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Ying X, Gao Y, Liao L. Brain Responses Difference between Sexes for Strong Desire to Void: A Functional Magnetic Resonance Imaging Study in Adults Based on Graph Theory. J Clin Med 2024; 13:4284. [PMID: 39124552 PMCID: PMC11313296 DOI: 10.3390/jcm13154284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 08/12/2024] Open
Abstract
Background: The alternations of brain responses to a strong desire to void were unclear, and the gender differences under the strong desire to void remain controversial. The present study aims to identify the functional brain network's topologic property changes evoked by a strong desire to void in healthy male and female adults with synchronous urodynamics using a graph theory analysis. Methods: The bladders of eleven healthy males and eleven females were filled via a catheter using a specific infusion and withdrawal pattern. A resting-state functional magnetic resonance imaging (fMRI) was performed on the enrolled subjects, scanning under both the empty bladder and strong desire to void states. An automated anatomical labeling (AAL) atlas was used to identify the ninety cortical and subcortical regions. Pearson's correlation calculations were performed to establish a brain connection matrix. A paired t-test (p < 0.05) and Bonferroni correction were applied to identify the significant statistical differences in topological properties between the two states, including small-world network property parameters [gamma (γ) and lambda (λ)], characteristic path length (Lp), clustering coefficient (Cp), global efficiency (Eglob), local efficiency (Eloc), and regional nodal efficiency (Enodal). Results: The final data suggested that females and males had different brain response patterns to a strong desire to void, compared with an empty bladder state. Conclusions: More brain regions involving emotion, cognition, and social work were active in females, and males might obtain a better urinary continence via a compensatory mechanism.
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Affiliation(s)
- Xiaoqian Ying
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China;
- Rehabilitation School, Capital Medical University, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing 100068, China
| | - Yi Gao
- Department of Neurourology, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing 100068, China
| | - Limin Liao
- Rehabilitation School, Capital Medical University, Beijing Boai Hospital, China Rehabilitation Research Center, Beijing 100068, China
- Department of Urology, Capital Medical University, Beijing 100068, China
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2
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Deng H, Liao L, Wu J, Wan L. Intravesical Electrical Stimulation Improves Abnormal Prefrontal Brain Activity in Patients With Underactive Bladder: A Possible Central Mechanism. Int Neurourol J 2023; 27:260-270. [PMID: 38171326 PMCID: PMC10762371 DOI: 10.5213/inj.2346232.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/11/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE The aim of this study was to explore the mechanisms of central brain action in patients with neurogenic underactive bladder (UAB) treated with intravesical electrical stimulation (IVES). METHODS We prospectively recruited patients with neurogenic UAB who chose to receive IVES treatment and healthy subjects (HS). At baseline, the following data were obtained: a 72-hour voiding diary; measurements of postvoid residual urine (PVR), voiding efficiency (VE) and first sensation of bladder filling (FS); American Urological Association Symptom Index Quality of Life (AUA-SI-QOL) scores, and functional near-infrared spectroscopy scans of the prefrontal cortex in the voiding stage. All UAB patients were re-evaluated for these indices after completing 4 weeks of IVES. A >50% improvement in PVR was defined as successful IVES treatment. Prefrontal activity was analyzed using the NIRS_KIT software, corrected with the false discovery rate (P<0.05). Statistical analysis was performed using IBM SPSS Statistics ver. 22.0, and P<0.05 was considered statistically significant. RESULTS Eighteen UAB patients and 16 HS were included. IVES treatment was successful in 11 UAB patients and failed in 7. The PVR, VE, 24-hour clean intermittent catheterization, FS volume, and AUA-SI-QOL scores of the UAB group significantly improved after successful IVES treatment. BA9 (right dorsolateral prefrontal cortex [DLPFC]) and BA10 (right frontal pole) were significantly activated after successful IVES, and no significant difference was found between the successful group and HS group after IVES. Before IVES, BA10 (right frontal pole) was significantly deactivated in the failed group compared with the successful group. CONCLUSION The possible central mechanism of IVES treatment for neurogenic UAB is that IVES reactivates the right DLPFC and right frontal pole.
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Affiliation(s)
- Han Deng
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
- China Rehabilitation Science Institute, Beijing, China
- University of Health and Rehabilitation Sciences, Qingdao, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
- Wenzhou Medical University, Wenzhou, China
| | - Juan Wu
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
| | - Li Wan
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
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3
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Mazeaud C, Salazar BH, Braun M, Hossu G, Khavari R. Functional MRI in neuro-urology: A narrative review. Prog Urol 2023:S1166-7087(23)00082-9. [PMID: 37062631 DOI: 10.1016/j.purol.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/26/2023] [Indexed: 04/18/2023]
Abstract
Neuro-imaging has given urologists a new tool to investigate the neural control of the lower urinary tract. Using functional magnetic resonance imaging (fMRI), it is now possible to understand which areas of the brain contribute to the proper function of the storage and voiding of the lower urinary tract. This field of research has evolved from simple anatomical descriptions to elucidating the complex micturition network. A keyword search of the Medline database was conducted by two reviewers for relevant studies from January 1, 2010, to August 2022. Of 2047 peer-reviewed articles, 49 are included in this review. In the last decade, a detailed understanding of the brain-bladder network has been described, elucidating a dedicated network, as well as activated areas in the brainstem, cerebellum, and cortex that share reproducible connectivity patterns. Research has shown that various urological diseases can lead to specific changes in this network and that therapies used by urologists to treat lower urinary tract symptoms (LUTS) are also able to modify neuronal activity. This represents a set of potential new therapeutic targets for the management of the lower urinary tract symptoms (LUTS). fMRI technology has made it possible to identify subgroups of responders to various treatments (biofeedback, anticholinergic, neuromodulation) and predict favourable outcomes. Lastly, this breakthrough understanding of neural control over bladder function has led to treatments that directly target brain regions of interest to improve LUTS. One such example is the use of non-invasive transcranial neuromodulation to improve voiding symptoms in individuals with multiple sclerosis.
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Affiliation(s)
- C Mazeaud
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States of America; Department of Urology, Nancy University Hospital, Nancy, France; Université de Lorraine, Inserm, IADI U1254, 54000 Nancy, France
| | - B H Salazar
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States of America
| | - M Braun
- Université de Lorraine, Inserm, IADI U1254, 54000 Nancy, France; Department of Diagnostic and Interventional Neuroradiology, Nancy University Hospital, Nancy, France
| | - G Hossu
- Université de Lorraine, Inserm, IADI U1254, 54000 Nancy, France
| | - R Khavari
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States of America.
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4
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Clarkson BD, Wei Z, Karim HT, Tyagi S, Resnick NM, Salkeld R, Conklin C. Neuroimaging of situational urgency and incontinence provoked by personal urgency cues. Neurourol Urodyn 2022; 41:166-173. [PMID: 34570403 PMCID: PMC8738101 DOI: 10.1002/nau.24800] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/23/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Situational triggers for urinary urgency and incontinence (UUI) such as "latchkey incontinence" and running water are often reported clinically, but no current clinical tools exist to directly address symptoms of UUI provoked by environmental stimuli. Previously we have shown that urgency and leakage can be reproduced during urodynamic studies with exposure to personal urgency-related images. Here we investigate the neural signatures associated with such situational triggers to inform potential therapies for reducing reactivity to these personal urgency-related cues among women with situational UUI. METHOD We recruited 23 women with situational UUI who took photographs of their personal "urgency trigger" and "safe" situations and were exposed to them in a magnetic resonance imaging (MRI) scanner. We identified brain areas that were more active during urgency versus safe image exposure. RESULTS We found that, during urgency image exposure, main components of the attention network and decision-related processes, the middle and medial frontal gyri, were more active (p < 0.01). In addition, areas well known to be involved in the continence mechanism, such as the cingulate and parahippocampal areas, were also more active during urgency image exposure. CONCLUSION Exposure to personal situational urgency images activated different areas of the brain compared with safe environments, highlighting the complex brain mechanisms that provoke real-world urgency. Using brain and behavioral-based therapies which target the attentional areas identified here and extinguish cue reactivity might reduce symptom burden in this subset of UUI sufferers.
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Affiliation(s)
- Becky D Clarkson
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Zhiyang Wei
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Helmet T Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Shachi Tyagi
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Neil M Resnick
- Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Ronald Salkeld
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
| | - Cynthia Conklin
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15213, USA
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5
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Wu W, Su Y, Huang H, Chen M, Fan F, Zhu D, Li K, Guo Z, Liang Z, Huang H. Neuroimaging Study Investigating the Supraspinal Control of Lower Urinary Tract Function in Man With Orthotopic Ileal Neobladder. Front Surg 2021; 8:751236. [PMID: 34950694 PMCID: PMC8688399 DOI: 10.3389/fsurg.2021.751236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Recent studies employing functional imaging methodology have revealed reference brain regions of urinary tract function, namely, the midbrain periaqueductal gray matter, thalamus, and cingulate and prefrontal cortices. The orthotopic ileal neobladder is a desirable method for urinary diversion after radical cystectomy, but its supraspinal control remains unknown. We aimed to evaluate brain activity while maintaining urinary urgency and voluntary urinary control in male subjects with ileal orthotopic neobladders by performing functional MRI (fMRI) during a block design experiment. Materials and Methods: Patients were recruited at the Sun Yat-sen Memorial Hospital of the Sun Yat-sen University from October 2017 to May 2019. Two tasks were performed during fMRI scanning: (1) repeated infusion and withdrawal of sterile saline solution into and out of the neobladder to simulate urgency; and (2) repeated contraction of the pelvic floor muscle with a full neobladder to induce inhibition of micturition since the subjects were asked not to urinate. The obtained data were visualized and statistically analyzed. Results: Sixteen subjects were recruited in the study, and data were obtained from 10 subjects: mean age 60.1 years, average postoperative time 20.2 months, and daytime continence rate 100%. The parahippocampus, frontal lobe, vermis, and anterior cingulate cortex were activated with large bladder volumes, and the thalamus and caudate nucleus were deactivated during voluntary urinary control. Conclusion: A complex supraspinal program is involved during ileal orthotopic neobladder control, which is significantly different from that with normal bladders, in which the original intestine visceral volume sensation is preserved.
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Affiliation(s)
- Wanhua Wu
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yun Su
- Department of Radiology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hao Huang
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meiwei Chen
- Department of Radiology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fan Fan
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dingjun Zhu
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Kaiwen Li
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhenghui Guo
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiying Liang
- Department of Radiology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai Huang
- Department of Urology, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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6
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Walter M, Leitner L, Betschart C, Engeler DS, Freund P, Kessler TM, Kollias S, Liechti MD, Scheiner DA, Michels L, Mehnert U. Considering non-bladder aetiologies of overactive bladder: a functional neuroimaging study. BJU Int 2021; 128:586-597. [PMID: 33547746 DOI: 10.1111/bju.15354] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To better understand the neuropathophysiology of overactive bladder (OAB) in women by characterising supraspinal activity in response to bladder distention and cold stimulation. SUBJECTS/PATIENTS AND METHODS We recruited 24 female participants, 12 with OAB (median [interquartile range, IQR] age 40 [32-42] years) and 12 healthy controls (HCs) without lower urinary tract (LUT) symptoms (median [IQR] age 34 [28-44] years), and assessed LUT and cognitive function through neuro-urological examination, 3-day bladder diary, urodynamic investigation, and questionnaires. Functional magnetic resonance (MR) imaging using a 3-T scanner was performed in all participants during automated, repetitive bladder filling and draining (block design) with 100 mL body temperature (37 °C) saline using a MR-compatible and MR-synchronised infusion-drainage device until strong desire to void (HIGH-FILLING/DRAINING) and bladder filling with cold saline (4 °C, i.e. COLD). Whole-brain and region-of-interest analyses were conducted using Statistical Parametric Mapping, version 12. RESULTS Significant between-group differences were found for 3-day bladder diary variables (i.e. voiding frequency/24 h, P < 0.001; voided volume/void, P = 0.04; and urinary incontinence [UI] episodes/24 h, P = 0.007), questionnaire scores (International Consultation on Incontinence Questionnaire-Female LUT symptoms [overall, filling, and UI scores, all P < 0.001]; the Overactive Bladder Questionnaire short form [symptoms and quality-of-life scores, both P < 0.001]; the Hospital Anxiety and Depression Scale [anxiety P = 0.004 and depression P = 0.003 scores]), as well as urodynamic variables (strong desire to void, P = 0.02; maximum cystometric capacity, P = 0.007; and presence of detrusor overactivity, P = 0.002). Age, weight and cognitive function (i.e. Mini-Mental State Examination, P = 1.0) were similar between groups (P > 0.05). In patients with OAB, the HIGH task elicited activity in the superior temporal gyrus, ventrolateral prefrontal cortex (VLPFC), and mid-cingulate cortex; and the COLD task elicited activity in the VLPFC, cerebellum, and basal ganglia. Compared to HCs, patients with OAB showed significantly stronger cerebellar activity during HIGH-FILLING and significantly less activity in the insula and VLPFC during HIGH-DRAINING. CONCLUSIONS The present findings suggest a sensory processing and modulation deficiency in our OAB group, probably as part of their underlying pathophysiology, as they lacked activity in essential sensory processing areas, such as the insula. Instead, accessory areas, such as the cerebellum, showed significantly stronger activation compared to HCs, presumably supporting pelvic-floor motor activity to prevent UI. The novel findings of the present study provide physiological evidence of the necessity to consider non-bladder aetiologies of bladder symptoms.
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Affiliation(s)
- Matthias Walter
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lorenz Leitner
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Cornelia Betschart
- Department of Gynecology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Daniel S Engeler
- Department of Urology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Patrick Freund
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK.,Department of Neurology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Spyros Kollias
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - David A Scheiner
- Department of Gynecology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Lars Michels
- Department of Neuroradiology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Pang D, Gao Y, Liao L, Ying X. Brain functional network alterations caused by a strong desire to void in healthy adults: a graph theory analysis study. Neurourol Urodyn 2020; 39:1966-1976. [PMID: 32806881 DOI: 10.1002/nau.24445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE This resting-state functional magnetic resonance imaging (fMRI) study determined the functional connectivity (FC) changes and topologic property alterations of the brain functional network provoked by a strong desire to void in healthy adults using a graph theory analysis (GTA). MATERIALS AND METHODS Thirty-four healthy, right-handed subjects filled their bladders by drinking water. The subjects were scanned under an empty bladder and a strong desire to void states. The Pearson's correlation coefficients were calculated among 90 brain regions in the automated anatomical labeling (AAL) atlas to construct the brain functional network. A paired t test (P < .05, after false discovery rate [FDR] correction) was used to detect significant differences in the FC, topologic properties (small-world parameters [gamma, sigma], Cp, Lp, Eglob, Eloc, and Enodal) between the two states in all subjects. RESULTS Both the two states showed small-world network properties. The clustering coefficient (Cp) and local efficiency (Eloc) in the whole brain network decreased, while the FC within the default mode network (DMN) increased during the strong desire to void compared with the empty bladder state. Moreover, an increased nodal efficiency (Enodal) was detected in the basal ganglia (BG), DMN, sensorimotor-related network (SMN), and visual network (VN). CONCLUSION We detected FC changes and topologic property alterations in brain functional networks caused by a strong desire to void in healthy and suggest that the micturition control may be a process dominated by DMN and coordinated by multiple sub-networks (such as, BG, SMN, and VN), which could serve as a baseline for understanding the pathologic process underlying bladder dysfunction and be useful to improve targeted therapy in the future.
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Affiliation(s)
- Dongqing Pang
- Rehabilitation School of Capital Medical University, Department of Urology of Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Centre, Beijing, China
| | - Yi Gao
- Rehabilitation School of Capital Medical University, Department of Urology of Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Centre, Beijing, China
| | - Limin Liao
- Rehabilitation School of Capital Medical University, Department of Urology of Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Centre, Beijing, China
| | - Xiaoqian Ying
- Rehabilitation School of Capital Medical University, Department of Urology of Capital Medical University, Beijing, China.,Department of Urology, China Rehabilitation Research Centre, Beijing, China
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8
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Linking bodily, environmental and mental states in the self—A three-level model based on a meta-analysis. Neurosci Biobehav Rev 2020; 115:77-95. [DOI: 10.1016/j.neubiorev.2020.05.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 04/06/2020] [Accepted: 05/08/2020] [Indexed: 02/01/2023]
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9
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Khavari R, Elias SN, Pande R, Wu KM, Boone TB, Karmonik C. Higher Neural Correlates in Patients with Multiple Sclerosis and Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA. J Urol 2019; 201:135-140. [PMID: 30076906 DOI: 10.1016/j.juro.2018.07.066] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OnabotulinumtoxinA is a well described treatment of neurogenic overactive bladder. While motor effects on the detrusor muscle have been extensively studied, the sensory effects have not. The aim of this study was to evaluate the impact of intradetrusor onabotulinumtoxinA injection on brain activity in female patients with multiple sclerosis and neurogenic overactive bladder. MATERIALS AND METHODS We prospectively studied 12 women with stable multiple sclerosis and neurogenic overactive bladder using concurrent functional magnetic resonance imaging and urodynamic studies prior to and 6 to 10 weeks following onabotulinumtoxinA injection. Individual functional magnetic resonance imaging activation maps at the time of strong urgency were averaged before and after onabotulinumtoxinA injection where areas of significant activation were identified. RESULTS After onabotulinumtoxinA injection functional magnetic resonance imaging activation increased in the right cingulate body (p = 0.0012), the left posterior cingulate (p = 0.02), the left anterior cingulate (p = 0.0015), the right prefrontal cortex (p = 0.0015), the insula (p = 0.0138) and the pons micturition center (p = 0.05). Sparse areas showed decreased activity, including the left cerebellum (p = 0.001), the left fusiform gyrus (p = 0.065) and the bilateral lentiform nucleus (p = 0.026). CONCLUSIONS Intradetrusor injection of onabotulinumtoxinA appeared to increase the activity of most brain regions known to be involved in the sensation and process of urinary urgency in female patients with multiple sclerosis and neurogenic overactive bladder. To our knowledge this is the first study of its kind to evaluate the possible effects of onabotulinumtoxinA at the human brain level where sensory awareness is located. This activation pattern may be used to further phenotype patients to optimize therapy or determine the sensory effects of onabotulinumtoxinA beyond the bladder.
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Affiliation(s)
- Rose Khavari
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Saba N Elias
- MRI Core, Houston Methodist Research Institute, Houston, Texas
| | - Rashmi Pande
- Department of Urology, Houston Methodist Hospital, Houston, Texas
| | - Katherine M Wu
- MRI Core, Houston Methodist Research Institute, Houston, Texas
| | - Timothy B Boone
- Department of Urology, Houston Methodist Hospital, Houston, Texas
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10
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Zare A, Jahanshahi A, Rahnama'i MS, Schipper S, van Koeveringe GA. The Role of the Periaqueductal Gray Matter in Lower Urinary Tract Function. Mol Neurobiol 2018; 56:920-934. [PMID: 29804231 PMCID: PMC6400878 DOI: 10.1007/s12035-018-1131-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 05/14/2018] [Indexed: 12/18/2022]
Abstract
The periaqueductal gray matter (PAG), as one of the mostly preserved evolutionary components of the brain, is an axial structure modulating various important functions of the organism, including autonomic, behavioral, pain, and micturition control. It has a critical role in urinary bladder physiology, with respect to storage and voiding of urine. The PAG has a columnar composition and has extensive connections with its cranially and caudally located components of the central nervous system (CNS). The PAG serves as the control tower of the detrusor and sphincter contractions. It serves as a bridge between the evolutionary higher decision-making brain centers and the lower centers responsible for reflexive micturition. Glutamatergic cells are the main operational neurons in the vlPAG, responsible for the reception and relay of the signals emerging from the bladder, to related brain centers. Functional imaging studies made it possible to clarify the activity of the PAG in voiding and filling phases of micturition, and its connections with various brain centers in living humans. The PAG may be affected in a wide spectrum of disorders, including multiple sclerosis (MS), migraine, stroke, Wernicke’s encephalopathy, and idiopathic normal pressure hydrocephalus, all of which may have voiding dysfunction or incontinence, in certain stages of the disease. This emphasizes the importance of this structure for the basic understanding of voiding and storage disorders and makes it a potential candidate for diagnostic and therapeutic interventions.
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Affiliation(s)
- Aryo Zare
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands.
| | - Ali Jahanshahi
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Sandra Schipper
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands
| | - Gommert A van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands.
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Science, Maastricht, The Netherlands.
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11
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Leitner L, Walter M, Jarrahi B, Wanek J, Diefenbacher J, Michels L, Liechti MD, Kollias SS, Kessler TM, Mehnert U. A novel infusion-drainage device to assess lower urinary tract function in neuro-imaging. BJU Int 2016; 119:305-316. [PMID: 27617867 DOI: 10.1111/bju.13655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the applicability and precision of a novel infusion-drainage device (IDD) for standardized filling paradigms in neuro-urology and functional magnetic resonance imaging (fMRI) studies of lower urinary tract (LUT) function/dysfunction. SUBJECTS/PATIENTS AND METHODS The IDD is based on electrohydrostatic actuation which was previously proven feasible in a prototype setup. The current design includes hydraulic cylinders and a motorized slider to provide force and motion. Methodological aspects have been assessed in a technical application laboratory as well as in healthy subjects (n=33) and patients with LUT dysfunction (n=3) undergoing fMRI during bladder stimulation. After catheterization, the bladder was pre-filled until a persistent desire to void was reported by each subject. The scan paradigm comprised automated, repetitive bladder filling and withdrawal of 100 mL body warm (37 °C) saline, interleaved with rest and sensation rating. Neuroimaging data were analysed using Statistical Parametric Mapping version 12 (SMP12). RESULTS Volume delivery accuracy was between 99.1±1.2% and 99.9±0.2%, for different flow rates and volumes. Magnetic resonance (MR) compatibility was demonstrated by a small decrease in signal-to-noise ratio (SNR), i.e. 1.13% for anatomical and 0.54% for functional scans, and a decrease of 1.76% for time-variant SNR. Automated, repetitive bladder-filling elicited robust (P = 0.05, family-wise error corrected) brain activity in areas previously reported to be involved in supraspinal LUT control. There was a high synchronism between the LUT stimulation and the blood oxygenation level-dependent (BOLD) signal changes in such areas. CONCLUSION We were able to develop an MR-compatible and MR-synchronized IDD to routinely stimulate the LUT during fMRI in a standardized manner. The device provides LUT stimulation at high system accuracy resulting in significant supraspinal BOLD signal changes in interoceptive and LUT control areas in synchronicity to the applied stimuli. The IDD is commercially available, portable and multi-configurable. Such a device may help to improve precision and standardization of LUT tasks in neuro-imaging studies on supraspinal LUT control, and may therefore facilitate multi-site studies and comparability between different LUT investigations in the future.
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Affiliation(s)
- Lorenz Leitner
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.,Department of Urology, University Hospital Basel, Basel, Switzerland
| | - Matthias Walter
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Behnaz Jarrahi
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland.,UCLA Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Johann Wanek
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | | | - Lars Michels
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
| | - Martina D Liechti
- Department of Brain Repair and Rehabilitation, Institute of Neurology, University College London, London, UK
| | - Spyros S Kollias
- Department of Neuroradiology, University Hospital Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Jarrahi B, Gassert R, Wanek J, Michels L, Mehnert U, Kollias SS. Design and Application of a New Automated Fluidic Visceral Stimulation Device for Human fMRI Studies of Interoception. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2016; 4:2000108. [PMID: 27551646 PMCID: PMC4991687 DOI: 10.1109/jtehm.2016.2538239] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 01/07/2016] [Accepted: 02/29/2016] [Indexed: 02/05/2023]
Abstract
Mapping the brain centers that mediate the sensory-perceptual processing of visceral afferent signals arising from the body (i.e., interoception) is useful both for characterizing normal brain activity and for understanding clinical disorders related to abnormal processing of visceral sensation. Here, we report a novel closed-system, electrohydrostatically driven master–slave device that was designed and constructed for delivering controlled fluidic stimulations of visceral organs and inner cavities of the human body within the confines of a 3T magnetic resonance imaging (MRI) scanner. The design concept and performance of the device in the MRI environment are described. In addition, the device was applied during a functional MRI (fMRI) investigation of visceral stimulation related to detrusor distention in two representative subjects to verify its feasibility in humans. System evaluation tests demonstrate that the device is MR-compatible with negligible impact on imaging quality [static signal-to-noise ratio (SNR) loss <2.5% and temporal SNR loss <3.5%], and has an accuracy of 99.68% for flow rate and 99.27% for volume delivery. A precise synchronization of the stimulus delivery with fMRI slice acquisition was achieved by programming the proposed device to detect the 5 V transistor–transistor logic (TTL) trigger signals generated by the MRI scanner. The fMRI data analysis using the general linear model analysis with the standard hemodynamic response function showed increased activations in the network of brain regions that included the insula, anterior and mid-cingulate and lateral prefrontal cortices, and thalamus in response to increased distension pressure on viscera. The translation from manually operated devices to an MR-compatible and MR-synchronized device under automatic control represents a useful innovation for clinical neuroimaging studies of human interoception.
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Affiliation(s)
- Behnaz Jarrahi
- Clinic for NeuroradiologyUniversity Hospital ZurichZürich8091Switzerland; Department of Psychiatry and Biobehavioral SciencesSemel Institute for Neuroscience and Human BehaviorUniversity of California at Los AngelesLos AngelesCA90095USA
| | - Roger Gassert
- Department of Health Sciences and Technology Institute of Robotics and Intelligent Systems, ETH Zurich Zürich 8092 Switzerland
| | - Johann Wanek
- Spinal Cord Injury Center Balgrist University Hospital Zürich 8008 Switzerland
| | - Lars Michels
- Clinic for Neuroradiology University Hospital Zurich Zürich 8091 Switzerland
| | - Ulrich Mehnert
- Spinal Cord Injury Center Balgrist University Hospital Zürich 8008 Switzerland
| | - Spyros S Kollias
- Clinic for Neuroradiology University Hospital Zurich Zürich 8091 Switzerland
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13
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Deruyver Y, Hakim L, Franken J, De Ridder D. The use of imaging techniques in understanding lower urinary tract (dys)function. Auton Neurosci 2016; 200:11-20. [PMID: 27477680 DOI: 10.1016/j.autneu.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/22/2015] [Accepted: 05/23/2016] [Indexed: 12/11/2022]
Abstract
The ability to store urine in the bladder and to void at an appropriate time depends on several complex mechanisms in the lower urinary tract (LUT) and its neural control. Normal LUT function requires coordination of the urinary bladder, urethra, pelvic floor, efferent and afferent neurons and specific spinal cord and brain areas. These structures can be visualised using different imaging modalities, such as ultrasound, X-ray and magnetic resonance imaging. The supraspinal neural control of the LUT can be studied using functional brain imaging. During the last two decades, the many technological improvements of these imaging techniques have increased our knowledge of voiding dysfunction. Here, we review the different imaging modalities of the LUT and its neural control and discuss their importance for diagnosing and understanding voiding dysfunction.
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Affiliation(s)
- Yves Deruyver
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lukman Hakim
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Airlangga University School of Medicine and Dr. Soetomo General Hospital, Department of Urology, Surabaya, Indonesia
| | - Jan Franken
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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14
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Arya NG, Weissbart SJ, Xu S, Rao H. Brain activation in response to bladder filling in healthy adults: An activation likelihood estimation meta-analysis of neuroimaging studies. Neurourol Urodyn 2016; 36:960-965. [PMID: 27367364 DOI: 10.1002/nau.23058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 05/30/2016] [Indexed: 01/23/2023]
Abstract
AIMS Recent studies have used different neuroimaging techniques and identified various brain regions that are activated during bladder filling. However, there is a lack of consensus regarding which of these brain regions regulate the process of urine storage. The aim of this meta-analysis is to identify brain regions that are commonly activated during bladder filling in healthy adults across different studies. METHODS PubMed was searched for neuroimaging studies investigating the effects of bladder filling on regional brain activation. Studies were excluded if they did not report brain activation differences from whole-brain group analysis by comparing the state of bladder filling with the state of bladder rest. The current version of the activation likelihood estimation (ALE) approach was used for meta-analysis. RESULTS We identified 14 neuroimaging studies examining brain activation in response to experimental bladder filling in 181 healthy subjects, which reported 89 foci for ALE analysis. The meta-analysis revealed significant activation in multiple brain regions including thalamus (bilaterally), right insula, cerebellum, and brainstem (bilaterally). CONCLUSIONS Several key brain regions involved in sensory processing are commonly activated during bladder filling in healthy adults across different studies. Neurourol. Urodynam. 36:960-965, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Nisha G Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Division of Urogynecology, Department of Obstetrics and Gynecology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sihua Xu
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China.,Center for Functional Neuroimaging, Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Laboratory of Applied Brain and Cognitive Sciences, Shanghai International Studies University, Shanghai, China.,Center for Functional Neuroimaging, Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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15
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Central control of visceral pain and urinary tract function. Auton Neurosci 2016; 200:35-42. [PMID: 26905459 DOI: 10.1016/j.autneu.2016.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 08/17/2015] [Accepted: 02/01/2016] [Indexed: 12/21/2022]
Abstract
Afferent input from Aδ and C-fibres innervating the urinary bladder are processed differently by the brain, and have different roles in signaling bladder sensation. Aδ fibres that signal bladder filling activate a spino-bulbo-spinal loop, which relays in the midbrain periaqueductal grey (PAG) and pontine micturition centre (PMC). The excitability of this circuitry is regulated by tonic GABAergic inhibitory processes. In humans and socialised animals micturition is normally under volitional control and influenced by a host of psychosocial factors. Higher nervous decision-making in a social context to 'go now' or 'do not go' probably resides in frontal cortical areas, which act as a central control switch for micturition. Exposure to psychosocial stress can have profoundly disruptive influence on the process and lead to maladaptive changes in the bladder. During sleeping the voiding reflex threshold appears to be reset to a higher level to promote urinary continence. Under physiological conditions C-fibre bladder afferents are normally silent but are activated in inflammatory bladder states and by intense distending pressure. Following prolonged stimulation visceral nociceptors sensitise, leading to a lowered threshold and heightened sensitivity. In addition, sensitization may occur within the central pain processing circuitry, which outlasts the original nociceptive insult. Visceral nociception may also be influenced by genetic and environmental influences. A period of chronic stress can produce increased sensitivity to visceral pain that lasts for months. Adverse early life events can produce even longer lasting epigenetic changes, which increase the individual's susceptibility to developing visceral pain states in adulthood.
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16
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Jarrahi B, Mantini D, Balsters JH, Michels L, Kessler TM, Mehnert U, Kollias SS. Differential functional brain network connectivity during visceral interoception as revealed by independent component analysis of fMRI TIME-series. Hum Brain Mapp 2015; 36:4438-68. [PMID: 26249369 DOI: 10.1002/hbm.22929] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 07/20/2015] [Accepted: 07/27/2015] [Indexed: 12/15/2022] Open
Abstract
Influential theories of brain-viscera interactions propose a central role for interoception in basic motivational and affective feeling states. Recent neuroimaging studies have underlined the insula, anterior cingulate, and ventral prefrontal cortices as the neural correlates of interoception. However, the relationships between these distributed brain regions remain unclear. In this study, we used spatial independent component analysis (ICA) and functional network connectivity (FNC) approaches to investigate time course correlations across the brain regions during visceral interoception. Functional magnetic resonance imaging (fMRI) was performed in thirteen healthy females who underwent viscerosensory stimulation of bladder as a representative internal organ at different prefill levels, i.e., no prefill, low prefill (100 ml saline), and high prefill (individually adapted to the sensations of persistent strong desire to void), and with different infusion temperatures, i.e., body warm (∼37°C) or ice cold (4-8°C) saline solution. During Increased distention pressure on the viscera, the insula, striatum, anterior cingulate, ventromedial prefrontal cortex, amygdalo-hippocampus, thalamus, brainstem, and cerebellar components showed increased activation. A second group of components encompassing the insula and anterior cingulate, dorsolateral prefrontal and posterior parietal cortices and temporal-parietal junction showed increased activity with innocuous temperature stimulation of bladder mucosa. Significant differences in the FNC were found between the insula and amygdalo-hippocampus, the insula and ventromedial prefrontal cortex, and the ventromedial prefrontal cortex and temporal-parietal junction as the distention pressure on the viscera increased. These results provide new insight into the supraspinal processing of visceral interoception originating from an internal organ.
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Affiliation(s)
- Behnaz Jarrahi
- Clinic for Neuroradiology, University Hospital, Zurich, Switzerland.,Department of Information Technology and Electrical Engineering, Institute for Biomedical Engineering, Federal Institute of Technology (ETH), Zurich, Switzerland.,Neuro-Urology Spinal Cord Injury Center and Research, Balgrist University Hospital, Zurich, Switzerland.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), California.,Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
| | - Dante Mantini
- Neuroscience Center Zurich, University and ETH, Zurich, Switzerland.,Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.,Department of Health Sciences and Technology, Neural Control of Movement Laboratory, ETH Zurich, Switzerland
| | - Joshua Henk Balsters
- Department of Health Sciences and Technology, Neural Control of Movement Laboratory, ETH Zurich, Switzerland
| | - Lars Michels
- Clinic for Neuroradiology, University Hospital, Zurich, Switzerland.,Center for MR-Research, University Children's Hospital, Zurich, Switzerland
| | - Thomas M Kessler
- Neuro-Urology Spinal Cord Injury Center and Research, Balgrist University Hospital, Zurich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology Spinal Cord Injury Center and Research, Balgrist University Hospital, Zurich, Switzerland
| | - Spyros S Kollias
- Clinic for Neuroradiology, University Hospital, Zurich, Switzerland.,Neuroscience Center Zurich, University and ETH, Zurich, Switzerland
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17
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Leitner L, Walter M, Freund P, Mehnert U, Michels L, Kollias S, Kessler TM. Protocol for a prospective magnetic resonance imaging study on supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity. BMC Urol 2014; 14:68. [PMID: 25132340 PMCID: PMC4144688 DOI: 10.1186/1471-2490-14-68] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 08/13/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The control of the lower urinary tract is a complex, multilevel process involving both the peripheral and central nervous system. Due to lesions of the neuraxis, most spinal cord injury patients suffer from neurogenic lower urinary tract dysfunction, which may jeopardise upper urinary tract function and has a negative impact on health-related quality of life. However, the alterations to the nervous system following spinal cord injury causing neurogenic lower urinary tract dysfunction and potential effects of treatments such as intradetrusor onabotulinumtoxinA injections on lower urinary tract control are poorly understood. METHODS/DESIGN This is a prospective structural and functional magnetic resonance imaging study investigating the supraspinal lower urinary tract control in healthy subjects and spinal cord injury patients undergoing intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity.Neuroimaging data will include structural magnetic resonance imaging (T1-weighted imaging and diffusion tensor imaging) as well as functional, i.e. blood oxygen level-dependent sensitive magnetic resonance imaging using a 3 T magnetic resonance scanner. The functional magnetic resonance imaging will be performed simultaneously to three different bladder stimulation paradigms using an automated magnetic resonance compatible and synchronised pump system.All subjects will undergo two consecutive and identical magnetic resonance imaging measurements. Healthy subjects will not undergo any intervention between measurements but spinal cord injury patients will receive intradetrusor onabotulinumtoxinA injections for treating neurogenic detrusor overactivity.Parameters of the clinical assessment including bladder diary, urinalysis, medical history, neuro-urological examination, urodynamic investigation as well as standardised questionnaires regarding lower urinary tract function and quality of life will serve as co-variates in the magnetic resonance imaging analysis. DISCUSSION This study will identify structural and functional alterations in supraspinal networks of lower urinary tract control in spinal cord injury patients with neurogenic detrusor overactivity compared to healthy controls. Post-treatment magnetic resonance imaging measurements in spinal cord injury patients will provide further insights into the mechanism of action of treatments such as intradetrusor onabotulinumtoxinA injections and the effect on supraspinal lower urinary tract control. TRIAL REGISTRATION ClinicalTrials.gov NCT01768910.
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Affiliation(s)
- Lorenz Leitner
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Matthias Walter
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Patrick Freund
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Ulrich Mehnert
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Lars Michels
- Institute of Neuro-Radiology, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Spyros Kollias
- Institute of Neuro-Radiology, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
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Walter M, Michels L, Kollias S, van Kerrebroeck PE, Kessler TM, Mehnert U. Protocol for a prospective neuroimaging study investigating the supraspinal control of lower urinary tract function in healthy controls and patients with non-neurogenic lower urinary tract symptoms. BMJ Open 2014; 4:e004357. [PMID: 24848086 PMCID: PMC4039803 DOI: 10.1136/bmjopen-2013-004357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 04/23/2014] [Accepted: 04/29/2014] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTS) are highly prevalent, cause an enormous economic burden on healthcare systems and significantly impair the quality of life (QoL) of affected patients. The dependence of the LUT on complex central neuronal circuits makes it unique in comparison to other visceral functions, such as the gastrointestinal tract, but also more vulnerable to neurological diseases. METHODS AND ANALYSIS This is a prospective neuroimaging study investigating the supraspinal control of LUT function in healthy controls and in patients with non-neurogenic LUTS. The clinical assessment will include medical history, neuro-urological examination, bladder diary, urine analysis, urodynamic investigations, as well as standardised questionnaires regarding LUTS and QoL. The acquisition of neuroimaging data will include structural assessments (T1-weighted imaging and diffusion tensor imaging) as well as functional investigations using blood-oxygen-level dependent sensitive functional MRI (fMRI) in a 3 T MR scanner. The fMRI will be performed during four different bladder tasks using an automated MR-compatible and MR-synchronised pump system. The first three task-related fMRIs will consist of automated, repetitive filling of 100 mL warm (37°C) saline starting with (1) an empty bladder, (2) a low prefilled bladder volume (100 mL) and (3) a high prefilled bladder volume (persistent desire to void). The fourth task-related fMRI will comprise of automated, repetitive filling of 100 mL cold (4-8°C) saline starting with an empty bladder. ETHICS AND DISSEMINATION The local ethics committee approved this study (KEK-ZH-Nr. 2011-0346). The findings of the study will be published in peer-reviewed journals and presented at national and international scientific meetings. TRIAL REGISTRATION NUMBER This study has been registered at clinicaltrials.gov (http://www.clinicaltrials.gov/ct2/show/NCT01768910).
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Affiliation(s)
- Matthias Walter
- Department of Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Lars Michels
- Institute of Neuro-Radiology, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | - Spyros Kollias
- Institute of Neuro-Radiology, University of Zürich, University Hospital Zürich, Zürich, Switzerland
| | | | - Thomas M Kessler
- Department of Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Ulrich Mehnert
- Department of Neuro-Urology, Spinal Cord Injury Centre & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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De Pauw K, Roelands B, Marusic U, Tellez HF, Knaepen K, Meeusen R. Brain mapping after prolonged cycling and during recovery in the heat. J Appl Physiol (1985) 2013; 115:1324-31. [PMID: 23990240 PMCID: PMC3841834 DOI: 10.1152/japplphysiol.00633.2013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/23/2013] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to determine the effect of prolonged intensive cycling and postexercise recovery in the heat on brain sources of altered brain oscillations. After a max test and familiarization trial, nine trained male subjects (23 ± 3 yr; maximal oxygen uptake = 62.1 ± 5.3 ml·min(-1)·kg(-1)) performed three experimental trials in the heat (30°C; relative humidity 43.7 ± 5.6%). Each trial consisted of two exercise tasks separated by 1 h. The first was a 60-min constant-load trial, followed by a 30-min simulated time trial (TT1). The second comprised a 12-min simulated time trial (TT2). After TT1, active recovery (AR), passive rest (PR), or cold water immersion (CWI) was applied for 15 min. Electroencephalography was measured at baseline and during postexercise recovery. Standardized low-resolution brain electromagnetic tomography was applied to accurately pinpoint and localize altered electrical neuronal activity. After CWI, PR and AR subjects completed TT2 in 761 ± 42, 791 ± 76, and 794 ± 62 s, respectively. A prolonged intensive cycling performance in the heat decreased β activity across the whole brain. Postexercise AR and PR elicited no significant electrocortical differences, whereas CWI induced significantly increased β3 activity in Brodmann areas (BA) 13 (posterior margin of insular cortex) and BA 40 (supramarginal gyrus). Self-paced prolonged exercise in the heat seems to decrease β activity, hence representing decreased arousal. Postexercise CWI increased β3 activity at BA 13 and 40, brain areas involved in somatosensory information processing.
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Affiliation(s)
- Kevin De Pauw
- Department of Human Physiology, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
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De Wachter S, Smith P, Tannenbaum C, Van Koeveringe G, Drake M, Wyndaele J, Chapple C. How should bladder sensation be measured?: ICI-RS 2011. Neurourol Urodyn 2012; 31:370-4. [DOI: 10.1002/nau.22214] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 01/12/2012] [Indexed: 01/25/2023]
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