Jang Yongchang, Tran Khue, Shi Zhaoyue, Christof Karmonik, Choksi Darshil, Salazar Betsy H, Lincoln John A, Khavari Rose
Texas A&M College of Medicine, Houston, TX, USA.
Carle Health, Urbana, IL, USA.
Continence (Amst). 2022 Dec;4. doi: 10.1016/j.cont.2022.100517. Epub 2022 Oct 19.
Multiple sclerosis (MS) is a multifocal demyelinating disease that affects the central nervous system (CNS) and commonly leads to neurogenic lower urinary tract dysfunction (NLUTD). Proper storage and release of urine relies on synchronized activity of the LUT, which is meticulously regulated by supraspinal circuits, making it vulnerable to diseases such as MS. NLUTD, characterized by voiding dysfunction (VD), storage issues, or a combination of both is a common occurrence in MS. Unfortunately, there are limited treatment options for NLUTD, making the search for alternative treatments such as transcranial rotating permanent magnet stimulation (TRPMS) of utmost importance. To assess effectiveness of treatment we also need to understand underlying factors that may affect outcomes, which we addressed here.
Ten MS subjects with VD and median age of 54.5 years received daily TRPMS sessions for two weeks. Five pre-determined regions of interest (ROIs) known to be involved in the micturition cycle were modulated (stimulated or inhibited) using TRPMS. Clinical data (non-instrumented uroflow and urodynamics parameters, PVR, bladder symptom questionnaires) and neuro-imaging data were collected at baseline and following TRPMS via 7-Tesla Siemens MAGNETOM Terra magnetic resonance imaging (MRI) scanner. Each participant underwent functional MRI (fMRI) concurrently with a repeated urodynamic study (UDS). Baseline data of each arm was evaluated to determine any indicators of successful response to treatment.
多发性硬化症（MS）是一种影响中枢神经系统（CNS）的多灶性脱髓鞘疾病，通常会导致神经源性下尿路功能障碍（NLUTD）。尿液的正常储存和排出依赖于下尿路（LUT）的同步活动，而LUT活动由脊髓上神经回路精细调节，因此易受MS等疾病影响。以排尿功能障碍（VD）、储尿问题或两者兼具为特征的NLUTD在MS中很常见。不幸的是，NLUTD的治疗选择有限，因此寻找诸如经颅旋转永磁刺激（TRPMS）等替代治疗方法至关重要。为了评估治疗效果，我们还需要了解可能影响治疗结果的潜在因素，我们在此进行了探讨。
10名患有VD且中位年龄为54.5岁的MS患者接受了为期两周的每日TRPMS治疗。使用TRPMS对已知参与排尿周期的五个预先确定的感兴趣区域（ROI）进行调制（刺激或抑制）。在基线时以及TRPMS治疗后，通过7特斯拉西门子MAGNETOM Terra磁共振成像（MRI）扫描仪收集临床数据（非仪器化尿流率和尿动力学参数、残余尿量、膀胱症状问卷）和神经影像数据。每位参与者在进行重复尿动力学研究（UDS）的同时接受功能磁共振成像（fMRI）检查。对每组的基线数据进行评估，以确定治疗成功反应的任何指标。
