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Cortical substrate of bladder control in SCI and the effect of peripheral pudendal stimulation


Zempleni, M Z; Michels, L; Mehnert, U; Schurch, B; Kollias, S (2010). Cortical substrate of bladder control in SCI and the effect of peripheral pudendal stimulation. NeuroImage, 49(4):2983-2994.

Abstract

We investigate (i) the central representation of lower urinary tract (LUT) control and (ii–iii) the acute and 23
short-term central neuromodulatory effect of peripheral pudendal nerve stimulation in incomplete spinal 24
cord injured (SCI) patients using functional magnetic resonance imaging (fMRI). The urinary bladder of eight 25
SCI patients has been passively filled and emptied using a catheter, to identify the neural substrate of bladder 26
control (i), and with simultaneous peripheral pudendal nerve stimulation to investigate its acute central 27
neuromodulatory effect (ii). To identify the potential effects of pudendal nerve stimulation treatment (iii), 28
six patients underwent a 2-week training using pudendal nerve stimulation followed by another fMRI 29
session of bladder filling. The pre- and post-training fMRI results have been compared and correlated with 30
the patient's pre- and post-training urological status. Our results suggest that the central representation of 31
bladder filling sensation is preserved in the subacute stage of incomplete SCI. However, compared to earlier 32
data from healthy subjects, it shows decreased neural response in right prefrontal areas and increased in left 33
prefrontal regions, indicating diminished inhibitory micturition control as well as, compensatory or de- 34
compensatory reorganization of bladder control. We also provide evidence for a neuromodulatory effect of 35
acute pudendal nerve stimulation, which was most prominent in the right posterior insula, a brain region 36
implicated in homeostatic interoception in human. Pudendal stimulation training also induced significant 37
neuromodulation, predominantly signal increases, in the normal cortical network of bladder control. 38
Correlations with the patient's urological status indicate that this neuromodulatory effect may reflect the 39
clinical improvement following training.

We investigate (i) the central representation of lower urinary tract (LUT) control and (ii–iii) the acute and 23
short-term central neuromodulatory effect of peripheral pudendal nerve stimulation in incomplete spinal 24
cord injured (SCI) patients using functional magnetic resonance imaging (fMRI). The urinary bladder of eight 25
SCI patients has been passively filled and emptied using a catheter, to identify the neural substrate of bladder 26
control (i), and with simultaneous peripheral pudendal nerve stimulation to investigate its acute central 27
neuromodulatory effect (ii). To identify the potential effects of pudendal nerve stimulation treatment (iii), 28
six patients underwent a 2-week training using pudendal nerve stimulation followed by another fMRI 29
session of bladder filling. The pre- and post-training fMRI results have been compared and correlated with 30
the patient's pre- and post-training urological status. Our results suggest that the central representation of 31
bladder filling sensation is preserved in the subacute stage of incomplete SCI. However, compared to earlier 32
data from healthy subjects, it shows decreased neural response in right prefrontal areas and increased in left 33
prefrontal regions, indicating diminished inhibitory micturition control as well as, compensatory or de- 34
compensatory reorganization of bladder control. We also provide evidence for a neuromodulatory effect of 35
acute pudendal nerve stimulation, which was most prominent in the right posterior insula, a brain region 36
implicated in homeostatic interoception in human. Pudendal stimulation training also induced significant 37
neuromodulation, predominantly signal increases, in the normal cortical network of bladder control. 38
Correlations with the patient's urological status indicate that this neuromodulatory effect may reflect the 39
clinical improvement following training.

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9 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Neuroradiology
04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:10 February 2010
Deposited On:18 Nov 2009 11:25
Last Modified:05 Apr 2016 13:33
Publisher:Elsevier
ISSN:1053-8119
Publisher DOI:10.1016/j.neuroimage.2009.10.064
PubMed ID:19878725
Permanent URL: http://doi.org/10.5167/uzh-24195

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