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LOWER URINARY TRACT SYMPTOMS IN FUNCTIONAL MOVEMENT DISORDERS
  1. Amit Batla,
  2. Jalesh Panicker,
  3. Mark Edwards,
  4. Maria Stamelou,
  5. Isabel Parees,
  6. Panagiotis Kasavetis,
  7. Kailash Bhatia
  1. UCL Institute of Neurology; National Hospital Neurology Neurosurgery

    Abstract

    Introduction The presence of lower urinary tract dysfunction in the setting of neurological signs is usually considered an indicator for organic disease. However, we have noted lower urinary tract symptoms (LUTS) in several patients with functional movement disorders (FMD).

    Objective The objective of this study was to evaluate the prevalence of LUTS in patients with FMD using validated questionnaires to assess the impact of these symptoms on patients' quality of life.

    Methods Patients identified rom the movement disorders clinics were reterospectively screened for urinary symptoms and the one's who had LUTS were asked to complete the Urinary Symptom Profile (USP) and Short Form Qualiveen (SFQ). Scores were compared between different clinical FMD subtypes using Mann–Whitney and 2–tailed tests for significance.

    Results We identified 150 patients with clinically established (n=97) and probable (n=53) FMDs. These patients most commonly had tremor (38%, n=57), dystonia (32.7%, n=49), myoclonus (11.3%, n=17), mixed atypical movements (9.3%, n=14), facial spasm and blepharospasm (4.7%, n=7) and gait disorder (4%, n=6). The mean duration of FMD was 7.52 years (SD–6.4).Thirty patients reported LUTS (20%) with a mean duration of 3.8 years (SD 3.7). Of these, 20 (66.7%) had dystonia and 8 (26.7%) had tremor, 2 (6.7%) had mixed movement disorders. All patients were female with mean age of 46.4 yrs (SD 13.2). All patients with dystonia reporting LUTS had a fixed dystonia: in total 20 out of 33 patients with fixed dystonia in the whole cohort (60.6%) reported LUTS. Twenty–two patients completed the USP and SFQ (Table 1). Most patients had overactive bladder symptoms (63.6%) (Table 1). The overall score on the USP was 10.7 (SD 7.4). The severity of bladder symptoms was greater in patients with fixed dystonia as compared to patients with other FMD (p=0.01) and had a greater impact on quality of life.(p<0.001) All three women reporting a low stream belonged to the fixed dystonia group and were taking opiates for pain. Indeed, patients on opiates had a higher low stream score (mean score=5) compared to those not on opiates (mean score=1.1) (p=0.02). Three patients of fixed dystonia required catheterization and two had a suprapubic cystostomy performed which were complicated with recurrent urinary tract infections (UTI).

    Conclusion LUTS are seen in 20% of our patients with FMD. Patients with fixed dystonia appear to have more severe symptoms with a greater impact on quality of life. Awareness of these symptoms in this group may allow early recognition of urinary symptoms and prevent unnecessary interventions and long term complications.

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