Consensus Statement on Neurogenic Detrusor Overactivity (NDO): Multiple Sclerosis and Spinal Cord Injury
Improving Diagnosis, Management, and Treatment of NDO Through Integrated Care

Program Description:

This consensus statement on neurogenic detrusor overactivity (NDO) discusses the effect of NDO on the quality of life and overall health of patients with multiple sclerosis (MS) and spinal cord injury (SCI), identifies health care provider and patient barriers to care, describes best practices to screen for urinary dysfunction, and summarizes the panel’s recommendations for management of NDO in this patient population. Management strategies include antimuscarinic agents such as oxybutynin, onabotulinumtoxinA intradetrusor injection, sacral nerve stimulation, bladder augmentation or urinary diversion, and clean intermittent catheterization. Long-term follow-up of patients with NDO is important because changes in detrusor compliance and urodynamic patterns may occur over time.

INTENDED AUDIENCE:

This activity is designed for urologists, neurologists, physiatrists, and other health care professionals interested in or involved with the management of patients with multiple sclerosis or spinal cord injury who are at risk for neurogenic detrusor overactivity.

Activity Objectives:

At the conclusion of this activity, participants should be able to:

• Describe the effect of bladder dysfunction on health and health-related quality of life in individuals with multiple sclerosis (MS) and spinal cord injury (SCI)


• Identify factors and barriers influencing optimal management of neurogenic detrusor overactivity (NDO) across specialties


• Discuss the clinical aspects of NDO including its multiple etiologies, patient evaluation, varying treatment goals, and common coexisting conditions


• Review current and future options for the management of NDO in patients with MS and SCI


• Adopt new standards of care for multidisciplinary management of NDO in the practice setting

Credits	Type	Accreditation Statement	Designation Statement
1.00	AMA PRA Category 1 Credit(s)TM	This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the Warren Alpert Medical School of Brown University and Health and Wellness Education Partners. The Warren Alpert Medical School is accredited by the ACCME to provide continuing medical education for physicians.	The Warren Alpert Medical School designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty:

Pamela I. Ellsworth, MD
(Program Chair)
Associate Professor of Surgery
Division of Urology
The Warren Alpert Medical School of Brown University
Providence, RI

Patricia K. Coyle, MD
(Program Co-Chair)
Professor and Acting Chair
Department of Neurology
Stony Brook University
Director, Stony Brook MS Comprehensive Care Center
Stony Brook, NY

Alberto Esquenazi, MD
(Program Co-Chair)
Professor and Chair
Department of Physical Medicine and Rehabilitation
Moss Rehab and Albert Einstein
Philadelphia, PA
Director, Gait & Motion Analysis Laboratory
Moss Rehab
Elkin Park, PA

Karl-Erik Andersson, MD, PhD
Professor, Institute for Regenerative Medicine
Wake Forest University
Professor, Department of Urology
Wake Forest School of Medicine
Winston-Salem, NC

Jack S. Burks, MD
Chief Medical Officer
Multiple Sclerosis Association of America
Cherry Hill, NJ

June Halper, NP
Adult Nurse Practitioner
Consortium of Multiple Sclerosis Centers
Hackensack, NJ
Advanced Practice Nurse
Division of Neurology
Department of Neuroscience
Multiple Sclerosis Center
University of Medicine & Dentistry of New Jersey
Newark, NJ

Victor W. Nitti, MD
Professor and Vice Chairman
Department of Urology
Director of Female Pelvic Medicine and Reconstructive Surgery
NYU Langone Medical Center
New York, NY

William A. Sheremata, MD
Professor of Clinical Neurology
Department of Neurology
Miller School of Medicine
University of Miami
Miami, FL

David R. Staskin, MD
Associate Professor of Urology
Tufts University School of Medicine
Head, Female Urology and Neurourology
Division of Urology
Steward – St. Elizabeth’s Medical Center
Boston, MA

Paul J. Tobin, MSW
President and CEO
United Spinal Association, Inc.
East Elmhurst, NY

Alan J. Wein, MD, FACS, PhD (hon)
Professor and Chief
Division of Urology
Penn Medicine, Perelman School of Medicine
Chief, Division of Urology
Penn Medicine, University of Pennsylvania Health System
Philadelphia, PA

Disclosures:

This enduring material is produced for educational purposes only. Content is provided by faculty who have been selected because of recognized expertise in their field. The opinions and recommendations expressed by the faculty whose input is included in this activity are their own. The use of the Warren Alpert Medical School of Brown University name implies oversight and review by the CME Office of educational content, format, design, and approach. Participants have the professional responsibility to review the complete prescribing information of specific drugs or combination of drugs including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients. The Warren Alpert School of Medicine of Brown University assumes no liability for the information herein.

Faculty
In accordance with the disclosure policy of the Warren Alpert Medical School of Brown University as well as standards set forth by the Accreditation Council for Continuing Medical Education, all individuals in a position to control the content of a CME activity are required to disclose relevant financial relationships with commercial interests (within the past 12 months). Disclosures of this activity’s faculty and planning committee have been reviewed and all identified conflicts of interest, if applicable, have been resolved.

Pamela I. Ellsworth, MD, is a consultant/advisory board member for Allergan, Inc., Astellas Pharma US, Inc.; and Pfizer Inc. She is a speaker for Allergan, Inc. and Pfizer Inc.

Karl-Erik Andersson, MD, PhD, is a consultant for Allergan, Inc.; Astellas Pharma US, Inc.; GlaxoSmithKline plc; and Pfizer Inc.

Jack S. Burks, MD, is a consultant and speaker for Acorda Therapeutics; Allergan, Inc.; Avanir Pharmaceuticals, Inc.; Bayer Corporation; EMD Serono, Inc.; and Novartis AG.

Patricia K. Coyle, MD, is a consultant for Acorda Therapeutics; Avanir Pharmaceuticals, Inc.; Bayer Corporation; Biogen Idec Inc.; EMD Serono, Inc.; Novartis AG; Sanofi-Aventis U.S. LLC; and Teva Neuroscience, Inc. She has received grant/research support from Actelion Pharmaceuticals Ltd and Novartis AG.

Alberto Esquenazi, MD has received grant/research support from Allergan, Inc., and Ipsen.

June Halper, NP, is a consultant for Acorda Therapeutics; Questcor Pharmaceuticals, Inc.; and Teva Neuroscience, Inc. She is a speaker for non-CME programs for Acorda Therapeutics.

Victor W. Nitti, MD, has received grant/research support from Allergan, Inc., and Astellas Pharma US, Inc. He is a consultant for Allergan, Inc.; Astellas Pharma US, Inc.; Medtronic, Inc., and Uroplasty, Inc.

William A. Sheremata, MD, has received grant/research support from Acorda Therapeutics, Novartis AG, and Roche. He is a consultant for Acorda Therapeutics, Novartis AG, and Teva Neuroscience, Inc.

David R. Staskin, MD, is a consultant for Allergan, Inc.; Antares Pharma; and Astellas Pharma US, Inc. He is a speaker for Allergan, Inc.; Astellas Pharma US, Inc.; and Watson Pharmaceuticals, Inc.

Paul J. Tobin, MSW, is chief executive of the United Spinal Association, which has received grant support from Allergan, Inc.

Alan J. Wein, MD, FACS, PhD (Hon), has served as a consultant for Allergan, Inc.; Astellas Pharma US, Inc.; Endo Pharmaceuticals; Ferring Pharmaceuticals; Medtronic, Inc.; and Pfizer Inc.

Activity Staff Disclosures
The planners, reviewers, editors, staff, or other members at Health and Wellness Education Partners and the Alpert Medical School CME Office who control content have no relevant financial relationships to disclose.

Disclaimer
This enduring material is produced for educational purposes only. Content is provided by faculty who have been selected because of recognized expertise in their field. The opinions and recommendations expressed by the faculty whose input is included in this activity are their own. The use of the Warren Alpert Medical School of Brown University name implies oversight and review by the CME Office of educational content, format, design, and approach. Participants have the professional responsibility to review the complete prescribing information of specific drugs or combination of drugs including indications, contraindications, warnings, and adverse effects before administering pharmacologic therapy to patients. The Warren Alpert School of Medicine of Brown University assumes no liability for the information herein.

Corresponding Author
Pamela I. Ellsworth, MD
University Urological Associates
2 Dudley Street, Suite 185, Providence, RI 02908
Phone: 1-401-421-0710, ext. 1323
Fax: 1-401-421-0720
E-mail: pamelaellsworth@aol.com

Accredited Provider:

Jointly sponsored by the Warren Alpert Medical School of Brown University and Health and Wellness Education Partners.

Commercial Supporter:

This activity is supported by an educational grant from Allergan, Inc.

Instructions:

Method of Participation/CME Credit

• There are no prerequisites or fees for participating in and receiving credit for this activity.


• Review the learning objectives, faculty information, and CME information that follows.


• Review the Manuscript.


• Complete the post-test and activity evaluation at the conclusion of the activity. A minimum score of 75% is required to receive a CME credit certificate.


• Your online certificate will be saved on myCME.com within your Profile/Exam History, which you can then access at any time.

If you have any questions relating to the accreditation for this activity, please contact:
Warren Alpert Medical School of Brown University
Office of Continuing Medical Education
233 Richmond Street, Providence, RI 02912
Phone: 1-401-863-1208
E-mail: CME@Brown.edu

If you have any other questions relating to your certificate or other issues with this activity, please contact myCME.Support@haymarketmedical.com.

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SYSTEM REQUIREMENTS:

WINDOWS PC SYSTEM REQUIREMENTS:
266-MHz Pentium II; Windows 98 or higher; 64 MB RAM; 800 x 600 screen resolution set for “High Color (16-Bit)”; Macromedia Flash Player 6 or higher.

MACINTOSH^® SYSTEM REQUIREMENTS:
Power Mac g3 at 300 MHz; System 8.5 or higher (excluding Mac OSX); 96 MB RAM; 20 MB minimum hard disk space available; 800 x 600 screen resolution set to “Thousands of Colors”; Macromedia Flash Player 6 or higher.