re: Impact of overactive bladder on the brain (more interesting info)

[Guest guest]

Dr McCandless/,

Thank you for the article on Over Active Bladder (OAB). We have had this

issue for a while. I believe that a portion of the article you sent applies

to our son (and possibly other asd children) , namely " may apply to

pathologies that arise from other pelvic viscera and engage the same brain

circuitry, e.g. colonic distention from chronic constipation and irritable

bowel disorder. "

I am pasting a note that I sent to a few parents (and doctors) months ago

after talking to another tough nut parent about OAB. She referred me to a

web site of a doctor in NY (Dr Israel Franco), who is doing some interesting

work in this area and has written a few very interesting articles on the

topic as it relates to neurological disorders. Please let me know your

thoughts on this. L

There is a pediatric urology specialist in NY named Dr Israel Franco. He is

part of a large office in NY that is looking beyond regular treatments for

urinary issues in children since the regular treatments have not been

totally effective. His web site is at: <http://www.pedsurology.com/>

http://www.pedsurology.com/

He has written two articles that really opened my eyes up about OAB and

neurology issues. If the links below do not work, go to the web site above

and click on Useful Publications. Scroll down to articles 33 and 34 which

are titled as follows.

.. (Overactive Bladder in

<http://www.pedsurology.com/oabpathfranco.pdf> Children: Pathophysiology.

J Urol Sept 178: 761-768 2007

.. Overactive Bladder in

<http://www.pedsurology.com/oabmanagementfranco.pdf> Children: Management.

J Urol Sept 178:769-774 2007

What is interesting about these articles is that although Dr. Franco is not

a DAN doctor and probably knows nothing about DAN treatments, he has tied

the urinary symptoms in children to the CNS and is specifically looking at

the serotonin and dopamine pathways. The most shocking thing I read in these

articles is the fact that he says one of the more common OAB symptoms is

when little boys grab their groin (not because they are playing or having

pain) but because they are trying to stop the OAB issues they have. He has

heard this symptom reported a lot. Several parents of asd children have

posted on different forums about how they were frustrated about their boys

having this symptom (and not knowing why). This doctor says it is not

playing or pain as much as it is trying to control the OAB. The problem he

says is that a vicious cycle is created whereby the more the boys do that

they in fact create a situation in the muscles where it (OAB) becomes worse

over time. I think this sounds like a major issue that he is aware of in his

practice and NONE of us talking about groin pain or grabbing in some asd

boys are aware of.

Also, another major piece of info indicates there is a close association

between constipation or fecal retention and OAB. The mainstay in the

management of OAB is correction of (drum role please...constipation ). So,

maybe what we all do to help constipation and colitis actually helps the OAB

issues, but doesn't FIX the OAB issue.

In the 2nd article Dr. Franco talks about 5-HTP drugs used for IBS. It

sounds like 5-HTP (serotonin) drugs can cause increased motility of the gut,

so I can see why they help IBS. And he indicates that the colon has the

highest levels of 5-HTP and IBS patients have low levels of 5-HTP so it

makes sense this would help them. This line of drugs may have a dual

beneficial effect since correcting constipation and emptying the colon could

prevent bladder contractions. I do not have any knowledge about 5HTP drugs,

but would be interested to know the difference between 5HTP-type drugs, the

supplement 5HTP, and the drugs mentioned in the article below (celexa and

lexapro).

Most parents (like me) see the frequent urination and/or groin grabbing and

associate it with either odd behaviors, pain, or other things like oxalates.

Dr Franco's articles offer another possibility tracing it all back to

metabolic pathways creating a cascade effect of bowel and urine symptoms.

Our son has had several tests to look for urinary issues like UTI

(negative), abdominal ultrasonography for the kidney and bladder (negative).

However, a KUB a few months ago showed that a high % of his colon was

clogged with stool (even though he had BMs each day). So, we have been more

aggressive at cleaning him out and it helped for a while (just like the

article says), but the issue has come back. None of the fibers seem to work

for him, so maybe it is worth talking to our doc about considering the meds

mentioned in the article you sent below citalopram (celexa) and escitalopram

(lexapro) to help with the OAB (looks like it may help with OCD also).

Another test we are getting is called the Uroflow test; a noninvasive

urodynamics test that assesses the ability to initiate voiding on command.

Based on what we see at home, he looks like he has to push to urinate so

this test may show issues. So, OAB, constipation, metabolic pathway issues,

and CNS symptoms seem to be related. If we do not correct this soon locally,

I will be making an appt in NY with Dr Franco as I believe he is on to

something very important for a subset of asd children.

I would be interested in your thoughts on these articles.

L

From: csb-autism-rx [mailto:csb-autism-rx ]

On Behalf Of JAQUELYN MCCANDLESS

Sent: Saturday, July 26, 2008 4:55 PM

To: csb-autism-rx

Subject: Re: re: Impact of overactive bladder on the brain:

Central sequelae of a visceral pathology

: Thanks for this very interesting article, as

I do have some adult and child patients with

overactive bladder. This is my summary of a very

scientific article for or others who may be

interested:

" This very interesting article shows that persistently

elevated activity in the Locus Coeruleus part of the

brain links urinary bladder events to the brain to

behavior, particularly hyperarousal, sleep

disturbances, and disruption of sensorimotor

integration as a result of central noradrenergic

hyperactivity.

In plain English, this means:

Overactive bladder affects 17% of the population and

negatively impacts quality of life. Among its

cortical functions, the Locus Coeruleus (LC) regulates

arousal, shifts in attention and involvement in

behavioral tasks, and this study shows an elevation of

40% arousal in animals with bladder dysfunction. This

is significant as the LC controls cortical

desynchronization and hippocampal theta rhythm.

Neurobehavioral consequences for LC function in

relation to behavior suggest that the system

facilitates decisions related to task-directed

behavior, that is whether to maintain behavior in an

ongoing task or to disengage and seek alternative

strategies. Persistently elevated LC tone would be

associated with hyperarousal, disordered attention,

and inability to stay on task, effects that would

disrupt normal behavioral function. LC activation has

also been linked to anxiety along with sleep disorders

and sensorimotor integration difficulties along with

adversely impacting functions requiring focused

attention. This study emphasizes the previously

unrecognized potential for this visceral disorder to

affect cognitive and behavioral functions, and may

apply to pathologies that arise from other pelvic

viscera and engage the same brain circuitry, e.g.

colonic distention from chronic constipation and

irritable bowel disorder.

A useful therapeutic approach is suggested from what

is known about the norepinephrine activity connected

with the locus coeruleus portion of the brain; the

study used a serotonin reuptake inhibitor, citalopram,

to prevent uptake into serotonergic terminals to help

them determine the role of LC activation in EEG

changes induced by bladder dysfunction. Though this

article does not extrapolate effects in animals to

those in humans or recommend these agents at all, of

course, we know that serotonin reuptake inhibitors

such as citalopram (celexa) and escitalopram (lexapro)

already do help some children with anxiety and

obsessive-compulsive issues, and as drugs go are

harmless enough to warrant a trial in children or

adults with overactive bladder in my opinion. Dr. JM

--- Binstock <binstock@... <mailto:binstock%40peakpeak.com>

> wrote:

> et al,

>

> The last url herein is for the pdf of the article.

>

>

>

> - - - -

>

> Impact of overactive bladder on the brain: Central

> sequelae of a

> visceral pathology

>

> by Rickenbacher, Madelyn A. Baez, Lyman

> Hale, C.

> Leiser, Zderic, and Rita J. Valentino

>

http://www.pnas.org/cgi/content/abstract/0800969105v1

>

>

http://www.pnas.org/content/early/2008/07/18/0800969105.full.pdf+html

>

> .

>

>

> [Non-text portions of this message have been

> removed]

>

>