This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Sacral nerve stimulation reduces corticoanal excitability in patients with faecal incontinence. BJS 2005; 92: 1423-1431.
Published: 25th July 2005
Authors: R. Sheldon, E. S. Kiff, A. Clarke, M. L. Harris, S. Hamdy
Background
Sacral nerve stimulation (SNS) can produce symptomatic relief in patients with faecal incontinence. Moreover, peripheral nerve stimulation has been shown to affect brain function. The aim of this study was to determine whether SNS might produce important changes in cortical activity linked to improved continence.
Method
In an experimental study, ten women with intractable faecal incontinence (mean age 51·3 years) were serially mapped with transcranial magnetic stimulation before and immediately after 14 days of temporary SNS (15 Hz, pulse width 210 µs), and then 2 weeks later. Anal sphincter electromyographic responses were recorded to cortical stimulation of multiple points over a scalp grid covering the bilateral medial cortex. Continence scores, anorectal manometry and rectal sensitivity data were also collected.
Results
SNS improved global symptom scores in the majority of patients; mean(s.e.m.) continence scores fell from 16·9(1·6) to 10·6(1·8) (P = 0·042). Cortical mapping showed a consistent decrease in corticoanal representation and overall excitability immediately after SNS compared with baseline (mean(s.e.m.) 38 083(13 669) versus 42 507(13 297) µV s; P = 0·017), which was reversed 2 weeks after SNS wire removal.
Conclusion
SNS produces symptom benefit in patients with faecal incontinence that is associated with a reversible reduction in corticoanal excitability. SNS therefore drives dynamic brain changes that may play a functional role in influencing anal continence. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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