title: A prospective trial of temporary sacral nerve stimulation for constipation associated with neurological disease.
abstract: OBJECTIVE
  This study assessed the effectiveness of temporary sacral nerve stimulation (SNS) in patients with constipation associated with neurological disease using an off-on-off design, and evaluated the long-term response in patients undergoing permanent SNS.
  
  
  METHODS
  Patients with chronic constipation associated with neurological disease receiving specialist clinic care at the University Hospital North Durham over a 2-year period were recruited to a trial of SNS. Recordings of bowel function were made for 6 weeks (baseline) and a temporary electrode was then inserted and recordings were made for the next 3 weeks (stimulation). The electrodes were then removed and assessment was continued for a further 3 weeks (posttreatment). Patient-completed questionnaires were used to determine the severity of constipation (Global Assessment of Symptoms, Constipation, GA Constipation), symptoms (Patient Assessment of Constipation Symptoms score, PAC-SYM) and quality-of-life (Patient Assessment of Constipation-Quality Of Life score, PAC-QOL; European Quality of Life-Five-Domain score; European Quality of Life-Visual Analogue Score). Information was obtained on bowel function and medication. Physiological data were also available for transit and laser Doppler flow cytometry to measure mucosal blood flow.
  
  
  RESULTS
  Twenty-two patients were recruited, of whom 18 completed the trial. GA Constipation reduced significantly during temporary SNS: -1.09 (95% CI -1.59 to -0.59; P = 0.0003). PAC-SYM and PAC-QOL scores showed similar improvements. There was also a significant fall in the time spent in the toilet (P = 0.04) and a decrease in laxative use (P = 0.03). Twelve (67%) patients responded to temporary SNS and received a permanent implant with long-term success in 50%.
  
  
  CONCLUSIONS
  Sacral nerve stimulation can be effective in treating some patients with refractory severe neuroconstipation. A response to temporary SNS may predict long-term benefit in only half the patients undergoing permanent SNS.
authors.affiliation: Wrexham Maelor Hospital, Wrexham, UK.
authors.forename: U
authors.initials: U
authors.lastname: Khan
authors.forename: J M
authors.initials: JM
authors.lastname: Mason
authors.forename: M
authors.initials: M
authors.lastname: Mecci
authors.forename: Y
authors.initials: Y
authors.lastname: Yiannakou
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003248:Constipation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003672:Defecation; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D005772:Gastrointestinal Transit; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use; D008160:Lumbosacral Plexus; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D011446:Prospective Studies; D011788:Quality of Life; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors
chemical_list: D054368:Laxatives
keywords: Sacral nerve stimulation; neuropathic constipation; off-on-off trial design; prospective study