To use functional magnetic resonance imaging(fMRI) for identifying changes in brain activity during sacral neuromodulation(SNM) in women with overactive bladder(OAB) who were responsive to therapy.
Women with non-neurogenic refractory OAB who responded to SNM, had a stable program for at least 3 months, with no subsequent OAB treatment were recruited.
Enrolled patients completed pre-fMRI validated symptom and quality of life instruments. Stimulus settings were recorded, devices switched off (5-day washout), and instruments repeated. Three fMRI scans with simultaneous SNM stimulation were performed below, at, and above stimulus sensory threshold, using a block design, yielding brain activity maps represented by changes in blood oxygenation level dependence(BOLD). A total of 5 stimulator-off and 4 stimulator-on cycles of 42 seconds each were imaged. A group analysis used a single voxel p-value 0.05 with false positive error of 0.05 (cluster-analysis determined).
Of 13 patients enrolled, 6 completed fMRI and had a median age of 52[36-64] years. Urinary symptoms and voiding diary data worsened with washout. Overall, brain activation generally progressed with increasing stimulation amplitude, but activation of the right inferior frontal gyrus remained stable, while deactivation of the pons and periacqueductal gray matter only occurred with sub-sensory stimulation. Sensory stimulation activated insula but deactivated the medial and superior parietal lobes. Suprasensory stimulation activated multiple structures and the expected S3 somatosensory region. All devices had normal impedances after fMRI.
fMRI confirms SNM influences brain activity in women with OAB who responded to therapy. These changes vary with stimulus intensity.
Go “Beyond the Abstract” - Read an article commentary written by the authors
The Journal of urology. 2017 Jun 20 [Epub ahead of print]
Bradley C Gill, Javier Pizarro Berdichevsky, Pallab K Bhattacharyya, Thaddeus S Brink, Brian K Marks, Adrienne Quirouet, Sandip P Vasavada, Stephen E Jones, Howard B Goldman
Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH; Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Urogynecology Unit, Sotero del Rio Hospital, Santiago, Chile; Division Obstetricia y Ginecologia, Pontificia Universidad Catolica de Chile, Santiago, Chile., Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH., Research and Core Technology, Restorative Therapies Group, Medtronic, Inc., Minneapolis, MN., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH., Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH; Lerner College of Medicine, Education Institute, Cleveland Clinic, Cleveland, OH. Electronic address: .