#36 CEREBELLAR FUNCTIONAL CONNECTIVITY IN WOMEN WITH MULTIPLE SCLEROSIS AND VOIDING DYSFUNCTION IS LINKED TO LOWER URINARY TRACT SYTMPTOMS

Introduction: There is growing evidence indicating the cerebellum's involvement in controlling lower urinary tract (LUT) function. Our research has pinpointed three cerebellar regions of interest (ROIs) that have notable functional connectivity (FC) with other cortical areas involved in LUT function in healthy patients, but how these networks change with neurogenic lower urinary tract dysfunction (NLUTD) is unknown. This study focuses on examining how this connectivity is influenced by demyelinating conditions like Multiple Sclerosis (MS), by employing 7 Tesla MRI imaging with urodynamics (UDS).

Methods: We recruited women(average age 53.40, 35 to 77)diagnosed with MS and voiding dysfunction (VD), characterized by a post-void residual/bladder capacity ratio ≥ 40%, a Liverpool Nomogram percentile > 10%, or self-catheterizing. On an empty bladder, anatomical images were acquired and functional MRI (fMRI) scans were conducted while sterile saline was infused into the bladder. FC was computed using the CONN toolbox in MATLAB, utilizing statistical parametric mapping. Contrast maps were generated from blood oxygen level-dependent (BOLD) signals and seed-to-voxel analysis performed using cerebellar ROIs (p < 0.05).

Results: We observed different resting state FC (rs-FC) patterns of the cerebellar storage and voiding regions in women with MS and VD compared to healthy controls. During the empty bladder state (Figure 1a.) the MS cohort has more intracerebellar FC, suggesting increased internal sensitivity to bladder state, as well as lower supplementary motor area (SMA) activity. Additionally, in the full bladder state (Figure 1b.) there is lower SMA FC but higher FC in the prefrontal cortex. These findings show that the cerebellum is involved in dysfunctional pathways known in NLUTD.

Conclusions: These initial findings offer insights into the cerebellum's FC and its implications for NLUTD. By deepening our comprehension of the brain-bladder network in d those with neurological conditions, we can pave the way for the development of more precise therapeutic interventions.