Department of Urology, University Hospital, Ostrava, Czech Republic.
Department of Surgical Studies, Ostrava University, Ostrava, Czech Republic.
Neurourol Urodyn. 2023 Aug;42(6):1352-1361. doi: 10.1002/nau.25197. Epub 2023 May 5.
To compare brain responses to peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) and transcutaneous tibial nerve stimulation (TTNS), two methods for treating overactive bladder (OAB), using functional magnetic resonance imaging (fMRI). The present study was not designed to compare their clinical efficacy.
This study included 32 healthy adult female volunteers (average age 38.3 years (range 22-73)). Brain MRI using 3 T scanner was performed during three 8-min blocks of alternating sequences. During each 8-min block, the protocol alternated between sham stimulation (30 s) and rest (30 s) for 8 repeats; then peroneal eTNM® stimulation (30 s) and rest (30 s) for 8 repeats; then, TTNS stimulation (30 s) and rest (30 s) for 8 repeats. Statistical analysis was performed at the individual level with a threshold of p = 0.05, family-wise error (FWE)-corrected. The resulting individual statistical maps were analyzed in group statistics using a one-sample t-test, p = 0.05 threshold, false discovery rate (FDR)-corrected.
During peroneal eTNM®, TTNS, and sham stimulations, we recorded activation in the brainstem, bilateral posterior insula, bilateral precentral gyrus, bilateral postcentral gyrus, left transverse temporal gyrus, and right supramarginal gyrus. During both peroneal eTNM® and TTNS stimulations, but not sham stimulations, we recorded activation in the left cerebellum, right transverse temporal gyrus, right middle frontal gyrus, and right inferior frontal gyrus. Exclusively during peroneal eTNM® stimulation, we observed activation in the right cerebellum, right thalamus, bilateral basal ganglia, bilateral cingulate gyrus, right anterior insula, right central operculum, bilateral supplementary motor cortex, bilateral superior temporal gyrus, and left inferior frontal gyrus.
Peroneal eTNM®, but not TTNS, induces the activation of brain structures that were previously implicated in neural control of the of bladder filling and play an important role in the ability to cope with urgency. The therapeutic effect of peroneal eTNM® could be exerted, at least in part, at the supraspinal level of neural control.
使用功能磁共振成像 (fMRI) 比较治疗膀胱过度活动症 (OAB) 的两种方法——腓肠神经电经皮神经调节 (peroneal eTNM®) 和经皮胫神经刺激 (TTNS) 的大脑反应。本研究的设计目的不是比较它们的临床疗效。
本研究纳入了 32 名健康成年女性志愿者（平均年龄 38.3 岁（范围 22-73 岁））。使用 3T 扫描仪进行脑 MRI，在三个 8 分钟的交替序列块中进行。在每个 8 分钟的块中，方案在假刺激（30 秒）和休息（30 秒）之间交替重复 8 次；然后是腓肠神经 eTNM®刺激（30 秒）和休息（30 秒）重复 8 次；然后是 TTNS 刺激（30 秒）和休息（30 秒）重复 8 次。使用阈值为 p=0.05，校正后的家族错误 (FWE)，在个体水平上进行统计分析。使用单样本 t 检验，校正后的错误发现率 (FDR)，对个体统计映射进行组统计分析，p=0.05。
在腓肠神经 eTNM®、TTNS 和假刺激期间，我们记录到大脑脑干、双侧后岛叶、双侧中央前回、双侧中央后回、左侧横颞叶和右侧缘上回的激活。在腓肠神经 eTNM®和 TTNS 刺激期间，但在假刺激期间，我们记录到左侧小脑、右侧横颞叶、右侧额中回和右侧额下回的激活。仅在腓肠神经 eTNM®刺激期间，我们观察到右侧小脑、右侧丘脑、双侧基底节、双侧扣带回、右侧前岛叶、右侧中央后回、双侧辅助运动皮质、双侧颞上回和左侧额下回的激活。
腓肠神经 eTNM®，而不是 TTNS，可诱导先前涉及膀胱充盈神经控制的大脑结构的激活，并在应对紧迫性方面发挥重要作用。腓肠神经 eTNM®的治疗效果至少部分可以在脊髓以上的神经控制水平发挥作用。
