PD04-01 CHANGES IN BRAIN ACTIVITY FOLLOWING INTRADETRUSOR INJECTION OF ONABOTULINUMTOXINA IN PATIENTS WITH MULTIPLE SCLEROSIS: AN FMRI STUDY

Abstract

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Neurogenic Voiding Dysfunction I1 Apr 2018PD04-01 CHANGES IN BRAIN ACTIVITY FOLLOWING INTRADETRUSOR INJECTION OF ONABOTULINUMTOXINA IN PATIENTS WITH MULTIPLE SCLEROSIS: AN FMRI STUDY Rose Khavari, Christof Karmonik, Saba Elias, and Timothy Boone Rose KhavariRose Khavari More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , Saba EliasSaba Elias More articles by this author , and Timothy BooneTimothy Boone More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.279AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES OnabotulinumtoxinA (BTX-A) is a well-described treatment for Neurogenic Detrusor Overactivity (NDO) and while its motor effects on detrusor muscle is extensively studied, its sensory effects are not. Prior functional neuroimaging studies have suggested that women with overactive bladder have increased brain activity in the cingulate cortex, insula, and frontal cortex in response to bladder filling. The aim of this study was to evaluate the impact of intradetrusor BTX-A on brain activity in female multiple sclerosis (MS) patients with NDO using concurrent functional magnetic resonance imaging (fMRI) and UDS in a priori regions of interest. METHODS We conducted a prospective study of 12 women with stable MS and NDO undergoing fMRI with simultaneous UDS prior to and 6-weeks following BTX-A. During the filling phase patients signalled the strong urgency. From individual fMRI activation maps at strong urgency average fMRI activation map in MNI (Montreal Neuroimaging Institute) space were created for pre and post BTX-A from which areas of significant activation were identified (p<0.05). RESULTS fMRI activation increased post BTX-A in the right cingulate body (x (right positive),y (posterior positive),z (inferior positive) coordinates = 17,4,39, p=0.0012), ), the left posterior cingulate (-7,-37,22,p=0.02), the left anterior cingulate (-3,24,8,p=0.0015), the right prefrontal cortex (3,51,46,p=0.0015), the insula (32,12,14,p=0.0138) and the pons micturition center (3,-29,-28,p=0.05). Areas that showed decreased activity were sparse and included the left cerebellum (-31,-63,-62,p=0.001), the left fusiform gyrus (-40,-3,-28,p=0.065) and the bilateral lentiform nucleus (-17,6,-9 and 18,2,-9, p=0.026). CONCLUSIONS Intradetrusor injection of BTX-A appears to increase the activity of the brain regions known to be involved in sensation and process of urinary urgency in female MS patients with NDO. This is the first study of its kind to evaluate the possible sensory effects of BTX-A at the human brain level where sensory awareness is located. This pattern of activation may be used to phenotype patients further to optimize therapy or to uncover sensory effects of onabotulinumtoxinA beyond the bladder. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e77 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Rose Khavari More articles by this author Christof Karmonik More articles by this author Saba Elias More articles by this author Timothy Boone More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...