Skip to main content
Top
Published in: Orphanet Journal of Rare Diseases 1/2018

Open Access 01-12-2018 | Research

Gastrointestinal and urinary complaints in adults with hereditary spastic paraparesis

Authors: Øivind J. Kanavin, Krister W. Fjermestad

Published in: Orphanet Journal of Rare Diseases | Issue 1/2018

Login to get access

Abstract

Background

Hereditary spastic paraparesis (HSP) is a group of rare genetic disorders affecting the central nervous system. Pure HSP is limited to lower limb spasticity and urinary voiding dysfunction. Complex HSP involves additional neurological features. Beyond the described core symptoms, knowledge about the burden of disease for adults with HSP is limited, particularly regarding gastrointestinal functions, fecal incontinence, and urinary symptoms.

Methods

We conducted a cross-sectional self-report survey with 108 adult HSP patients (Mage = 57.7 years, SD = 11.5, range 30 to 81; 54.2% females) recruited from a national HSP user group association and a national (non-clinical) advisory unit for rare disorders. HSP data was compared to data from a Norwegian population study, HUNT-3 (N = 46,293).

Results

The HSP group reported more gastrointestinal and urinary complaints compared to controls. Gastrointestinal complaints included at least “much” complaints with constipation (14.6%) and alternating constipation/diarrhea (8.0%), and at least daily uncontrollable flatulence (47.6%), fecal incontinence (11.6%), and inability to hold back stools (38.5%). Urinary complaints included frequent urination (27.4% > 8 times daily), sudden urge (51.9%) and urinary incontinence (30.5% at least daily/nightly).

Conclusion

This survey of adults with HSP recruited from non-clinical settings showed constipation, alternate constipation and diarrhea, fecal incontinence, and voiding dysfunction represent considerable problems for many persons with HSP. Health care providers should screen and manage often unrecognized gastrointestinal and fecal incontinence complaints among HSP patients.
Literature
1.
go back to reference Salinas S, Proukakis C, Crosby A, Warner TT. Hereditary spastic paraplegia: clinical features and pathogenetic mechanisms. The Lancet Neurology. 2008;7(12):1127–38.CrossRefPubMed Salinas S, Proukakis C, Crosby A, Warner TT. Hereditary spastic paraplegia: clinical features and pathogenetic mechanisms. The Lancet Neurology. 2008;7(12):1127–38.CrossRefPubMed
2.
go back to reference Fink JK. Hereditary spastic paraplegia overview. In: Pagon RA, Adam MP, Ardinger HH, Bird TD, Dolan CR, Fong CT, et al., editors. GeneReviews(R). Seattle (WA): University of Washington, Seattle University of Washington, Seattle. All rights reserved.; 1993. Fink JK. Hereditary spastic paraplegia overview. In: Pagon RA, Adam MP, Ardinger HH, Bird TD, Dolan CR, Fong CT, et al., editors. GeneReviews(R). Seattle (WA): University of Washington, Seattle University of Washington, Seattle. All rights reserved.; 1993.
3.
go back to reference Harding AE. Hereditary “pure” spastic paraplegia: a clinical and genetic study of 22 families. J Neurol Neurosurg Psychiatry. 1981;44(10):871–83.CrossRefPubMedPubMedCentral Harding AE. Hereditary “pure” spastic paraplegia: a clinical and genetic study of 22 families. J Neurol Neurosurg Psychiatry. 1981;44(10):871–83.CrossRefPubMedPubMedCentral
4.
5.
go back to reference Klebe S, Stevanin G, Depienne C. Clinical and genetic heterogeneity in hereditary spastic paraplegias: from SPG1 to SPG72 and still counting. Rev Neurol. 2015;171(6–7):505–30.CrossRefPubMed Klebe S, Stevanin G, Depienne C. Clinical and genetic heterogeneity in hereditary spastic paraplegias: from SPG1 to SPG72 and still counting. Rev Neurol. 2015;171(6–7):505–30.CrossRefPubMed
6.
go back to reference Erichsen AK, Koht J, Stray-Pedersen A, Abdelnoor M, Tallaksen CM. Prevalence of hereditary ataxia and spastic paraplegia in Southeast Norway: a population-based study. Brain : a journal of neurology. 2009;132(Pt 6):1577–88.CrossRef Erichsen AK, Koht J, Stray-Pedersen A, Abdelnoor M, Tallaksen CM. Prevalence of hereditary ataxia and spastic paraplegia in Southeast Norway: a population-based study. Brain : a journal of neurology. 2009;132(Pt 6):1577–88.CrossRef
7.
go back to reference Joussain C, Levy J, Charlanes A, Even A, Falcou L, Chartier-Kastler E, et al. Neurogenic detrusor overactivity in patients with hereditary spastic paraplegias. Ann Phys Rehabil Med. 2016;59S:e104.CrossRef Joussain C, Levy J, Charlanes A, Even A, Falcou L, Chartier-Kastler E, et al. Neurogenic detrusor overactivity in patients with hereditary spastic paraplegias. Ann Phys Rehabil Med. 2016;59S:e104.CrossRef
8.
go back to reference Fourtassi M, Jacquin-Courtois S, Scheiber-Nogueira MC, Hajjioui A, Luaute J, Charvier K, et al. Bladder dysfunction in hereditary spastic paraplegia: a clinical and urodynamic evaluation. Spinal Cord. 2012;50(7):558–62.CrossRefPubMed Fourtassi M, Jacquin-Courtois S, Scheiber-Nogueira MC, Hajjioui A, Luaute J, Charvier K, et al. Bladder dysfunction in hereditary spastic paraplegia: a clinical and urodynamic evaluation. Spinal Cord. 2012;50(7):558–62.CrossRefPubMed
9.
go back to reference Braschinsky M, Zopp I, Kals M, Haldre S, Gross-Paju K. Bladder dysfunction in hereditary spastic paraplegia: what to expect? J Neurol Neurosurg Psychiatry. 2010;81(3):263–6.CrossRefPubMed Braschinsky M, Zopp I, Kals M, Haldre S, Gross-Paju K. Bladder dysfunction in hereditary spastic paraplegia: what to expect? J Neurol Neurosurg Psychiatry. 2010;81(3):263–6.CrossRefPubMed
10.
go back to reference Faecal incontinence in adults: management clinical guideline. United Kingdom: National Institute for health and care excellence; 2007. p. 5. Faecal incontinence in adults: management clinical guideline. United Kingdom: National Institute for health and care excellence; 2007. p. 5.
11.
go back to reference Cotterill N, Norton C, Avery KN, Abrams P, Donovan JL. A patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon rectum. 2008;51(1):82–7.CrossRefPubMed Cotterill N, Norton C, Avery KN, Abrams P, Donovan JL. A patient-centered approach to developing a comprehensive symptom and quality of life assessment of anal incontinence. Dis Colon rectum. 2008;51(1):82–7.CrossRefPubMed
13.
go back to reference Jennum P, Neerup Jensen L, Fenger K, Nielsen JE, Fuglsang-Frederiksen A, Nielsen JE. Motor evoked potentials from the external anal sphincter in patients with autosomal dominant pure spastic paraplegia linked to chromosome 2p. J Neurol Neurosurg Psychiatry. 2001;71(4):561–2.CrossRefPubMedPubMedCentral Jennum P, Neerup Jensen L, Fenger K, Nielsen JE, Fuglsang-Frederiksen A, Nielsen JE. Motor evoked potentials from the external anal sphincter in patients with autosomal dominant pure spastic paraplegia linked to chromosome 2p. J Neurol Neurosurg Psychiatry. 2001;71(4):561–2.CrossRefPubMedPubMedCentral
14.
go back to reference De Bot ST, Burggraaff RC, Herkert JC, Schelhaas HJ, Post B, Diekstra A, et al. Rapidly deteriorating course in Dutch hereditary spastic paraplegia type 11 patients. European journal of human genetics : EJHG. 2013;21(11):1312–5.CrossRefPubMedPubMedCentral De Bot ST, Burggraaff RC, Herkert JC, Schelhaas HJ, Post B, Diekstra A, et al. Rapidly deteriorating course in Dutch hereditary spastic paraplegia type 11 patients. European journal of human genetics : EJHG. 2013;21(11):1312–5.CrossRefPubMedPubMedCentral
15.
go back to reference Jensen LN, Gerstenberg T, Kallestrup EB, Koefoed P, Nordling J, Nielsen JE. Urodynamic evaluation of patients with autosomal dominant pure spastic paraplegia linked to chromosome 2p21-p24. J Neurol Neurosurg Psychiatry. 1998;65(5):693–6.CrossRefPubMedPubMedCentral Jensen LN, Gerstenberg T, Kallestrup EB, Koefoed P, Nordling J, Nielsen JE. Urodynamic evaluation of patients with autosomal dominant pure spastic paraplegia linked to chromosome 2p21-p24. J Neurol Neurosurg Psychiatry. 1998;65(5):693–6.CrossRefPubMedPubMedCentral
16.
go back to reference Chelban V, Tucci A, Lynch DS, Polke JM, Santos L, Jonvik H, et al. Truncating mutations in SPAST patients are associated with a high rate of psychiatric comorbidities in hereditary spastic paraplegia. J Neurol Neurosurg Psychiatry. 2017;88(8):681–7.CrossRefPubMedPubMedCentral Chelban V, Tucci A, Lynch DS, Polke JM, Santos L, Jonvik H, et al. Truncating mutations in SPAST patients are associated with a high rate of psychiatric comorbidities in hereditary spastic paraplegia. J Neurol Neurosurg Psychiatry. 2017;88(8):681–7.CrossRefPubMedPubMedCentral
17.
go back to reference Krokstad S, Langhammer A, Hveem K, Holmen TL, Midthjell K, Stene TR, et al. Cohort profile: the HUNT study, Norway. Int J Epidemiol. 2013;42(4):968–77.CrossRefPubMed Krokstad S, Langhammer A, Hveem K, Holmen TL, Midthjell K, Stene TR, et al. Cohort profile: the HUNT study, Norway. Int J Epidemiol. 2013;42(4):968–77.CrossRefPubMed
18.
go back to reference Fjermestad KW, Kanavin OJ, Naess EE, Hoxmark LB, Hummelvoll G. Health survey of adults with hereditary spastic paraparesis compared to population study controls. Orphanet journal of rare diseases. 2016;11(1):98.CrossRefPubMedPubMedCentral Fjermestad KW, Kanavin OJ, Naess EE, Hoxmark LB, Hummelvoll G. Health survey of adults with hereditary spastic paraparesis compared to population study controls. Orphanet journal of rare diseases. 2016;11(1):98.CrossRefPubMedPubMedCentral
19.
go back to reference Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trondelag. J Clin Epidemiol. 2000;53(11):1150–7.CrossRefPubMed Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. Epidemiology of incontinence in the county of Nord-Trondelag. J Clin Epidemiol. 2000;53(11):1150–7.CrossRefPubMed
20.
go back to reference Wood LN, Anger JT. Urinary incontinence in women. BMJ (Clinical research ed). 2014;349:g4531. Wood LN, Anger JT. Urinary incontinence in women. BMJ (Clinical research ed). 2014;349:g4531.
21.
go back to reference Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110(1):127–36.CrossRefPubMed Bharucha AE, Dunivan G, Goode PS, Lukacz ES, Markland AD, Matthews CA, et al. Epidemiology, pathophysiology, and classification of fecal incontinence: state of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. Am J Gastroenterol. 2015;110(1):127–36.CrossRefPubMed
22.
23.
go back to reference Nubling GS, Mie E, Bauer RM, Hensler M, Lorenzl S, Hapfelmeier A, et al. Increased prevalence of bladder and intestinal dysfunction in amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis & frontotemporal degeneration. 2014;15(3–4):174–9.CrossRef Nubling GS, Mie E, Bauer RM, Hensler M, Lorenzl S, Hapfelmeier A, et al. Increased prevalence of bladder and intestinal dysfunction in amyotrophic lateral sclerosis. Amyotrophic lateral sclerosis & frontotemporal degeneration. 2014;15(3–4):174–9.CrossRef
24.
go back to reference Lad M, Parkinson MH, Rai M, Pandolfo M, Bogdanova-Mihaylova P, Walsh RA, et al. Urinary, bowel and sexual symptoms in a cohort of patients with Friedreich's ataxia. Orphanet journal of rare diseases. 2017;12(1):158.CrossRefPubMedPubMedCentral Lad M, Parkinson MH, Rai M, Pandolfo M, Bogdanova-Mihaylova P, Walsh RA, et al. Urinary, bowel and sexual symptoms in a cohort of patients with Friedreich's ataxia. Orphanet journal of rare diseases. 2017;12(1):158.CrossRefPubMedPubMedCentral
25.
go back to reference Scheltens P, Bruyn RP, Hazenberg GJ. A Dutch family with autosomal dominant pure spastic paraparesis (Strumpell's disease). Acta Neurol Scand. 1990;82(3):169–73.CrossRefPubMed Scheltens P, Bruyn RP, Hazenberg GJ. A Dutch family with autosomal dominant pure spastic paraparesis (Strumpell's disease). Acta Neurol Scand. 1990;82(3):169–73.CrossRefPubMed
26.
go back to reference Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol. 1996;91(1):33–6.PubMed Johanson JF, Lafferty J. Epidemiology of fecal incontinence: the silent affliction. Am J Gastroenterol. 1996;91(1):33–6.PubMed
27.
go back to reference Mayer EA, Naliboff B, Lee O, Munakata J, Chang L. Review article: gender-related differences in functional gastrointestinal disorders. Aliment Pharmacol Ther. 1999;13(Suppl 2):65–9.CrossRefPubMed Mayer EA, Naliboff B, Lee O, Munakata J, Chang L. Review article: gender-related differences in functional gastrointestinal disorders. Aliment Pharmacol Ther. 1999;13(Suppl 2):65–9.CrossRefPubMed
28.
go back to reference Bushman W, Steers WD, Meythaler JM. Voiding dysfunction in patients with spastic paraplegia: urodynamic evaluation and response to continuous intrathecal baclofen. Neurourol Urodyn. 1993;12(2):163–70.CrossRefPubMed Bushman W, Steers WD, Meythaler JM. Voiding dysfunction in patients with spastic paraplegia: urodynamic evaluation and response to continuous intrathecal baclofen. Neurourol Urodyn. 1993;12(2):163–70.CrossRefPubMed
Metadata
Title
Gastrointestinal and urinary complaints in adults with hereditary spastic paraparesis
Authors
Øivind J. Kanavin
Krister W. Fjermestad
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2018
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-018-0804-8

Other articles of this Issue 1/2018

Orphanet Journal of Rare Diseases 1/2018 Go to the issue