the T-10 to L-2 dermatomes and underlying muscles can reduce the incidence of urgency and incontinence in patients with chronic progressive MS. There are also very positive side effects such as reversal of erectile dysfunction in most of the affected males.