b'or comparison. The ndings were published regarding urinary evaluations and the absencein the Multiple Sclerosis Journal.of blinding or control group. More research isDr. ThrowerNatalizumab (Tysabri) is one of needed but it was determined that TTNS andourmosteectivetherapiesusedinthe PFMT are feasible treatments to consider. Themanagement of relapsing forms of MS. Over study was published in the Multiple Sclerosisthe years, weve gained valuable knowledge Journal.about reducing the risk of PML that might be Dr. ThrowerBladder issues are common inlinked to the use of this drug. Shortly after multiple sclerosis. MS can cause a small, over-natalizumab began widespread use, people active bladder with associated urinary frequency,with MS would report feeling better with the urgency, and incontinence. MS can also causedrug.Thisisnottraditionallythewaywe a large underactive or neurogenic bladder.think about MS therapies. We counsel these This type of bladder dysfunction might bedrugs should be used to reduce the risk of compared to pouring water into a glass that thenrelapses, disability progression, and new MRI overflows from the top, but never completelylesions, but should not be thought of therapies empties. This study looked at the small OAB.to improve function or lessen symptoms. And This type of bladder dysfunction is frequentlyyet, some patients treated with natalizumab treated with anticholinergic medicationstold us they did feel and/or function better. (oxybutynin, tolterodine, solifenacin, andTurns out, they were right. This study shows that others) or antimuscarinic drugs (mirabegron)many people with MS treated with natalizumab orbetaadrenergicdrugs(vibegron).Thisdoexperienceobjectiveimprovementsin study shows there also treatment options fordisability as measured by EDSS. Thats great OAB that might not involve medications ornews. Now we need to gure out why. that might be used in addition to medications.Investigation nds alternative Pelvic oor muscle training and tibial nervefeasible bladder treatments stimulation both resulted in improvementsin the common symptoms of OAB due to MSA study, conducted in Istanbul, compared and improvements in quality of life. Thesethe eectiveness of transcutaneous tibial nerve typesoftherapywouldtypicallybedonestimulation and pelvic oor muscle training in through a physical therapist specializing inMS patients with lower urinary tract symptoms. pelvic oor and bladder issues. Fifty-ve patients with a mean age of 43.49 Eye may be new windowwho had MS for more than 10 years, and had for monitoring MS a similar sociodemographic background,were included in the analysis. Comparisons Researchers in Vienna followed 60 peoplewere made based on 24-hour frequency of with MS for three years by measuring threeurination, nocturia, urgency, urge incontinence, layersoftheretinaperipapillaryretinalpost-voiding residue, overactive bladder nerve ber layer, macular ganglion-cell-and-screening, and Qualiveen Scale. Both forms inner-plexiform-layer, and the inner nuclearof treatment resulted in improvements on layerby optical coherence tomography. Thisdifferent outcomes and were shown to be research was conducted as a retrospectiveeective. TTNS was more eective for reducing analysis of people with conrmed disability24-hour frequency, nocturia, and urgency. worseningbasedonEDSSscoresandtheThere are limits to this study to consider OCT scans were part of routine clinicalmsfocusmagazine.org 60'