NM84 EARLY FINDINGS ON NONINVASIVE STIMULATION TO TREAT NEUROGENIC OVERACTIVE BLADDER IN WOMEN WITH MULTIPLE SCLEROSIS

Introduction: Neurogenic Overactive Bladder (NOAB) affects about 88% of individuals with multiple sclerosis (MS), causing urinary frequency, urgency, or incontinence. While treatments like catheterization, chemodenervation, and anticholinergics can help, they often face issues with compliance and side effects. Neuromodulation therapies, such as repetitive transcranial magnetic stimulation (rTMS), may offer an effective second-line treatment for MS patients unresponsive to conventional therapies. This randomized, sham-controlled trial (NCT 06072703) assesses the impact of individualized rTMS on NOAB symptoms by targeting brain regions involved in bladder function during storage and bladder volume sensing.

Methods: Adult women with MS and NOAB, defined by a Neurogenic Bladder Symptom Score (NBSS) ≥ 15, at least one bladder storage symptom (OAB tool score ≥ 8), and an Expanded Disability Status Score ≤ 7.5, were recruited. Participants were randomized 2:1 to receive either active or sham rTMS. Baseline assessments included urodynamic metrics and validated surveys. Baseline fMRIs using a natural bladder filling paradigm were acquired and helped guidetreatment individualization using neuronavigation forrTMS probe placement. Patients had ten 40-minute rTMS sessions, with clinical and neuroimaging assessments repeated after treatment.

Results: So far, five subjects have successfully completed the neurostimulation treatment with no withdrawals and data up to a 3-month follow-up collected.Preliminary findings suggest symptoms associated with NOAB may be ameliorated following treatment/sham, as reportedby patients via validated questionnaires (Fig.1 A). Neuroimaging data appears to show changes in functional connectivity from the treatment (Fig.1B).No serious adverse events have been reported during the study, indicating a favorable safety profile for rTMS in MS individuals.

Conclusions: rTMS could address a significant unmet need for MS patients with neurogenic OAB who have not achieved sufficient relief from existing treatments. However, to accurately determine the true efficacy of rTMS in managing NOAB symptoms, further data collection is necessary. The current sample size is insufficient to achieve statistical significance, and additional participants (ongoing) are required to confirm these preliminary observations and establish robust conclusions regarding the impact of rTMS on NOAB symptom management in the MS population.