Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions

Yani, Moheb S.; Fenske, Sonja J.; Rodríguez, Larissa V.; Kutch, Jason J.

doi:10.1002/nau.24014

Cited by 21 publications

(19 citation statements)

References 27 publications

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“…In this pilot study, we aimed to lay the foundation for the eventual use of these therapies to improve stroke-related voiding dysfunction. 5,6 The objective of this study was to describe micturition-related brain activity in stroke patients using blood-oxygen-level-dependent (BOLD)-signal fMRI. We hypothesized that, when compared to healthy controls, stroke patients would exhibit distinct patterns of brain activity during both urinary storage and urinary voiding.…”

Section: Introductionmentioning

confidence: 99%

The effect of stroke on micturition associated brain activity: A pilot fMRI study

Kreydin

Gad

Gao

et al. 2020

Neurourology and Urodynamics

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Objective: Cerebral stroke is a unique model for studying the role of the brain in lower urinary tract (LUT) control. By its nature, stroke must change the activity of the brain to cause LUT dysfunction. The objective of this study was to describe changes in micturition-related brain activity in patients who develop LUT symptoms (LUTS) after a cerebral stroke. Materials and Methods: Healthy controls (HC, n = 10) and patients who developed storage LUTS after a cerebral stroke (n = 7) were recruited. Functional magnetic resonance imaging was used to assess brain activity in each subject. In the task-based block design, blood-oxygen-level-dependent (BOLD) signal was detected during rest, active bladder filling, and bladder voiding. BOLD signal intensity was compared between HCs and stroke subjects during bladder filling, voiding, and voiding initiation. Results: Stroke subjects exhibited higher activity in the periaqueductal gray and cerebellum during bladder filling and bladder voiding. HCs exhibited more intense activity in higher centers, such as the cingulate cortex, motor cortex, and the dorsolateral prefrontal cortex in each of the phases examined. Conclusions: Subjects with stroke-related LUTS exhibit a specific pattern of brain activity during bladder filling and voiding. There appears to be a greater reliance on primitive centers (cerebellum, midbrain) than in healthy controls during both phases of the micturition cycle. We hypothesize that these findings may reflect loss of connectivity with higher brain centers after a stroke.

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Section: Introductionmentioning

confidence: 99%

The effect of stroke on micturition associated brain activity: A pilot fMRI study

Kreydin

Gad

Gao

et al. 2020

Neurourology and Urodynamics

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“…3 B). All these associations were in the negative direction—as urinary urge and voided volume increase, slow-5 fALFF decreases (lower slow-5 fALFF values indicate higher neural activity 31 ). Table 2 summarizes these clusters.…”

Section: Resultsmentioning

confidence: 98%

“…This was consistent with numerous catheter-based bladder infusion studies where the dACC and SMA are reliably activated during strong desire to void and full bladder 10 , 11 , 37 , 38 . The broader ACC regulates midbrain homeostatic centers 39 and also supplies sympathetic outflow to the bladder 40 whereas the SMA provides motor output 31 , 41 . The ACC and SMA provides signals that ultimately tightens the urethral sphincter and inhibits contraction of the detrusor muscles, allowing the bladder to be filled 8 , 40 .…”

Section: Discussionmentioning

confidence: 99%

“…These loci might be encoding different PAG signals—for instance, the DLPFC, being a cardinal node of the cognitive control networks, may be providing descending signals to the PAG 47 to inhibit/not excite downstream micturition centers. At the same time, the SMA might be providing a motor output via the PAG to voluntarily engage the pelvic floor muscles to suppress urge and voiding until an appropriate circumstance arises 31 , 41 .…”

Section: Discussionmentioning

confidence: 99%

“…Fractional ALFF (fALFF) accounts for physiological confounds and individual differences by examining power in the frequency range of interest compared to power in the total frequency range. Here we focused on slow-5 oscillations (0.01–0.027 Hz), as we have previously identified changes specific to slow-5 fALFF in urologic disease compared to healthy controls 30 , and have correspondingly shown that slow-5 fALFF may predictably respond to different repetitive transcranial magnetic stimulation (rTMS) sequences known to both increase and decrease neural activity neuromodulation of BOLD activity in urologic conditions 31 . In order to generate slow-5 fALFF images, the 3dRSFC AFNI function was used instead of the 3dTproject algorithm above, with a bandpass filter set to 0.01–0.027 Hz.…”

Section: Methodsmentioning

confidence: 99%

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Natural bladder filling alters resting brain function at multiple spatial scales: a proof-of-concept MAPP Network Neuroimaging Study

Mawla

Schrepf

Ichesco

et al. 2020

Sci Rep

Self Cite

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Neural circuitry regulating urine storage in humans has been largely inferred from fMRI during urodynamic studies driven by catheter infusion of fluid into the bladder. However, urodynamic testing may be confounded by artificially filling the bladder repeatedly at a high rate and examining associated time-locked changes in fMRI signals. Here we describe and test a more ecologically-valid paradigm to study the brain response to bladder filling by (1) filling the bladder naturally with oral water ingestion, (2) examining resting state fMRI (rs-fMRI) which is more natural since it is not linked with a specific stimulus, and (3) relating rs-fMRI measures to self-report (urinary urge) and physiologic measures (voided volume). To establish appropriate controls and analyses for future clinical studies, here we analyze data collected from healthy individuals (N = 62) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. Participants orally ingested approximately 350 mL of water, and had a 10 min “fuller bladder” rs-fMRI scan approximately 1 h later. A second 10 min “empty bladder” rs-fMRI scan was conducted immediately following micturition. We examined multiple spatial scales of brain function, including local activity, circuits, and networks. We found changes in brain function distributed across micturition loci (e.g., subregions of the salience, sensorimotor, and default networks) that were significantly related to the stimulus (volume) and response (urinary urge). Based on our results, this paradigm can be applied in the future to study the neurobiological underpinnings of urologic conditions.

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Noninvasive brain stimulation in the treatment of functional urological and pelvic floor disorders: A scoping review

Mazeaud

Salazar

Khavari

2023

Neurourology and Urodynamics

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Introduction: Functional pelvic floor disorders (PFD) such as bowel and bladder dysfunctions can be challenging to manage with our current therapeutic modalities. Recently, noninvasive brain stimulation has emerged as a novel strategy for noninvasive pelvic floor management. Here, we assessed the current state of research on this topic. Methods: A scoping review was conducted with Pubmed, Web of Science, and Embase, in conjunction with clinicaltrials.gov, encompassing all manuscripts published without past time limit up until June 30, 2022. Results: Of the 880 abstracts identified in a blind selection by two reviewers, 14 publications with an evidence level of 1 or 2 (Oxford scale) were eligible and included in this review. Review articles, case reports (<5 patients), letters, and protocol studies were excluded. PFDs were described as either pelvic pain or lower urinary tracts symptoms (LUTS) with repeated transcranial magnetic stimulation (rTMS) as the most common treatment modality. Despite heterogeneous therapeutic protocols, significant improvements were observed such as reduction in postvoid residual of urine, increased bladder capacity, improved voiding flow paraments, and decreased chronic pelvic, and bladder pain. No appreciable adverse effects were noted. However, low sample populations allowed only provisional conclusions. Conclusion:Noninvasive transcranial neurostimulation for LUTS and pelvic pain is emerging as an effective tool for clinicians to utilize in the future. Further investigation is needed to elucidate the full significance of the indicated outcomes.

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Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions

Cited by 21 publications

References 27 publications

The effect of stroke on micturition associated brain activity: A pilot fMRI study

The effect of stroke on micturition associated brain activity: A pilot fMRI study

Natural bladder filling alters resting brain function at multiple spatial scales: a proof-of-concept MAPP Network Neuroimaging Study

Noninvasive brain stimulation in the treatment of functional urological and pelvic floor disorders: A scoping review

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