PD39-06 EARLY FINDINGS ON NONINVASIVE STIMULATION TO TREAT NEUROGENIC OVERACTIVE BLADDER IN WOMEN WITH MULTIPLE SCLEROSIS

INTRODUCTION AND OBJECTIVE:
Neurogenic Overactive Bladder (NOAB) affects approximately 88% of individuals with multiple sclerosis (MS), leading to urinary symptoms such as frequency, urgency, and incontinence. Although treatments like catheterization, chemodenervation, and anticholinergics are available, they often come with compliance challenges and side effects. Neuromodulation therapies, such as repetitive transcranial magnetic stimulation (rTMS), may offer an alternative for MS patients unresponsive to conventional treatments. This randomized, sham-controlled trial (NCT 06072703) aims to evaluate the impact of individualized rTMS on NOAB symptoms by targeting brain regions involved in bladder storage and volume sensing.

METHODS:
Adult women with MS and NOAB were recruited based on 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. Participants were randomized 2:1 to receive either active or sham rTMS. Baseline assessments included urodynamic measures and validated surveys. Functional MRI scans using a natural bladder filling paradigm were conducted to guide individualized rTMS probe placement via neuronavigation. Each patient received ten 40-minute rTMS sessions, with clinical and neuroimaging assessments repeated post-treatment.

RESULTS:
To date, five subjects have completed the neurostimulation treatment, with no withdrawals and follow-up data collected up to three months. Preliminary results suggest that NOAB symptoms may improve following treatment, as reported by patients through validated questionnaires (Figure 1A). Neuroimaging data indicate possible changes in functional connectivity associated with the treatment (Figure 1B). No serious adverse events were reported, suggesting a favorable safety profile for rTMS in MS patients.

CONCLUSIONS:
rTMS may provide a valuable option for MS patients with neurogenic OAB who have not responded to standard treatments. However, further data collection is needed to establish the efficacy of rTMS in managing NOAB symptoms. While the current sample size is too small for statistical significance, additional participants are being recruited to validate these preliminary findings and provide robust conclusions on the impact of rTMS for NOAB symptom management in MS.