1
|
Corrêa FI, Ledur ÂC, Uehara L, de Andrade ML, Corrêa JCF, Fregni F. Effect of transcranial direct current stimulation combined with pelvic muscle training in women: Randomized, controlled, double-blind, and clinical trial. Neurourol Urodyn 2024; 43:967-976. [PMID: 38426725 DOI: 10.1002/nau.25438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/25/2023] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is widely used for pelvic floor muscle (PFM) weakness in women; however, it has no prolonged effects. OBJECTIVE To evaluate the effect of Transcranial Direct Current Stimulation (tDCS) associated with PFMT on PFM contraction, sexual function and quality of life (QoL) in healthy women. STUDY DESIGN 32 nulliparous women, aged 22.7 ± 0.42 years, were randomized into two groups: G1 (active tDCS combined with PFMT) and G2 (sham tDCS combined with PFMT). The treatment was performed three times a week for 4 weeks, totaling 12 sessions. PFM function was assessed using the PERFECT scheme (P = power, E = endurance, R = repetitions, F = rapid contractions, ECT = each timed contraction) and the perineometer (cmH2O). Sexual function was assessed by The Female Sexual Function Index, and QoL by the SF-36 questionnaire. These assessments were performed before and after the 12nd treatment session and after 30-day follow-up. RESULTS There was a significant increase (p = 0.037) in the power of G2 compared to G1; repetitions and fast contraction increased in the G1 group, and the resistance increased in both groups, however, without statistical difference between the groups. ECT increased in the G1 group (p = 0.0). CONCLUSION Active tDCS combined with PFMT did not potentiate the effect of the PFMT to increase the PFM function, QoL, and sexual function in healthy women. However, adjunctive tDCS to PFMT improved the time of contractions, maintaining it during follow-up.
Collapse
Affiliation(s)
- Fernanda Ishida Corrêa
- Master's and Doctorate in Rehabilitation Sciences Program, Nove de Julho University, São Paulo, Brazil
| | - Ângela Cristina Ledur
- Master's and Doctorate in Rehabilitation Sciences Program, Nove de Julho University, São Paulo, Brazil
| | - Laura Uehara
- Master's and Doctorate in Rehabilitation Sciences Program, Nove de Julho University, São Paulo, Brazil
| | | | | | - Felipe Fregni
- Harvard Medical School, Neuromodulation Center and Center for Clinical Research Learning, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Desmons M, Cherif A, Rohel A, de Oliveira FCL, Mercier C, Massé-Alarie H. Corticomotor Control of Lumbar Erector Spinae in Postural and Voluntary Tasks: The Influence of Transcranial Magnetic Stimulation Current Direction. eNeuro 2024; 11:ENEURO.0454-22.2023. [PMID: 38167617 PMCID: PMC10883751 DOI: 10.1523/eneuro.0454-22.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/30/2023] [Accepted: 12/16/2023] [Indexed: 01/05/2024] Open
Abstract
Lumbar erector spinae (LES) contribute to spine postural and voluntary control. Transcranial magnetic stimulation (TMS) preferentially depolarizes different neural circuits depending on the direction of electrical currents evoked in the brain. Posteroanterior current (PA-TMS) and anteroposterior (AP-TMS) current would, respectively, depolarize neurons in the primary motor cortex (M1) and the premotor cortex. These regions may contribute differently to LES control. This study examined whether responses evoked by PA- and AP-TMS are different during the preparation and execution of LES voluntary and postural tasks. Participants performed a reaction time task. A Warning signal indicated to prepare to flex shoulders (postural; n = 15) or to tilt the pelvis (voluntary; n = 13) at the Go signal. Single- and paired-pulse TMS (short-interval intracortical inhibition-SICI) were applied using PA- and AP-TMS before the Warning signal (baseline), between the Warning and Go signals (preparation), or 30 ms before the LES onset (execution). Changes from baseline during preparation and execution were calculated in AP/PA-TMS. In the postural task, MEP amplitude was higher during the execution than that during preparation independently of the current direction (p = 0.0002). In the voluntary task, AP-MEP amplitude was higher during execution than that during preparation (p = 0.016). More PA inhibition (SICI) was observed in execution than that in preparation (p = 0.028). Different neural circuits are preferentially involved in the two motor tasks assessed, as suggested by different patterns of change in execution of the voluntary task (AP-TMS, increase; PA-TMS, no change). Considering that PA-TMS preferentially depolarize neurons in M1, it questions their importance in LES voluntary control.
Collapse
Affiliation(s)
- Mikaël Desmons
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Amira Cherif
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Antoine Rohel
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Fábio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Catherine Mercier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| | - Hugo Massé-Alarie
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec City, Quebec G1M 2S8, Canada
- Rehabilitation Department, University Laval, Quebec City, Quebec G1V 0A6, Canada, G1V 0A6
| |
Collapse
|
3
|
Albishi AM. Why do different motor cortical areas activate the same muscles? Brain Struct Funct 2023; 228:2017-2024. [PMID: 37709903 DOI: 10.1007/s00429-023-02703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/27/2023] [Indexed: 09/16/2023]
Abstract
The cortex contains multiple motor areas, including the primary motor cortex (M1) and supplementary motor area (SMA). Many muscles are represented in both the M1 and SMA, but the reason for this dual representation remains unclear. Previous work has shown that the M1 and SMA representations of a specific human muscle can be differentiated according to their functional connectivity with different brain areas located outside of the motor cortex. It is our perspective that this differential functional connectivity may be the neural substrate that allows an individual muscle to be accessed by distinct neural processes, such as those implementing volitional vs. postural task control. Here, we review existing human and animal literature suggesting how muscles are represented in the M1 and SMA and how these brain regions have distinct functions. We also discuss potential studies to further elucidate the distinct roles of the SMA and M1 in normal and dysfunctional motor control.
Collapse
Affiliation(s)
- Alaa M Albishi
- Department of Rehabilitation Sciences-Physical Therapy Division, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| |
Collapse
|
4
|
Mazeaud C, Salazar BH, Khavari R. Noninvasive brain stimulation in the treatment of functional urological and pelvic floor disorders: A scoping review. Neurourol Urodyn 2023; 42:1318-1328. [PMID: 37209294 PMCID: PMC10524349 DOI: 10.1002/nau.25205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/19/2023] [Accepted: 05/08/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Functional pelvic floor disorders (PFD) such as bowel and bladder dysfunctions can be challenging to manage with our current therapeutic modalities. Recently, noninvasive brain stimulation has emerged as a novel strategy for noninvasive pelvic floor management. Here, we assessed the current state of research on this topic. METHODS A scoping review was conducted with Pubmed, Web of Science, and Embase, in conjunction with clinicaltrials.gov, encompassing all manuscripts published without past time limit up until June 30, 2022. RESULTS Of the 880 abstracts identified in a blind selection by two reviewers, 14 publications with an evidence level of 1 or 2 (Oxford scale) were eligible and included in this review. Review articles, case reports (<5 patients), letters, and protocol studies were excluded. PFDs were described as either pelvic pain or lower urinary tracts symptoms (LUTS) with repeated transcranial magnetic stimulation (rTMS) as the most common treatment modality. Despite heterogeneous therapeutic protocols, significant improvements were observed such as reduction in postvoid residual of urine, increased bladder capacity, improved voiding flow paraments, and decreased chronic pelvic, and bladder pain. No appreciable adverse effects were noted. However, low sample populations allowed only provisional conclusions. CONCLUSION Noninvasive transcranial neurostimulation for LUTS and pelvic pain is emerging as an effective tool for clinicians to utilize in the future. Further investigation is needed to elucidate the full significance of the indicated outcomes.
Collapse
Affiliation(s)
- Charles Mazeaud
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
- Nancy University Hospital, Department of Urology, IADI-UL-INSERM (U1254), Nancy, France
| | - Betsy H. Salazar
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
| | - Rose Khavari
- Houston Methodist Hospital, Department of Urology, Houston, Texas, USA
| |
Collapse
|
5
|
Wang Y, Dong T, Li X, Zhao H, Yang L, Xu R, Fu Y, Li L, Gai X, Qin D. Research progress on the application of transcranial magnetic stimulation in spinal cord injury rehabilitation: a narrative review. Front Neurol 2023; 14:1219590. [PMID: 37533475 PMCID: PMC10392830 DOI: 10.3389/fneur.2023.1219590] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Traumatic or non-traumatic spinal cord injury (SCI) can lead to severe disability and complications. The incidence of SCI is high, and the rehabilitation cycle is long, which increases the economic burden on patients and the health care system. However, there is no practical method of SCI treatment. Recently, transcranial magnetic stimulation (TMS), a non-invasive brain stimulation technique, has been shown to induce changes in plasticity in specific areas of the brain by regulating the activity of neurons in the stimulation site and its functionally connected networks. TMS is a new potential method for the rehabilitation of SCI and its complications. In addition, TMS can detect the activity of neural circuits in the central nervous system and supplement the physiological evaluation of SCI severity. This review describes the pathophysiology of SCI as well as the basic principles and classification of TMS. We mainly focused on the latest research progress of TMS in the physiological evaluation of SCI as well as the treatment of motor dysfunction, neuropathic pain, spasticity, neurogenic bladder, respiratory dysfunction, and other complications. This review provides new ideas and future directions for SCI assessment and treatment.
Collapse
Affiliation(s)
- Yuhong Wang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Tingting Dong
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xiahuang Li
- Department of Neurosurgery, Mengzi People’s Hospital, Mengzi, China
| | - Huiyun Zhao
- Department of Rehabilitation Medicine, Dongchuan District People’s Hospital, Kunming, China
| | - Lili Yang
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Rui Xu
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Yi Fu
- Department of Pulmonary and Critical Care Medicine, Kunming Municipal Hospital of Traditional Chinese Medicine, Kunming, China
| | - Li Li
- Department of Emergency Trauma Surgery, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Xuesong Gai
- Department of Rehabilitation Medicine, The First People’s Hospital of Yunnan Province, Kunming, China
| | - Dongdong Qin
- Key Laboratory of Traditional Chinese Medicine for Prevention and Treatment of Neuropsychiatric Diseases, Yunnan University of Chinese Medicine, Kunming, China
| |
Collapse
|
6
|
Wang C, Kutch JJ, Labus JS, Yang CC, Harris RE, Mayer EA, Ellingson BM. Reproducible Microstructural Changes in the Brain Associated With the Presence and Severity of Urologic Chronic Pelvic Pain Syndrome (UCPPS): A 3-Year Longitudinal Diffusion Tensor Imaging Study From the MAPP Network. THE JOURNAL OF PAIN 2023; 24:627-642. [PMID: 36435486 PMCID: PMC10676766 DOI: 10.1016/j.jpain.2022.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/24/2022]
Abstract
Microstructural alterations have been reported in patients with urologic chronic pelvic pain syndrome (UCPPS). However, it isn't clear whether these alterations are reproducible within 6 months or whether long-term symptom improvement is associated with specific microstructural changes. Using data from the MAPP-II Research Network, the current study performed population-based voxel-wise DTI and probabilistic tractography in a large sample of participants from the multicenter cohort with UCPPS (N = 364) and healthy controls (HCs, N = 61) over 36 months. While fractional anisotropy (FA) differences between UCPPS patients and HCs were observed to be unique at baseline and 6-month follow-up visits, consistent aberrations in mean diffusivity (MD) were observed between UCPPS and HCs at baseline and repeated at 6 months. Additionally, compared to HCs, UCPPS patients showed stronger structural connectivity (SC) between the left postcentral gyrus and the left precuneus, and weaker SC from the left cuneus to the left lateral occipital cortex and the isthmus of the left cingulate cortex at baseline and 6-month. By 36 months, reduced FA and MD aberrations in these same regions were associated with symptom improvement in UCPPS. Together, results suggest changes in white matter microstructure may play a role in the persistent pain symptoms in UCPPS. PERSPECTIVE: This longitudinal study identified reproducible, "disease-associated" patterns in altered mean diffusivity and abnormal microstructural connectivity in UCPPS comparing to HCs over 6 months. These differences were found in regions involved in sensory processing and integration and pain modulation, making it potentially amenable for clinical interventions that target synaptic and/or neuronal reorganization.
Collapse
Affiliation(s)
- Chencai Wang
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California
| | - Jennifer S Labus
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, Washington
| | - Richard E Harris
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| | - Emeran A Mayer
- Oppenheimer Center for the Neurobiology of Stress and Resilience, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Benjamin M Ellingson
- Department of Radiological Science, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
| |
Collapse
|
7
|
Yani MS, Eckel SP, Kirages DJ, Rodriguez LV, Corcos DM, Kutch JJ. Impaired Ability to Relax Pelvic Floor Muscles in Men With Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Phys Ther 2022; 102:6585840. [PMID: 35576002 PMCID: PMC9618172 DOI: 10.1093/ptj/pzac059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 02/08/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Excessive pelvic floor muscle activity has been suggested as a source of pain in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Our objective was to determine whether men with CP/CPPS have changes in neural drive that impair their ability to relax pelvic floor muscles. METHODS We recruited 90 men (42 with CP/CPPS and 48 in the control group [without a history of pelvic pain]). All completed the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI). We quantified the ability to relax by comparing resting pelvic floor muscle activity under 2 conditions: a "rest-only" condition, in which participants were instructed to simply relax, and a "rest-between-contraction" condition, in which participants were instructed to rest for several seconds between voluntary pelvic floor muscle contractions. We used multivariate mixed-effects models to examine differences between the groups (men with CP/CPPS and men in the control group) as well as the effect of 6 symptoms captured by the NIH-CPSI: pain related to location (perineum, testicles, penis, suprapubic region) and activity (urination, ejaculation). RESULTS Men with CP/CPPS were significantly different from men in the control group; men with CP/CPPS had higher resting activity in the rest-between-contraction condition than in the rest-only condition, whereas men in the control group had similar resting activities in both conditions. This effect was strongest in men who reported ejaculation-related pain, which was 70% of the CP/CPPS group. CONCLUSION Men without a history of pelvic pain were able to relax their pelvic floor muscles back to baseline after performing voluntary pelvic floor muscle contractions. In contrast, men with CP/CPPS, particularly those with ejaculation-related pain, had an impaired ability to relax their pelvic floor muscles. IMPACT This study may support the investigation of more personalized physical therapist approaches for CP/CPPS that enhance the ability to relax pelvic floor muscles as a mechanism for pain reduction.
Collapse
Affiliation(s)
- Moheb S Yani
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Sandrah P Eckel
- Division of Biostatistics, Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Daniel J Kirages
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Daniel M Corcos
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, Illinois, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
8
|
When Two Is Better Than One: A Pilot Study on Transcranial Magnetic Stimulation Plus Muscle Vibration in Treating Chronic Pelvic Pain in Women. Brain Sci 2022; 12:brainsci12030396. [PMID: 35326352 PMCID: PMC8946237 DOI: 10.3390/brainsci12030396] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic pelvic pain syndrome (CPPS) affects about 4–16% of adult women, and about one-third of them require medical assistance due to severe symptoms. Repetitive transcranial magnetic stimulation (rTMS) over the supplementary motor area (SMA) has been shown to manage pain in refractory CPPS. Focal muscle vibration (FMV) has also been reported to relieve pelvic pain. The objective of this study was to assess the feasibility and effect of rTMS coupled with FMV to reduce pain in seven adult women with refractory CPPS. This pilot, open-labeled, prospective trial examined treatment by 5 Hz rTMS over SMA and 150 Hz FMV over the perineum, suprapubic, and sacrococcygeal areas, with one daily session for five consecutive days for three weeks. We assessed tolerance and subjective pain changes (as per visual analog scale, VAS) until one month post-treatment, with a primary endpoint at day 7. No patients experienced serious adverse effects or a significant increase in pain. Six out of seven patients experienced a VAS improvement of at least 10% at T7; three of these individuals experienced a VAS improvement of more than 30%. Overall, we found a significant VAS reduction of 15 points (95% CI 8.4–21.6) at T7 (t = 6.3, p = 0.001; ES = 2.3 (1.1–3.9)). Three of the women who demonstrated a significant VAS reduction at T7 retained such VAS improvement at T30. VAS decreased by six points (95% CI 1.3–10.7) at T30 (t = 3.1, p = 0.02; ES = 1.5 (0.2–2.6)). This coupled approach seems promising for pain management in adult women with refractory CPPS and paves the way for future randomized controlled trials.
Collapse
|
9
|
McLain NJ, Yani MS, Kutch JJ. Analytic consistency and neural correlates of peak alpha frequency in the study of pain. J Neurosci Methods 2022; 368:109460. [PMID: 34958820 PMCID: PMC9236562 DOI: 10.1016/j.jneumeth.2021.109460] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Several studies have found evidence of reduced resting-state peak alpha frequency (PAF) in populations with pain. However, the stability of PAF from different analytic pipelines used to study pain has not been determined and underlying neural correlates of PAF have not been validated in humans. NEW METHOD For the first time we compare analytic pipelines and the relationship of PAF to activity in the whole brain and thalamus, a hypothesized generator of PAF. We collected resting-state functional magnetic resonance imaging (rs-fMRI) data and subsequently 64 channel resting-state electroencephalographic (EEG) from 47 healthy men, controls from an ongoing study of chronic prostatitis (a pain condition affecting men). We identified important variations in EEG processing for PAF from a review of 17 papers investigating the relationship between pain and PAF. We tested three progressively complex pre-processing pipelines and varied four postprocessing variables (epoch length, alpha band, calculation method, and region-of-interest [ROI]) that were inconsistent across the literature. RESULTS We found a single principal component, well-represented by the average PAF across all electrodes (grand-average PAF), explained > 95% of the variance across participants. We also found the grand-average PAF was highly correlated among the pre-processing pipelines and primarily impacted by calculation method and ROI. Across methods, interindividual differences in PAF were correlated with rs-fMRI-estimated activity in the thalamus, insula, cingulate, and sensory cortices. CONCLUSIONS These results suggest PAF is a relatively stable marker with respect to common pre and post-processing methods used in pain research and reflects interindividual differences in thalamic and salience network function.
Collapse
Affiliation(s)
| | | | - Jason J. Kutch
- Correspondence to: University of Southern California, 1540 E. Alcazar Street, CHP 155, Los Angeles, CA 90033, USA. (J.J. Kutch)
| |
Collapse
|
10
|
Contemporary Review of MRI in Benign Genitourinary Pelvic Medicine: What Every Urologist Should Know. CURRENT BLADDER DYSFUNCTION REPORTS 2021. [DOI: 10.1007/s11884-021-00631-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
11
|
Mawla I, Schrepf A, Ichesco E, Harte SE, Klumpp DJ, Griffith JW, Strachan E, Yang CC, Lai H, Andriole G, Magnotta VA, Kreder K, Clauw DJ, Harris RE, Clemens JQ, Landis JR, Mullins C, Rodriguez LV, Mayer EA, Kutch JJ. Natural bladder filling alters resting brain function at multiple spatial scales: a proof-of-concept MAPP Network Neuroimaging Study. Sci Rep 2020; 10:19901. [PMID: 33199816 PMCID: PMC7669903 DOI: 10.1038/s41598-020-76857-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/29/2020] [Indexed: 01/23/2023] Open
Abstract
Neural circuitry regulating urine storage in humans has been largely inferred from fMRI during urodynamic studies driven by catheter infusion of fluid into the bladder. However, urodynamic testing may be confounded by artificially filling the bladder repeatedly at a high rate and examining associated time-locked changes in fMRI signals. Here we describe and test a more ecologically-valid paradigm to study the brain response to bladder filling by (1) filling the bladder naturally with oral water ingestion, (2) examining resting state fMRI (rs-fMRI) which is more natural since it is not linked with a specific stimulus, and (3) relating rs-fMRI measures to self-report (urinary urge) and physiologic measures (voided volume). To establish appropriate controls and analyses for future clinical studies, here we analyze data collected from healthy individuals (N = 62) as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. Participants orally ingested approximately 350 mL of water, and had a 10 min “fuller bladder” rs-fMRI scan approximately 1 h later. A second 10 min “empty bladder” rs-fMRI scan was conducted immediately following micturition. We examined multiple spatial scales of brain function, including local activity, circuits, and networks. We found changes in brain function distributed across micturition loci (e.g., subregions of the salience, sensorimotor, and default networks) that were significantly related to the stimulus (volume) and response (urinary urge). Based on our results, this paradigm can be applied in the future to study the neurobiological underpinnings of urologic conditions.
Collapse
Affiliation(s)
- Ishtiaq Mawla
- Neuroscience Graduate Program, University of Michigan, Ann Arbor, MI, USA.,Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Schrepf
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Eric Ichesco
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Steven E Harte
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - David J Klumpp
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Strachan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Claire C Yang
- Department of Urology, University of Washington, Seattle, WA, USA
| | - Henry Lai
- Department of Anesthesiology, Washington University, St. Louis, MO, USA.,Division of Urologic Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | - Gerald Andriole
- Division of Urologic Surgery, Department of Surgery, Washington University, St. Louis, MO, USA
| | | | - Karl Kreder
- Department of Urology, University of Iowa, Iowa City, IA, USA
| | - Daniel J Clauw
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Harris
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, University of Michigan, Ann Arbor, MI, USA
| | | | - J Richard Landis
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Chris Mullins
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Larissa V Rodriguez
- Department of Urology, University of Southern California, Los Angeles, CA, USA
| | - Emeran A Mayer
- G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Jason J Kutch
- Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E. Alcazar Street, CHP 155, Los Angeles, CA, 90033, USA.
| |
Collapse
|
12
|
Kreydin EI, Gad P, Gao B, Liu CY, Ginsberg DA, Jann K. The effect of stroke on micturition associated brain activity: A pilot fMRI study. Neurourol Urodyn 2020; 39:2198-2205. [PMID: 32761953 DOI: 10.1002/nau.24473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/25/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Cerebral stroke is a unique model for studying the role of the brain in lower urinary tract (LUT) control. By its nature, stroke must change the activity of the brain to cause LUT dysfunction. The objective of this study was to describe changes in micturition-related brain activity in patients who develop LUT symptoms (LUTS) after a cerebral stroke. MATERIALS AND METHODS Healthy controls (HC, n = 10) and patients who developed storage LUTS after a cerebral stroke (n = 7) were recruited. Functional magnetic resonance imaging was used to assess brain activity in each subject. In the task-based block design, blood-oxygen-level-dependent (BOLD) signal was detected during rest, active bladder filling, and bladder voiding. BOLD signal intensity was compared between HCs and stroke subjects during bladder filling, voiding, and voiding initiation. RESULTS Stroke subjects exhibited higher activity in the periaqueductal gray and cerebellum during bladder filling and bladder voiding. HCs exhibited more intense activity in higher centers, such as the cingulate cortex, motor cortex, and the dorsolateral prefrontal cortex in each of the phases examined. CONCLUSIONS Subjects with stroke-related LUTS exhibit a specific pattern of brain activity during bladder filling and voiding. There appears to be a greater reliance on primitive centers (cerebellum, midbrain) than in healthy controls during both phases of the micturition cycle. We hypothesize that these findings may reflect loss of connectivity with higher brain centers after a stroke.
Collapse
Affiliation(s)
- Evgeniy I Kreydin
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California.,Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.,USC Neurorestoration Center, University of Southern California, Los Angeles, California
| | - Parag Gad
- Department of Neurobiology, University of California Los Angeles, Los Angeles, California
| | - Bingchen Gao
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Charles Y Liu
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California.,Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California.,USC Neurorestoration Center, University of Southern California, Los Angeles, California
| | - David A Ginsberg
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Kay Jann
- Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of University of Southern California, Los Angeles, California
| |
Collapse
|
13
|
Transcranial magnetic stimulation and bladder function: A systematic review. Clin Neurophysiol 2019; 130:2032-2037. [PMID: 31541980 DOI: 10.1016/j.clinph.2019.08.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/10/2019] [Accepted: 08/22/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE We aimed at assessing the usefulness of motor evoked potentials (MEPs) for exploring the integrity of striated sphincters and pelvic floor motor innervation in normal subjects and of repetitive transcranial magnetic stimulation TMS (rTMS) in patients with neurogenic bladder dysfunction. METHODS A systematic literature search was conducted using PubMed and Embase. RESULTS We identified, reviewed and discussed 11 articles matching the inclusion criteria. CONCLUSIONS The assessment of MEPs could represent a useful tool in the investigation of patients with urologic disorders. High frequency rTMS can improve detrusor contraction and/or urethral sphincter relaxation in patients with multiple sclerosis and bladder dysfunction. Low frequency (LF) rTMS seems to be an effective treatment of neurogenic lower urinary tract dysfunctions in subjects with Parkinson's disease and possibly other neurodegenerative disorders. Furthermore, rTMS might have the potential to restore bladder and bowel sphincter function after incomplete spinal cord injury. LF rTMS could also relieve some symptoms of bladder pain syndrome and chronic pelvic pain. SIGNIFICANCE The clinical applicability of MEPs appears to be questionable, since a poor reproducibility was detected for all pelvic floor muscles. The use of rTMS in this field is emerging and the results of a few preliminary studies should be replicated in controlled, randomized studies with larger sample sizes.
Collapse
|