Evaluating noninvasive brain stimulation to treat overactive bladder in individuals with multiple sclerosis: a...

Area of Science:

• Neuroscience
• Neurology
• Biomedical Engineering

Background:

• Multiple Sclerosis (MS) is a neurological disease impacting the myelin sheath, often leading to neurogenic lower urinary tract dysfunction (NLUTD).
• Current treatments for NLUTD primarily manage symptoms, not the underlying neural circuitry disruption between the brain and bladder.
• Overactive bladder (OAB) is a common symptom of NLUTD in MS patients, significantly affecting quality of life.

Purpose of the Study:

• To investigate the effectiveness of repetitive transcranial magnetic stimulation (rTMS) in resolving overactive bladder (OAB) symptoms associated with NLUTD in women with Multiple Sclerosis (MS).
• To leverage functional magnetic resonance imaging (fMRI) and neural plasticity to restore brain-bladder neural circuitry.
• To improve the quality of life for individuals with MS and NLUTD.

Main Methods:

• Utilized advanced neuro-navigation with fMRI and diffusion tensor imaging to precisely target brain regions.
• Administered tailored neuromodulation protocols, including excitatory (10 Hz) and inhibitory (1 Hz) rTMS, to specific pre-frontal cortex and pelvic motor areas.
• Assessed rTMS effectiveness through questionnaires, bladder diaries, and stimulation session analysis in clinically stable MS patients.

Main Results:

• The study aims to demonstrate that targeted neuromodulation can restore or reroute autonomic and sensorimotor activity between the brain and bladder.
• Preliminary data suggests potential for improving OAB symptoms in MS patients.
• The effectiveness is contingent on sufficient intact white matter in targeted brain regions for stimulation.

Conclusions:

• This neuromodulatory approach offers a novel strategy for treating NLUTD in MS by addressing the root cause in neural circuitry.
• Challenges include participant recruitment due to the heterogeneous nature of MS and the requirement for intact white matter.
• Despite limitations, the study is expected to enhance the quality of life for MS patients suffering from NLUTD.