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DDAVP in the management of nocturia in multiple sclerosis.

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DDAVP in the
Management of Nocturia
in Multiple Sclerosis
Guy Valiquette, MD,” Gary M. Abrams, MD,? and Joseph
Herbert, MDtS
Neurogenic bladder (NB) is a frequent consequence of multiple sclerosis (MS) and a major source of morbidity. One of
the more distressing symptoms of NB is nocturia. Recently,
we created 8 MS patients with poor response of nocturia to
conventional therapy with DDAVP (1-desamino, 8-EDfarginine vasopressin). All patients had definite or probable MS
and symptoms of NB. Therapy with anticholinergic drugs
and intermittent self-catheterization were initiated or continued as indicated. All patients were instructed not to drink
any fluids after dinner. If nocturia persisted, they were considered for a trial of DDAVP.
Four patients began DDAVP treatment while hospitalized
and the remaining four as outpatients. Ten micrograms of
DDAVP were administered intranasally at bedtime. Patients
recorded the number of episodes of nocturia for one week
prior to and one week following DDAVP therapy. They
were also admonished not to administer DDAVP more than
once daily. In one case, nocturnal urine output was measured
for three consecutive one-week periods. Average nocturnal
urine production during DDAVP administration was 125 ml,
compared with 450 and 410 ml, respectively, during the
weeks prior to and following treatment.
Five patients reported complete relief of nocturia and 2
others experienced considerable improvement. The improvement persisted throughout follow-up, ranging from I
month to 2.5 years (average 13 months). Antidiuresis obtained from a IO-pg dose of DDAVP lasted 6 to 8 hours,
with one exception. Serum electrolytes remained unchanged.
Side effects were experienced by 2 patients. One reported
headache on the first night of DDAVP but not subsequently.
Another patient had antidiuresis lasting up to 15 hours after
10 kg of DDAVP. Twice during the first week of treatment,
she developed palpitation, diaphoresis, and tachycardia in the
early afternoon, associated with a compensatory diuresis of
up to 1 liter. After the dose was reduced to 5 kg, she experienced no further autonomic dysreflexia-like symptoms. No
changes in the frequency of urinary tract infections were observed. No patient has developed urolithiasis. At the time of
writing, 7 of 8 patients still use DDAVP.
DDAVP is used to control enuresis in children and has
also been used, although less successfully, in adults [I, 2). In
one study [I), patients with MS seemed to benefit most from
DDAVP, and subsequently Hilton and associates [ 3 } reported a 50% reduction in the number of nocturia episodes
in 9 of 16 female MS patients treated with DDAVP. It is
not clear why our preliminary results are more favorable than
those of Hilton and colleagues. W e can only note that they
reported difficulties in self-administration of DDAVP by
some patients, which may have resulted in erratic absorption.
Our preliminary data suggest that DDAVP, alone or combined with other therapeutic modalities, is useful for symptomatic control of nocturia in MS. W e are conducting a
double-blind cross-over study and long-term follow-up to assess formally efficacy and safety of this approach.
Multiple Sclerosis Comprehensive Care Center
Departments of ‘Medicine and fNeurology
Helen Hayes HoJpital
West Hauerstraw, NY
Departments of ‘Medicine, fNeurology, and #Pathology
College of Physicians 6Surgeons
Colzlmbia University
New York, N Y
References
1. Hilton P, Stranton SL. The use of desmopressin (DDAVP) in
nocturnal enuresis in the female. Br J Urol 1982;54:252-255
2. Ramsden PD, Hindmarsh JR, Price DA, et al. DDAVP for adult
enuresis-a preliminary report. Br J Urol 1982;54:256-258
3. Hilton P, Hertogs K, Stranton SL. The use of desmopressin
(DDAVP) for nocturia in women with multiple sclerosis.J Neurol Neurosurg Psychiatr 1983;46854-855
Annals of Neurology
Vol 31 N o 5
May 1992 577
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