Efficacy and Safety of Mirabegron Add-on Therapy After Failure With Solifenacin in Multiple Sclerosis Patients With Overactive Bladder: A Pilot Study.

OBJECTIVES: Multiple sclerosis (MS) is a chronic neuroinflammatory and neurodegenerative progressive disease of central nervous system that mostly affects young adults. (1) Because of involvement of spinal cord and brain, lower urinary dysfunction symptoms are commonly encountered. MS patients mostly show overactive bladder symptoms like urgency, frequent daytime urination, and urgency incontinence. Among MS patients, antimuscarinic therapy is the first-line treatment with overactive bladder symptoms as well as in general population yet 30% of the patients show insufficient improvement or intolerance to the treatment (2). In our study, our aim is to evaluate the efficacy and safety of mirabegron add-on treatment in MS patients after inadequate response to antimuscarinic monotherapy. METHODS: University of Kyrenia and Dr Burhan Nalbantoglu State hospital's databases were screened for the study. Seventy patients who were residents diagnosed with MS according to McDonald criteria were questioned. Among these patients, a total of 22 of them were included in the study. Inclusion criteria was at least 3 years of MS diagnosis, score of <6 at Expanded Disability Status Scale, and a score of ≥3 at Overactive Bladder Symptom Score Scale. RESULTS: Among selected patients, 10 mg solifenacin treatment was daily started and followed for 4 weeks. Mirabegron add-on treatment was initiated to the 11 patient who had inadequate improvement in overactive bladder symptom score. After mirabegron add-on treatment among 11 patient, there was a sufficient improvement in overactive bladder symptom score (P < 0.008). CONCLUSIONS: In our study, we have found that antimuscarinic and mirabegron combination causes improved efficacy for overactive bladder in MS population.

Pupillary Involvement in Miller Fisher Syndrome.

Miller Fisher Syndrome is characterised by the classical triad of ophthalmoplegia, ataxia, and areflexia. Ophthalmoparesis without ataxia, without areflexia, or with neither have been attributed as atypical forms of MFS. We report two patients with MFS who had tonic pupils and raised anti-GQ1b antibody titres. Bilateral dilated pupils (either tonic or fixed) can be a manifestation of MFS and anti-GQ1b immunoglobulin G (IgG) antibodies are useful to confirm the diagnosis in unexplained cases. The site of involvement is thought to be the ciliary ganglion or short ciliary nerves.

Anatomical variations of brachial plexus in fetal cadavers.

AIM: The plexus brachialis is a complex structure with anatomical variations and connections with neighboring tissues. These variations may cause disparity in the motor and sensorial innervations of the upper extremity. The knowledge of anatomy and probable variations are important for performing surgical procedures in the neck, shoulder and axilla. This study was planned to demonstrate the anatomical variations of infantile brachial plexus. MATERIAL AND METHODS: A total of 20 plexus brachialis from 11 fetal cadavers were dissected and examined microscopically. The branching patterns and variations were evaluated. The width of the nerves was assessed at the level of the nerve root, trunk and cord on the basis of all brachial plexuses and they were arranged in terms of thickness. RESULTS: Half of the brachial plexuses were found to be prefixed, while 15% were found to be postfixed. Truncus superior, medial cord and nervus ulnaris were found in normal formation, whereas anatomical variations were detected in the rest of the structures. The plexus brachialis elements were arranged in the following order from large to small according to their average thicknesses: C7 C6 C8 C5 = T1; TS TI TM; PC LC MC. CONCLUSION: Since the risk of injury for variated branches is higher, understanding the anatomical variations of plexus brachialis and its extensions are significant importance during surgical intervention.