Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Neurourol Urodyn. 2022 Nov;41(8):1703-1710. doi: 10.1002/nau.25012. Epub 2022 Jul 29.
To better understand the role of the brain in urgency urinary incontinence (UUI), we used onabotulinumtoxin A (BoNTA) as a probe to evaluate changes in the brain's response to urgency in successful and unsuccessful treatment. Because BoNTA acts peripherally, brain changes observed should represent a reaction to changes in bladder function caused by BoNTA, or changes in the brain's compensatory mechanisms, rather than a direct effect of BoNTA on the brain.
We recruited 20 women aged over 60 years with nonneurogenic UUI who were to undergo treatment with onabotulinum A toxin injected intravesically. We performed a baseline evaluation which included a 3-day bladder diary and functional magnetic resonance imaging with an urgency provocation task; we repeated this evaluation 6 weeks posttreatment. We performed an analysis of variance on a priori selected regions of interest and post hoc voxel-wise analysis on responders and nonresponders to treatment.
We found a significant interaction in the right insula [F(1,18) = 5.5, p = 0.031]; activity was different during urgency provocation in responders and non-responders to therapy, before and after therapy. The supramarginal gyrus (SMG) and inferior frontal gyrus (IFG) also displayed significant interactions (p < 0.005). Activity in the periaqueductal gray and prefrontal cortex was correlated with number of leakage episodes (p < 0.05).
The changes seen in the brain control mechanism after therapy likely reflect reduced bladder sensation caused by BoNTA's peripheral action. We ascribe the SMG and IFG changes to a coping mechanism for urgency which is reduced in those who respond well to treatment.
为了更好地了解大脑在急迫性尿失禁（UUI）中的作用，我们使用肉毒毒素 A（BoNTA）作为探针，评估成功和不成功治疗中大脑对急迫性反应的变化。由于 BoNTA 在外周起作用，因此观察到的大脑变化应该代表对 BoNTA 引起的膀胱功能变化的反应，或者是大脑代偿机制的变化，而不是 BoNTA 对大脑的直接影响。
我们招募了 20 名年龄在 60 岁以上的非神经性 UUI 女性，她们将接受膀胱内注射 BoNTA 毒素治疗。我们进行了基线评估，包括 3 天的膀胱日记和带有急迫性激发任务的功能磁共振成像；我们在治疗后 6 周重复了这项评估。我们对预先选择的感兴趣区域进行方差分析，并对治疗的反应者和非反应者进行事后体素分析。
我们发现右岛叶存在显著的交互作用[F(1,18)=5.5，p=0.031]；在治疗的反应者和非反应者中，治疗前后，在急迫性激发时，活动是不同的。缘上回（SMG）和额下回（IFG）也显示出显著的相互作用（p < 0.005）。导水管周围灰质和前额皮质的活动与漏尿发作次数相关（p < 0.05）。
治疗后大脑控制机制的变化可能反映了 BoNTA 的外周作用引起的膀胱感觉降低。我们将 SMG 和 IFG 的变化归因于对急迫性的应对机制，而这种机制在对治疗反应良好的患者中减少了。
