Examining the Brain's Control Systems in Normal and Overactive Bladder Using DTI and Functional MRI
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Urinary Incontinence, Urge
- Sponsor
- Oregon Health and Science University
- Enrollment
- 47
- Locations
- 1
- Primary Endpoint
- Determine differences in fluctuations in brain activity between different regions of the brain associated with control functions.
- Status
- Completed
- Last Updated
- 8 years ago
Overview
Brief Summary
Urgency incontinence (where the bladder muscles contract suddenly, causing an immediate urge to urinate that is difficult to prevent) is commonly experienced in patients with overactive bladder. New findings have discovered that urgency incontinence may be connected to the interactions of certain regions of the brain and the bladder. Although this is a common problem, researchers still do not know how these interactions impact the process of urgency incontinence. The purpose of this study is to better understand how the brain functions, by using Magnetic Resonance Imaging (MRI) machine and Diffusion Tensor Imaging (DTI) to create images of the brain during different bladder states.
Detailed Description
One devastating manifestation of overactive bladder is urgency incontinence. Although urgency incontinence is a common problem with profound clinical, social and psychological consequences, little is understood about its underlying cause. The involuntary detrusor overactivity (DO) often associated with the disease points to a possible abnormality in voluntary control of the spinobulbospinal voiding reflex by a higher order neuronal network. Recent functional MRI (fMRI) and PET studies have identified increased brain activity during bladder filling and voiding in normal subjects from higher order cognitive control centers. In addition, there are now data to suggest that interactions between these brain areas, which include the pontine micturition center (PMC), periaqueductal gray (PAG), thalamus, insula, dorsal anterior cingulate and prefrontal cortex, may be abnormal in patients with urgency incontinence. Despite these encouraging findings, we do not yet know how these regions are interacting with each other, or to other, unknown but important, regions in the brain. Nor do we know how this interaction might play a role in this disease process. Expanding our knowledge of how these regions are integrated to achieve continence and, importantly, what aspects of this complex circuitry are atypical in patients with urge incontinence is key to our future therapeutic endeavors. With this in mind, the goal of this study is to better characterize the functional integration (i.e. functional connectivity) of the brain's control networks in relation to typical and atypical bladder function. We aim to identify distinct differences in the brain's functional and anatomic topography in women with and without urgency incontinence. Our approach not only has the potential to advance our understanding of the higher level pathophysiology of this disease process, but could also lead to novel more centrally acting therapeutic approaches for treatment of urgency incontinence.
Investigators
Rahel Nardos
MD
Oregon Health and Science University
Eligibility Criteria
Inclusion Criteria
- •Female gynecology patients between age 40 and
- •Without a history of urinary incontinence (must answer "never" to question A1: how often do you leak urine, on initial screening questionnaire).
- •Without a history of incontinence surgery.
- •Without a history of overactive bladder.
- •Without pelvic pain.
- •Without irritative bladder symptoms (must say "no" to question A4: do you experience frequent urination on initial screening questionnaire).
- •Exclusion criteria:
- •Medical contraindications for MRI scanning.
- •Past or present overt neurological disease such as history of stroke, epilepsy, MS, spinal cord injury.
- •History of pelvic irradiation or bladder cancer.
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Determine differences in fluctuations in brain activity between different regions of the brain associated with control functions.
Time Frame: Once during up to 3 months
We will look at the overall group differences to see if there are differences between the case group participants and control group participants in control brain regions related to normal bladder function.
Secondary Outcomes
- Scores on the Pelvic Floor Distress Inventory(Once during up to 3 months)
- 3 Day Bladder Diary to Assess Participant Symptom Severity(Once during up to 3 months)
- Determine functional brain connectivity with bladder.(Once during up to 3 months)
- Determine any difference in brain response to bladder filling in subjects with and without overactive bladder.(Once during up to 3 months)
- Scores on the Pelvic Floor Impact Questionnaire(Once during up to 3 months)
- Scores on the International Consultation on Incontinence Questionnaire(Once during up to 3 months.)