Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial
Aim: Percutaneous tibial nerve stimulation is used to decrease incontinence in chronic neurogenic bladder. We report the findings from a subset of patients in a randomized control trial of transcutaneous tibial nerve stimulation (TTNS) for bladder neuromodulation in acute spinal cord injury (SCI) in...
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| Format: | Article |
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Frontiers Media S.A.
2019-02-01
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| Series: | Frontiers in Neuroscience |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fnins.2019.00119/full |
| _version_ | 1818022450377523200 |
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| author | Argyrios Stampas Kenneth Gustafson Radha Korupolu Christopher Smith Liang Zhu Sheng Li |
| author_facet | Argyrios Stampas Kenneth Gustafson Radha Korupolu Christopher Smith Liang Zhu Sheng Li |
| author_sort | Argyrios Stampas |
| collection | DOAJ |
| description | Aim: Percutaneous tibial nerve stimulation is used to decrease incontinence in chronic neurogenic bladder. We report the findings from a subset of patients in a randomized control trial of transcutaneous tibial nerve stimulation (TTNS) for bladder neuromodulation in acute spinal cord injury (SCI) in whom heart rate variability (HRV) was recorded before and after cystometrogram (CMG). The aim was to correlate autonomic nervous system (ANS) changes associated with the CMG changes after the trial using HRV analyses.Methods: The study was a double-blinded sham-controlled 2-week trial with consecutive acute SCI patients admitted for inpatient rehabilitation, randomized to TTNS vs. control sham stimulation. Pre- and Post- trial CMG were performed with concurrent 5-min HRV recordings with empty bladder and during filling. Primary outcomes were changes with CMG between/within groups and associations to the HRV findings.Results: There were 10 subjects in the TTNS group and 6 in the control group. Pre-trial baseline subject characteristics, blood pressures (BPs), and CMG were similar between groups. In both groups, the pre-trial systolic BP increased during filling CMG. After the trial, the control group had significantly increased detrusor pressure and counts of detrusor-sphincter dyssynergia on CMG, not seen in the TTNS group. Also, the control group did not maintain rising BP post-trial, which was observed pre-trial and remained in the TTNS group post-trial. HRV was able to detect a difference in the ANS response to bladder filling between groups. Post-trial HRV was significant for markers of overall increased parasympathetic nervous system activity during filling in the controls, not seen in the TTNS group.Conclusion: Preliminary evidence suggests that TTNS in acute SCI is able to achieve bladder neuromodulation via modulation of ANS functions.Clinical Trial Registration:clinicaltrials.gov, NCT02573402. |
| first_indexed | 2024-12-10T03:28:37Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1662-453X |
| language | English |
| last_indexed | 2024-12-10T03:28:37Z |
| publishDate | 2019-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neuroscience |
| spelling | doaj.art-107aaf675de3485cbc45d04012dd9ef72022-12-22T02:03:52ZengFrontiers Media S.A.Frontiers in Neuroscience1662-453X2019-02-011310.3389/fnins.2019.00119414367Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot TrialArgyrios Stampas0Kenneth Gustafson1Radha Korupolu2Christopher Smith3Liang Zhu4Sheng Li5Department of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United StatesDepartment of Bioengineering, Case Western Reserve University, Cleveland, OH, United StatesDepartment of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United StatesDepartment of Urology, Baylor College of Medicine, Houston, TX, United StatesBiostatistics and Epidemiology Research Design Core, University of Texas Health Science Center at Houston, Houston, TX, United StatesDepartment of Physical Medicine and Rehabilitation, University of Texas Health Science Center at Houston, Houston, TX, United StatesAim: Percutaneous tibial nerve stimulation is used to decrease incontinence in chronic neurogenic bladder. We report the findings from a subset of patients in a randomized control trial of transcutaneous tibial nerve stimulation (TTNS) for bladder neuromodulation in acute spinal cord injury (SCI) in whom heart rate variability (HRV) was recorded before and after cystometrogram (CMG). The aim was to correlate autonomic nervous system (ANS) changes associated with the CMG changes after the trial using HRV analyses.Methods: The study was a double-blinded sham-controlled 2-week trial with consecutive acute SCI patients admitted for inpatient rehabilitation, randomized to TTNS vs. control sham stimulation. Pre- and Post- trial CMG were performed with concurrent 5-min HRV recordings with empty bladder and during filling. Primary outcomes were changes with CMG between/within groups and associations to the HRV findings.Results: There were 10 subjects in the TTNS group and 6 in the control group. Pre-trial baseline subject characteristics, blood pressures (BPs), and CMG were similar between groups. In both groups, the pre-trial systolic BP increased during filling CMG. After the trial, the control group had significantly increased detrusor pressure and counts of detrusor-sphincter dyssynergia on CMG, not seen in the TTNS group. Also, the control group did not maintain rising BP post-trial, which was observed pre-trial and remained in the TTNS group post-trial. HRV was able to detect a difference in the ANS response to bladder filling between groups. Post-trial HRV was significant for markers of overall increased parasympathetic nervous system activity during filling in the controls, not seen in the TTNS group.Conclusion: Preliminary evidence suggests that TTNS in acute SCI is able to achieve bladder neuromodulation via modulation of ANS functions.Clinical Trial Registration:clinicaltrials.gov, NCT02573402.https://www.frontiersin.org/article/10.3389/fnins.2019.00119/fullspinal cord injuriesheart rate variabilityneuromodulationautonomic nervous systemneurogenic urinary bladdertranscutaneous electric stimulation |
| spellingShingle | Argyrios Stampas Kenneth Gustafson Radha Korupolu Christopher Smith Liang Zhu Sheng Li Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial Frontiers in Neuroscience spinal cord injuries heart rate variability neuromodulation autonomic nervous system neurogenic urinary bladder transcutaneous electric stimulation |
| title | Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial |
| title_full | Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial |
| title_fullStr | Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial |
| title_full_unstemmed | Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial |
| title_short | Bladder Neuromodulation in Acute Spinal Cord Injury via Transcutaneous Tibial Nerve Stimulation: Cystometrogram and Autonomic Nervous System Evidence From a Randomized Control Pilot Trial |
| title_sort | bladder neuromodulation in acute spinal cord injury via transcutaneous tibial nerve stimulation cystometrogram and autonomic nervous system evidence from a randomized control pilot trial |
| topic | spinal cord injuries heart rate variability neuromodulation autonomic nervous system neurogenic urinary bladder transcutaneous electric stimulation |
| url | https://www.frontiersin.org/article/10.3389/fnins.2019.00119/full |
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