Brain activation patterns of female multiple sclerosis patients with voiding dysfunction

Abstract

Aims We compared brain activation patterns between female multiple sclerosis (MS) patients with voiding dysfunction (VD) and those without. We aim to expand current knowledge of supraspinal correlates of voiding initiation within a cohort of female MS patients with and without VD. Materials and Methods Twenty‐eight ambulatory female MS patients with stable disease and lower urinary tract dysfunction were recruited for this study. Subjects were divided into group 1, without VD (n = 14), and group 2, with VD (n = 14), defined as postvoid residual urine of ≥40% of maximum cystometric capacity or need for self‐catheterization. We recorded brain activity via functional magnetic resonance imaging (fMRI) with simultaneous urodynamic testing. Average fMRI activation maps (the Student t test) were created for both groups, and areas of significant activation were identified (P < .05). A priori regions of interest (ROIs), identified by prior meta‐analysis to be involved in voiding, were selected. Results Group‐averaged blood‐oxygen level‐dependent (BOLD) activation maps demonstrated significant differences between groups 1 and 2 during initiation of voiding with group 2 showing significantly lower levels of activation in all ROIs except for the left cerebellum and right cingulate gyrus. Interestingly, group 2 displayed negative BOLD signals, while group 1 displayed positive signals in the right and left pontine micturition center, right periaqueductal gray, left thalamus, and left cingulate gyrus. The activation map of group 1 was similar to healthy controls. Conclusions Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.

Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol

“…Our research team has extensively examined how the brain controls LUT functions in women with MS [ 30 – 40 ]. We have also observed similar results indicating elevated BOLD signals in these specific ROIs within circuit 2 when individuals with MS and NOAB experience a strong urge to void, suggesting an abnormal perception of bladder volume in these individuals [ 32 , 35 ]. Although the precise mechanisms governing the interactions among these circuits are not yet understood, it is now apparent that they do not operate independently in either healthy individuals or those with OAB/NOAB [ 29 ].…”

Cuprizone‐mediated demyelination reversibly degrades voiding behavior in mice while sparing brainstem reflex

“…Clinical data have suggested that cortical dysfunction may contribute to MS bladder dysfunction (Khavari et al, 2020). In this study, we show for the first time that cortical demyelination in a standard MS mouse model (Ramasamy & Smith, 2021a, 2021b can produce an MS bladder dysfunction phenotype.…”

“…However, neither the standard clinical diagnoses nor a spinal‐centric MS bladder disease model is fully consistent with clinical physiologic findings (Leitner et al, 2016; Rantell et al, 2018), nor have yielded routinely safe and effective therapies for patients (Phé et al, 2016). Clinical data have suggested that cortical dysfunction may contribute to MS bladder dysfunction (Khavari et al, 2020). In this study, we show for the first time that cortical demyelination in a standard MS mouse model (Ramasamy & Smith, 2021a, 2021b) can produce an MS bladder dysfunction phenotype.…”

Preliminary Analysis of Brain Footprints in Multiple Sclerosis Females With Detrusor Sphincter Dyssynergia: A Concurrent Urodynamic and Functional Magnetic Resonance Imaging Study

“…[9,10] Dynamic imaging studies, such as positron emission tomography-computed tomography (PET-CT) and functional magnetic resonance imaging (fMRI) modalities, have been implemented to better characterize this complex disease process. [11][12][13] Previously, our team found distinct functional connectivity (FC) patterns using fMRI [13] with more damage in the left anterior thalamic radiation (ATR) on diffusion tensor imaging (DTI) [14] in patients with VD compared to those without. In this study, we aim to assess the grey and white matter of female MS patients with DSD, specifically the FC of brain regions that are activated at the initiation of voiding, and the integrity of two white matter tracts; the ATR and the superior longitudinal fasciculus (SLF), via their fractional anisotropy (FA) and mean diffusivity (MD) values.…”