PD10-02 HIGHER NEURAL CORRELATES AT INITIATION OF VOIDING IN PATIENTS WITH MULTIPLE SCLEROSIS WITH NEUROGENIC BLADDER DYSFUNCTION VIA CONCURRENT FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI) AND URODYNAMIC STUDIES

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Neurogenic Voiding Dysfunction II1 Apr 2015PD10-02 HIGHER NEURAL CORRELATES AT INITIATION OF VOIDING IN PATIENTS WITH MULTIPLE SCLEROSIS WITH NEUROGENIC BLADDER DYSFUNCTION VIA CONCURRENT FUNCTIONAL MAGNETIC RESONANCE IMAGING (FMRI) AND URODYNAMIC STUDIES Michael Shy, Christof Karmonik, Jeff Anderson, Abdulaziz Alkattan, Timothy Boone, Steve Fung, Sophie Fletcher, and Rose Khavari Michael ShyMichael Shy More articles by this author , Christof KarmonikChristof Karmonik More articles by this author , Jeff AndersonJeff Anderson More articles by this author , Abdulaziz AlkattanAbdulaziz Alkattan More articles by this author , Timothy BooneTimothy Boone More articles by this author , Steve FungSteve Fung More articles by this author , Sophie FletcherSophie Fletcher More articles by this author , and Rose KhavariRose Khavari More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.942AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Normal voiding is triggered by release of tonic inhibition from suprapontine centers, allowing the pontine micturition center to trigger the voiding reflex. Exploring brain areas in neurologic diseases is important to discern any altered control over the micturition cycle. Neurogenic bladder dysfunction is seen in 95% of multiple sclerosis (MS) patients and has a significant impact on their quality of life. In this preliminary study, we seek to discover brain activity processes during initiation of voiding via fMRI in female subjects with MS and neurogenic bladder overactivity (NDO) and compare it to healthy normal controls. METHODS Eleven ambulatory female patients with MS and NDO were recruited for this IRB approved study. We recorded brain activity via fMRI with simultaneous UDS. After motion correction, the Generalized Linear Model created individual fMRI activation maps at initiation of voiding. A high-resolution structural scan of the brain transformed the individual fMRI activation maps into Talairach space. From these transformed datasets, an average fMRI activation map (student t-test) was created, from which areas of significant activation were identified (p<0.05) and compared with maps obtained previously from healthy controls. RESULTS Nine of eleven patients were able to void while supine. Group analyses of all patients yielded consistent areas of activation at initiation of micturition in regions for motor control (cerebellum and thalamus), emotion (cingulate gyrus), recognition (middle temporal and fusiform gyrus), the occipital lobe (cuneus and lingual gyrus), and cerebellum (culmen). Comparison of average change of activations between healthy subjects and MS patients shows predominantly decreased activation relative to normal controls. CONCLUSIONS Our preliminary group and network analyses demonstrate for the first time the activation of a brain network consisting of regions for motor control, executive function, emotion processing, as well as the cerebellum during micturition in patients with neurogenic detrusor overactivity caused by Multiple Sclerosis. Further investigations are needed to define the optimal approach for the care of these patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e200-e201 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Michael Shy More articles by this author Christof Karmonik More articles by this author Jeff Anderson More articles by this author Abdulaziz Alkattan More articles by this author Timothy Boone More articles by this author Steve Fung More articles by this author Sophie Fletcher More articles by this author Rose Khavari More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...