Brain activation patterns of female multiple sclerosis patients with voiding dysfunction

• Published in: Neurourology and urodynamics Vol. 39; no. 3; pp. 969 - 977
• Main Authors: Khavari, Rose, Chen, Jessie, Boone, Timothy, Karmonik, Christof
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2020
• Subjects: Adult; Aged; Aged, 80 and over; bladder; Brain - diagnostic imaging; Brain - physiopathology; Brain mapping; Case-Control Studies; Catheterization; Cerebellum; Cerebellum - diagnostic imaging; Cerebellum - physiopathology; Female; fMRI; Functional magnetic resonance imaging; Functional Neuroimaging; Gyrus Cinguli - diagnostic imaging; Gyrus Cinguli - physiopathology; Humans; incontinence; Lower Urinary Tract Symptoms - etiology; Lower Urinary Tract Symptoms - physiopathology; Magnetic Resonance Imaging - methods; Middle Aged; Multiple sclerosis; Multiple Sclerosis - complications; Multiple Sclerosis - diagnostic imaging; Multiple Sclerosis - physiopathology; Neuroimaging; Periaqueductal Gray - diagnostic imaging; Periaqueductal Gray - physiopathology; Periaqueductal gray area; Pons - diagnostic imaging; Pons - physiopathology; Sexually transmitted diseases; STD; Thalamus; Thalamus - diagnostic imaging; Thalamus - physiopathology; urgency; Urinary Bladder - physiopathology; Urinary Bladder, Neurogenic - etiology; Urinary Bladder, Neurogenic - physiopathology; Urinary tract; Urination; Urination - physiology; Urination Disorders - etiology; Urination Disorders - physiopathology; Urodynamics - physiology; fMRI; incontinence; urgency; multiple sclerosis; bladder
• ISSN: 0733-2467; 1520-6777; 1520-6777
• DOI: 10.1002/nau.24304

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.