Neural Mechanisms of Differences in Micturition-Related Brain Activity of Stroke Survivors with Lower Urinary Tract Dysfunction: A Brain-Bladder Study Comparing Basal Ganglia and Pontine Lesions

Abedi A1, Montero Arcila V2, Morales Ojeda L2, Jen R2, Chapman D2, Kohli P2, Ha N2, Ponce S2, Jann K3, Ginsberg D2, Kreydin E2

Research Type

Clinical

Abstract Category

Imaging

Abstract 43
Applied Neuroscience
Scientific Podium Short Oral Session 7
Wednesday 27th September 2023
14:45 - 14:52
Room 101
Imaging Pathophysiology Voiding Dysfunction Incontinence Urodynamics Techniques
1. USC Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA; Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, California 90242, USA., 2. University of Southern California, Institute of Urology, Keck School of Medicine, Los Angeles, California 90033, USA, 3. University of Southern California, USC Stevens Neuroimaging and Informatics Institute, Los Angeles, California 90033, USA
Presenter
Links

Abstract

Hypothesis / aims of study
Advancements in neuroimaging modalities have enabled the evaluation of neural control over the lower urinary tract (LUT). Despite this significant progress, there remains a limited understanding of how stroke location influences LUT dysfunction in stroke survivors. In order to gain a more comprehensive understanding of this relationship, this original study is the first to measure and compare micturition-associated brain activity patterns in patients who suffered from strokes in the basal ganglia versus those with pontine strokes.
Study design, materials and methods
This prospective study was approved by our Institutional Review Board, and all participants provided informed consent prior to enrollment. Patients with a history of post-stroke LUT dysfunction resulting from chronic (>1 year) basal ganglia or pontine strokes of either embolic or hemorrhagic etiologies were enrolled. The severity of LUT symptoms was assessed and compared using the International Consultation on Incontinence Overactive Bladder (ICIQ-OAB) questionnaire. Micturition-related brain activity was assessed using simultaneous urodynamics and blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI). Statistical parametric mapping was used to compare BOLD signals during the period of maximal urgency (10 seconds before a detrusor contraction) between basal ganglia and pontine strokes, and brain regions with differential activation were identified using a conservative p value threshold of <0.01 and cluster size of >25 voxels. In order to identify typical activations, simulations have indicated that a sample size of at least 12 subjects would achieve 80% power at the single-voxel level. To account for the potential confounding factors, our models were adjusted for age, gender, and time since stroke.
Results
A total of 19 patients, including ten patients with basal ganglia strokes and nine patients with pontine lesions were enrolled. There was no significant difference in the ICIQ-OAB scores between the basal ganglia and pontine strokes (8.6±3.7 versus 8.1±4.4, p=0.56). There were no clusters of increased BOLD activity in patients with basal ganglia strokes. On the other hand, 22 clusters were identified that showed increased BOLD activity in patients with pontine strokes. Compared to basal ganglia strokes, patients with pontine strokes exhibited increased BOLD signal in the right midbrain, bilateral cerebellum, right insula, right middle and superior temporal gyri, right supramarginal gyrus, right precuneus, right postcentral gyrus, right inferior and middle frontal gyrus, as well as left basal ganglia.
Interpretation of results
Our study provides evidence that stroke location plays a critical role in the mechanism of stroke-related LUT dysfunction. In this cohort of patients with similar LUT symptoms, we observed marked differences in BOLD signal between basal ganglia and pontine strokes. These differences were identified across several brain regions that are critical for somatosensory, interoceptive and executive function, all of which have previously been shown to play a role in LUT control. Based on these findings, we propose the hypothesis that the basal ganglia may act as a gateway for LUT processing between the cortex and the rest of the central nervous system.
Concluding message
To our knowledge, the present study is the first of its kind to provide significant insights into the neural mechanisms underlying LUT dysfunction in relation to stroke location. Previous studies have attempted to correlate LUT symptoms with stroke location, but none have been successful in defining a clear relationship. By identifying the key differences in brain activity across stroke locations, this study sheds a broader light on the complex relationship between LUT symptoms, stroke location, and central nervous system mechanisms of LUT control.
Disclosures
Funding Funded by Urology Care Foundation Grant awarded to Evgeniy Kreydin Clinical Trial No Subjects Human Ethics Committee University of Southern California IRB #HS-18-00215; Rancho Research Institute IRB #246 Helsinki Yes Informed Consent Yes
Citation

Continence 7S1 (2023) 100761
DOI: 10.1016/j.cont.2023.100761

22/11/2024 22:46:28