Noninvasive, Individualized Cortical Modulation Using Transcranial Rotating Permanent Magnet Stimulator for Voiding Dysfunction in Women with Multiple Sclerosis: A Pilot Trial
Rose Khavari, Khue Tran, Santosh A Helekar, Zhaoyue Shi, Christof Karmonik, Hamida Rajab, Blessy John, Ali Jalali, Timothy Boone, Rose Khavari, Khue Tran, Santosh A Helekar, Zhaoyue Shi, Christof Karmonik, Hamida Rajab, Blessy John, Ali Jalali, Timothy Boone
Abstract
Purpose: Voiding dysfunction (VD) leading to urinary retention is a common neurogenic lower urinary tract symptom in patients with multiple sclerosis (MS). Currently, the only effective management for patients with MS with VD is catheterization. Transcranial Rotating Permanent Magnet Stimulator (TRPMS) is a noninvasive, portable, multifocal neuromodulator that simultaneously modulates multiple cortical regions and the strength of their functional connections. In this pilot trial (ClinicalTrials.gov Identifier: NCT03574610), we investigated the safety and therapeutic effects of TRPMS in modulating brain regions of interest (ROIs) engaged with voiding initiation to improve VD in MS women.
Materials and methods: Ten MS women with VD (having % post-void residual/bladder capacity [%PVR/BC] ≥40% or being in the lower 10th percentile of the Liverpool nomogram) underwent concurrent functional magnetic resonance imaging/urodynamic study (fMRI/UDS) with 3 cycles of bladder filling/emptying, at baseline and post-treatment. Predetermined ROIs and their activations at voiding initiation were identified on patients' baseline fMRI/UDS scans, corresponding to microstimulator placement. Patients received 10 consecutive 40-minute treatment sessions. Brain activation group analysis, noninstrumented uroflow, and validated questionnaires were compared at baseline and post-treatment.
Results: No treatment-related adverse effects were reported. Post-treatment, patients showed significantly increased activation in regions known to be involved at voiding initiation in healthy subjects. %PVR/BC significantly decreased. Significant improvement of bladder emptying symptoms were reported by patients via validated questionnaires.
Conclusions: Both neuroimaging and clinical data suggested TRPMS effectively and safely modulated brain regions that are involved in the voiding phase of the micturition cycle, leading to clinical improvements in bladder emptying in patients with MS.
Keywords: magnetic resonance imaging; multiple sclerosis.
Conflict of interest statement
Disclosure of Conflict of Interest: SAH is listed as an inventor on issued U.S. patent numbers 9456784, 10398907, 10500408 and 10874870 covering the device used in this study. The patent is licensed to Seraya Medical, LLC. Other authors declared no conflict of interest.
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Source: PubMed