TY - JOUR
T1 - Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis
T2 - a randomized controlled trial protocol
AU - Salazar, Betsy H.
AU - Hoffman, Kristopher A.
AU - Lincoln, John A.
AU - Karmonik, Christof
AU - Rajab, Hamida
AU - Helekar, Santosh A.
AU - Khavari, Rose
N1 - Funding Information:
We would like to thank Vi Phan and Lien Pham for their assistance in the MRI core facility.
Funding Information:
Funding is provided by the National Institutes of Health (NIH) grant (1R01DK134340-01).
Publisher Copyright:
© 2024, The Author(s).
PY - 2024/1/25
Y1 - 2024/1/25
N2 - Background: Multiple Sclerosis (MS) is an often debilitating disease affecting the myelin sheath that encompasses neurons. It can be accompanied by a myriad of pathologies and adverse effects such as neurogenic lower urinary tract dysfunction (NLUTD). Current treatment modalities for resolving NLUTD focus mainly on alleviating symptoms while the source of the discomfort emanates from a disruption in brain to bladder neural circuitry. Here, we leverage functional magnetic resonance imaging (fMRI), repetitive transcranial magnetic stimulation (rTMS) protocols and the brains innate neural plasticity to aid in resolving overactive bladder (OAB) symptoms associated with NLUTD. Methods: By employing an advanced neuro-navigation technique along with processed fMRI and diffusion tensor imaging data to help locate specific targets in each participant brain, we are able to deliver tailored neuromodulation protocols and affect either an excitatory (20 min @ 10 Hz, applied to the lateral and medial pre-frontal cortex) or inhibitory (20 min @ 1 Hz, applied to the pelvic supplemental motor area) signal on neural circuitry fundamental to the micturition cycle in humans to restore or reroute autonomic and sensorimotor activity between the brain and bladder. Through a regimen of questionnaires, bladder diaries, stimulation sessions and analysis, we aim to gauge rTMS effectiveness in women with clinically stable MS. Discussion: Some limitations do exist with this study. In targeting the MS population, the stochastic nature of MS in general highlights difficulties in recruiting enough participants with similar symptomology to make meaningful comparisons. As well, for this neuromodulatory approach to achieve some rate of success, there must be enough intact white matter in specific brain regions to receive effective stimulation. While we understand that our results will represent only a subset of the MS community, we are confident that we will accomplish our goal of increasing the quality of life for those burdened with MS and NLUTD. Trial registration: This trial is registered at ClinicalTrials.gov (NCT06072703), posted on Oct 10, 2023.
AB - Background: Multiple Sclerosis (MS) is an often debilitating disease affecting the myelin sheath that encompasses neurons. It can be accompanied by a myriad of pathologies and adverse effects such as neurogenic lower urinary tract dysfunction (NLUTD). Current treatment modalities for resolving NLUTD focus mainly on alleviating symptoms while the source of the discomfort emanates from a disruption in brain to bladder neural circuitry. Here, we leverage functional magnetic resonance imaging (fMRI), repetitive transcranial magnetic stimulation (rTMS) protocols and the brains innate neural plasticity to aid in resolving overactive bladder (OAB) symptoms associated with NLUTD. Methods: By employing an advanced neuro-navigation technique along with processed fMRI and diffusion tensor imaging data to help locate specific targets in each participant brain, we are able to deliver tailored neuromodulation protocols and affect either an excitatory (20 min @ 10 Hz, applied to the lateral and medial pre-frontal cortex) or inhibitory (20 min @ 1 Hz, applied to the pelvic supplemental motor area) signal on neural circuitry fundamental to the micturition cycle in humans to restore or reroute autonomic and sensorimotor activity between the brain and bladder. Through a regimen of questionnaires, bladder diaries, stimulation sessions and analysis, we aim to gauge rTMS effectiveness in women with clinically stable MS. Discussion: Some limitations do exist with this study. In targeting the MS population, the stochastic nature of MS in general highlights difficulties in recruiting enough participants with similar symptomology to make meaningful comparisons. As well, for this neuromodulatory approach to achieve some rate of success, there must be enough intact white matter in specific brain regions to receive effective stimulation. While we understand that our results will represent only a subset of the MS community, we are confident that we will accomplish our goal of increasing the quality of life for those burdened with MS and NLUTD. Trial registration: This trial is registered at ClinicalTrials.gov (NCT06072703), posted on Oct 10, 2023.
KW - Functional MRI
KW - Multiple sclerosis
KW - Neurogenic overactive bladder
KW - Transcranial magnetic stimulation
KW - Brain
KW - Humans
KW - Treatment Outcome
KW - Diffusion Tensor Imaging
KW - Randomized Controlled Trials as Topic
KW - Multiple Sclerosis/complications
KW - Urinary Bladder, Overactive
KW - Quality of Life
KW - Female
UR - http://www.scopus.com/inward/record.url?scp=85183033755&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85183033755&partnerID=8YFLogxK
U2 - 10.1186/s12894-023-01358-8
DO - 10.1186/s12894-023-01358-8
M3 - Article
C2 - 38273296
AN - SCOPUS:85183033755
SN - 1471-2490
VL - 24
SP - 20
JO - BMC Urology
JF - BMC Urology
IS - 1
M1 - 20
ER -