Specific Changes in Brain Activity during Urgency in Women with Overactive Bladder after Successful Sacral Neuromodulation: A Functional Magnetic Resonance Imaging Study

Autor: Rupal Bhavsar, Ariana L. Smith, Lily A. Arya, Steven J. Weissbart, Hengyi Rao, Alan J. Wein, John A. Detre
Rok vydání: 2018
Předmět:
medicine.medical_specialty
Brain activity and meditation
Urology
Lumbosacral Plexus
030232 urology & nephrology
Electric Stimulation Therapy
Brain mapping
03 medical and health sciences
0302 clinical medicine
Lower urinary tract symptoms
medicine
Humans
Postoperative Period
Urinary Bladder
Neurogenic
Aged
030219 obstetrics & reproductive medicine
Blood-oxygen-level dependent
Urinary bladder
medicine.diagnostic_test
business.industry
Urinary Bladder
Overactive
Functional Neuroimaging
Brain
Magnetic resonance imaging
Urinary Incontinence
Urge
Middle Aged
musculoskeletal system
medicine.disease
Magnetic Resonance Imaging
body regions
medicine.anatomical_structure
Implantable Neurostimulators
Treatment Outcome
Overactive bladder
Preoperative Period
Female
business
Functional magnetic resonance imaging
Zdroj: The Journal of urology. 200(2)
ISSN: 1527-3792
Popis: The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to the response to treatment.Women with refractory overactive bladder who elected sacral neuromodulation were invited to undergo functional magnetic resonance imaging before and after treatment. During imaging the bladder was filled until urgency was experienced. Regions of interest were identified a priori and brain activity in these regions of interest was compared before and after treatment as well as according to the treatment response. Whole brain exploratory analysis with an uncorrected voxel level threshold of p0.001 was also performed to identify additional brain regions which changed after sacral neuromodulation.Of the 12 women who underwent a pretreatment functional magnetic resonance imaging examination 7 were successfully treated with sacral neuromodulation and underwent a posttreatment examination. After sacral neuromodulation brain activity decreased in the left anterior cingulate cortex, the bilateral insula, the left dorsolateral prefrontal cortex and the bilateral orbitofrontal cortex (each p0.05). No new brain regions showed increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, the right insula, the bilateral dorsolateral prefrontal cortex, the right orbitofrontal cortex, the right supplementary motor area and the right sensorimotor cortex were higher in women who underwent successful treatment (each p0.05).Brain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency.
Databáze: OpenAIRE
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