Department of Urology, Houston Methodist Hospital, Houston, Texas.
Department of Urology, Baylor College of Medicine, Houston, Texas.
Neurourol Urodyn. 2020 Mar;39(3):969-977. doi: 10.1002/nau.24304. Epub 2020 Feb 7.
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.
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.
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.
Our results support the hypothesis that distinct supraspinal activation patterns exist between female MS patients with VD and those without.
我们比较了排尿功能障碍（VD）和无排尿功能障碍的女性多发性硬化症（MS）患者之间的大脑激活模式。我们旨在通过有和无排尿功能障碍的女性 MS 患者队列扩大目前对排尿起始的中枢神经系统相关性的认识。
本研究招募了 28 名患有稳定疾病和下尿路功能障碍的活动性女性 MS 患者。受试者分为无 VD 组 1（n=14）和有 VD 组 2（n=14），定义为残余尿量≥最大膀胱测压容量的 40%或需要自我导尿。我们通过功能磁共振成像（fMRI）和同时进行的尿动力学测试记录大脑活动。为两组都创建了平均 fMRI 激活图（学生 t 检验），并确定了显著激活区域（P<0.05）。选择了先前的荟萃分析确定与排尿有关的先行感兴趣区（ROI）。
组平均血氧水平依赖（BOLD）激活图显示在排尿起始时两组之间存在显著差异，除了左侧小脑和右侧扣带回外，2 组的所有 ROI 均显示出显著较低的激活水平。有趣的是，2 组显示负 BOLD 信号，而 1 组在右侧和左侧桥脑排尿中枢、右侧导水管周围灰质、左侧丘脑和左侧扣带回显示正信号。1 组的激活图与健康对照组相似。
我们的结果支持这样的假设，即有和无排尿功能障碍的女性 MS 患者之间存在不同的中枢神经系统激活模式。
