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JU INSIGHT Spinal Cord Stimulation Effect on Voiding-Related Brain Activity and Urinary Symptoms After Stroke
By: Evgeniy I. Kreydin, MD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California, University of Southern California Neurorestoration Center, Los Angeles; Aidin Abedi, MD, Keck School of Medicine, University of Southern California, Los Angeles, University of Southern California Neurorestoration Center, Los Angeles; Veronica Stefania Montero, MD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California; Luis Morales Ojeda, MD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California; Rita Jen, MD, Keck School of Medicine, University of Southern California, Los Angeles; Laura Perez, MD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California; Anibal La Riva, MD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California; Priya Kohli, BS, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California; Charles Y. Liu, MD, PhD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California, University of Southern California Neurorestoration Center, Los Angeles; David A. Ginsberg, MD, Keck School of Medicine, University of Southern California, Los Angeles, Rancho Los Amigos National Rehabilitation Center, Downey, California; Parag Gad, PhD, SpineX Inc, Los Angeles, California; V. Reggie Edgerton, PhD, Rancho Los Amigos National Rehabilitation Center, Downey, California, University of California, Los Angeles; Kay Jann, PhD, University of Southern California, Los Angeles | Posted on: 21 Feb 2024
Kreydin EI, Abedi A, Montero VS, et al. A pilot study of the effect of transcutaneous spinal cord stimulation on micturition-related brain activity and lower urinary tract symptoms after stroke. J Urol. 2024;211(2):294-304.
Study Need and Importance
There are currently no approved neuromodulation modalities for lower urinary tract symptoms (LUTS) in patients with neurogenic bladder. Yet, given the etiology of this condition, neuromodulation seems like an intuitively appropriate therapy. In this study we explored the effect of transcutaneous spinal cord stimulation (TSCS) on urinary symptoms and incontinence in patients with neurogenic bladder due to stroke. To investigate potential mechanisms of TSCS, we used functional MRI to assess changes in micturition-associated brain activity after undergoing this treatment and compared it to healthy controls.
What We Found
After 12 weeks of biweekly TSCS therapy, stroke survivors reported a reduction in incontinence episodes and a decrease in urinary urgency. These changes were accompanied by improvements in validated urinary questionnaire scores. TSCS also led to increased activation in several brain regions during voiding initiation (Figure) and attenuation of brain activity differences between stroke survivors and healthy controls.
Limitations
The study did not include a sham stimulation arm. Comparison to sham is critical to demonstrate the true efficacy of an intervention for LUTS and/or urinary incontinence. A multi-institutional trial comparing TSCS to sham in patients with neurogenic lower urinary tract dysfunction is currently ongoing. Urodynamics were not included as an outcome measure and were only performed simultaneously with functional MRI in a nonclinical environment. Finally, a relatively small sample size may preclude generalization of the therapeutic effect of TSCS to other patients with neurogenic bladder.
Interpretation for Patient Care
LUTS can be particularly difficult to treat in stroke survivors because of coexisting comorbidities such as benign prostatic hyperplasia and cognitive decline. This pilot study suggests that neuromodulation may offer a safe and well-tolerated therapeutic approach. Additionally, our study adds to the growing literature exploring the mechanisms of neuromodulation in urology and concurs with several others demonstrating induction of neuroplasticity and neuroactivation by both novel and established neuromodulation techniques.
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