MP52-11: MICTURITION-ASSOCIATED BRAIN ACTIVITY IN HEALTHY PATIENTS COMPARED TO STROKE SURVIVORS BEFORE AND AFTER TRANSCUTANEOUS SPINAL CORD STIMULATION
Introduction: Compared to healthy individuals, stroke survivors with neurogenic lower urinary tract dysfunction (NLUTD) exhibit decreased cortical activity in response to bladder filling and emptying. The use of transcutaneous spinal cord stimulation (TSCS) has been shown to reduce frequency, urgency and incontinence episodes in these individuals . The objective of this study was to determine whether TSCS also leads to normalization of micturition-related brain activity, as compared to healthy controls. Methods: Twelve stroke patients with post-stroke NLUTD received 12 weeks of TSCS. Each subject also completed simultaneous urodynamics (UDS) and blood-oxygen-level-dependent (BOLD) fMRI before initiation of TSCS and within 72 hours of completing the final TSCS session. Healthy subjects without LUTS completed an identical fMRI-UDS protocol. BOLD signal during the period of maximum urgency (10 seconds preceding a detrusor contraction) was determined using statistical parametric mapping (SPM) and compared between healthy controls and stroke patients before and after TSCS (p < 0.01, cluster size? 25 voxels). The SPM models were adjusted for age and sex. Results: Compared to healthy controls, stroke survivors prior to TSCS exhibited diminished activation in the right cerebellum, left putamen, right insula, right anterior cingulate gyrus, right precuneus, bilateral medial frontal gyri, and right superior frontal gyrus compared to healthy controls. Following TSCS, there was no significant difference in BOLD signal in these regions between stroke survivors and healthy controls. However, healthy controls continued to exhibit increased activation in the right precentral (motor cortex) and left postcentral (sensory cortex) gyri, left posterior cingulate and left middle temporal gyrus even after TSCS. Conclusions: Micturition-related brain activity appears to partially revert to the healthy phenotype in stroke survivors following TSCS. Regions, where differences in BOLD signal between healthy controls and stroke subjects diminish following treatment, are known to be involved in LUT control. As expected, the neurosignature of stroke patients did not revert to the healthy phenotype entirely, as indicated by significant remaining differences in BOLD signal in several brain regions following TSCS. SOURCE OF Funding: Urology Care Foundation
