Functional Magnetic Resonance Imaging with Concurrent Urodynamic Testing Identifies Brain Structures Involved in Micturition Cycle in Patients with Multiple Sclerosis

Abstract

Purpose: Neurogenic lower urinary tract dysfunction, which is common in patients with multiple sclerosis, has a significant impact on quality of life. In this study we sought to determine brain activity processes during the micturition cycle in female patients with multiple sclerosis and neurogenic lower urinary tract dysfunction.

Materials and methods: We report brain activity on functional magnetic resonance imaging and simultaneous urodynamic testing in 23 ambulatory female patients with multiple sclerosis. Individual functional magnetic resonance imaging activation maps at strong desire to void and at initiation of voiding were calculated and averaged at Montreal Neuroimaging Institute. Areas of significant activation were identified in these average maps. Subgroup analysis was performed in patients with elicitable neurogenic detrusor overactivity or detrusor-sphincter dyssynergia.

Results: Group analysis of all patients at strong desire to void yielded areas of activation in regions associated with executive function (frontal gyrus), emotional regulation (cingulate gyrus) and motor control (putamen, cerebellum and precuneus). Comparison of the average change in activation between previously reported healthy controls and patients with multiple sclerosis showed predominantly stronger, more focal activation in the former and lower, more diffused activation in the latter. Patients with multiple sclerosis who had demonstrable neurogenic detrusor overactivity and detrusor-sphincter dyssynergia showed a trend toward distinct brain activation at full urge and at initiation of voiding respectively.

Conclusions: We successfully studied brain activation during the entire micturition cycle in female patients with neurogenic lower urinary tract dysfunction and multiple sclerosis using a concurrent functional magnetic resonance imaging/urodynamic testing platform. Understanding the central neural processes involved in specific parts of micturition in patients with neurogenic lower urinary tract dysfunction may identify areas of interest for future intervention.

Keywords: brain mapping; magnetic resonance imaging; multiple sclerosis; urinary bladder; urodynamics.

Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Combined fMRI and UDS testing protocol

Figure 2

BOLD activation signals at strong desire to void. A, UDS tracing of 5 cycles. Pdet, detrusor pressure. Arrows indicate voiding initiation. B, group analysis of HC. C, group analysis of patients with MS. D, subtraction between patients with MS and HCs demonstrates predominantly lower activation in patients at strong desire to void. E, trend in patients with MS with vs without demonstrable NDO. Warmer colors represent increased activation in patients with MS. Cooler colors represent decreased activation in HCs.

Figure 3

BOLD activation signals at initiation of voiding. A, UDS tracing of 5 cycles. Pdet, detrusor pressure. Asterisks indicate voiding initiation. B, HC activation pattern. C, patients with MS showed greater activity and higher BOLD signal in regions with warmer colors. D, subtraction image between patients with MS and female HCs also reveals less activation in patients than in HCs.