Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol
Abstract 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 resolvi...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | BMC Urology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12894-023-01358-8 |
| _version_ | 1797276245795274752 |
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| author | Betsy H. Salazar Kristopher A. Hoffman John A. Lincoln Christof Karmonik Hamida Rajab Santosh A. Helekar Rose Khavari |
| author_facet | Betsy H. Salazar Kristopher A. Hoffman John A. Lincoln Christof Karmonik Hamida Rajab Santosh A. Helekar Rose Khavari |
| author_sort | Betsy H. Salazar |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-03-07T15:25:32Z |
| format | Article |
| id | doaj.art-392d8079f7eb4c139270211873e3a103 |
| institution | Directory Open Access Journal |
| issn | 1471-2490 |
| language | English |
| last_indexed | 2024-03-07T15:25:32Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Urology |
| spelling | doaj.art-392d8079f7eb4c139270211873e3a1032024-03-05T17:06:50ZengBMCBMC Urology1471-24902024-01-0124111210.1186/s12894-023-01358-8Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocolBetsy H. Salazar0Kristopher A. Hoffman1John A. Lincoln2Christof Karmonik3Hamida Rajab4Santosh A. Helekar5Rose Khavari6Department of Urology, Houston Methodist HospitalDepartment of Urology, Houston Methodist HospitalDepartment of Neurology, The University of Texas Health Science CenterTranslational Imaging Center, Houston Methodist Research InstituteDepartment of Urology, Houston Methodist HospitalCenter for Translational Biomagnetics and Neurometry, Houston Methodist Research InstituteDepartment of Urology, Houston Methodist HospitalAbstract 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.https://doi.org/10.1186/s12894-023-01358-8Multiple sclerosisNeurogenic overactive bladderFunctional MRITranscranial magnetic stimulation |
| spellingShingle | Betsy H. Salazar Kristopher A. Hoffman John A. Lincoln Christof Karmonik Hamida Rajab Santosh A. Helekar Rose Khavari Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol BMC Urology Multiple sclerosis Neurogenic overactive bladder Functional MRI Transcranial magnetic stimulation |
| title | Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol |
| title_full | Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol |
| title_fullStr | Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol |
| title_full_unstemmed | Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol |
| title_short | Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a randomized controlled trial protocol |
| title_sort | evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis a randomized controlled trial protocol |
| topic | Multiple sclerosis Neurogenic overactive bladder Functional MRI Transcranial magnetic stimulation |
| url | https://doi.org/10.1186/s12894-023-01358-8 |
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