A prospective trial of temporary sacral nerve stimulation for constipation associated with neurological disease

Abstract

Aim: The 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. Method: Patients with chronic constipation associated with neurological disease receiving specialist clinic care at the University Hospital North Durham over a two-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 three weeks (stimulation). The electrodes were then removed and assessment was continued for a further three weeks (post-treatment). Patient-assessed questionnaires were used to determine the global assessment of the severity of constipation (GA), symptoms (PAC-SYM) and quality-of-life (PAC-QOL, EuroQOL EQ-5D-3L and EQ-VAS). Information was obtained on bowel function and medication. Physiological data of transit and laser Doppler flow cytometry to measure mucosal blood folw were also available. Results: Twenty two patients were recruited of whom 18 patients completed the trial. GA constipation reduced significantly during temporary SNS from -1.09, 95% confidence interval [CI ]-1.59 to -0.59 (p=0.0003). PAC-SYM and PAC-QOL 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: SNS 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.