Functional Magnetic Resonance Imaging of the Brain in Women With Overactive Bladder: Brain Activation During Urinary Urgency

Objectives: To identify abnormal function of the limbic cortex (LC) in response to urinary urgency among patients with overactive bladder (OAB) using brain functional magnetic resonance imaging. Methods: For this study, 5 OAB subjects and 5 controls underwent bladder filling and rated urgency sensations while functional magnetic resonance imaging measured activation in discrete volumes (voxels) within the brain. Changes in brain activation were related to bladder distension and individual subject's rating of urgency via multiple regression analysis. &bgr; Weights from regression equations were converted into percent signal change for each voxel and percent signal change compared with the null hypothesis using t tests. Significance threshold of P < 0.05 was applied along with a cluster size threshold of 0.32 mL (5005 voxels left ACG). Results: Patients with OAB showed increased brain activation in LC, specifically the insula (IN) and anterior cingulate gyrus, associated with increased urgency. Urgency sensations during low volumes were associated with bilateral IN activation in OAB subjects (7621 voxels right IN and 4453 voxels left IN, mean &bgr; weights = 0.018 ± 0.014 and 0.014 ± 0.011). Minimal activation was present in controls (790 voxels right IN, &bgr; weight = 0.010 ± 0.007). Urgency sensations during high volumes were associated with bilateral anterior cingulate gyrus activation in OAB subjects (2304 voxels right ACG and 5005 voxels left IN, mean &bgr; weights = 0.005 ± 0.003 and 0.004 ± 0.003) without activation in controls. Conclusions: Urinary urgency in patients with OAB is associated with increased activation of the LC. This activation likely represents abnormal processing of sensory input in brain regions associated with emotional response to discomfort.

[1]  Jim C Hu,et al.  Economic costs of overactive bladder in the United States. , 2010, Urology.

[2]  J F R Paton,et al.  Neural control of the lower urinary and gastrointestinal tracts: Supraspinal CNS mechanisms , 2010, Neurourology and urodynamics.

[3]  G. Holstege.  The emotional motor system and micturition control , 2010, Neurourology and urodynamics.

[4]  C. Fowler,et al.  A decade of functional brain imaging applied to bladder control , 2010, Neurourology and urodynamics.

[5]  R. Freeman,et al.  An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction , 2010, International Urogynecology Journal.

[6]  Erno J. Hermans,et al.  From Specificity to Sensitivity: How Acute Stress Affects Amygdala Processing of Biologically Salient Stimuli , 2009, Biological Psychiatry.

[7]  Jennifer S. Labus,et al.  Brain networks underlying perceptual habituation to repeated aversive visceral stimuli in patients with irritable bowel syndrome , 2009, NeuroImage.

[8]  Rebecca N. Jerome,et al.  Treatment of overactive bladder in women. , 2009, Evidence report/technology assessment.

[9]  L. Miller,et al.  Persistence, Adherence, and Switch Rates Among Extended-Release and Immediate-Release Overactive Bladder Medications in a Regional Managed Care Plan , 2008, Journal of managed care pharmacy : JMCP.

[10]  Derek J. Griffiths,et al.  Abnormal connections in the supraspinal bladder control network in women with urge urinary incontinence , 2008, NeuroImage.

[11]  J. Bueller,et al.  Reduced Brainstem Inhibition during Anticipated Pelvic Visceral Pain Correlates with Enhanced Brain Response to the Visceral Stimulus in Women with Irritable Bowel Syndrome , 2008, The Journal of Neuroscience.

[12]  Derek J. Griffiths,et al.  Cerebral control of the bladder in normal and urge-incontinent women , 2007, NeuroImage.

[13]  C. Fowler,et al.  Cerebral mechanisms and voiding function , 2007, BJU international.

[14]  N. Resnick,et al.  Brain control of normal and overactive bladder. , 2005, The Journal of urology.

[15]  K. Coyne,et al.  Validation of an overactive bladder awareness tool for use in primary care settings , 2005, Advances in therapy.

[16]  Lin Chang.  Brain responses to visceral and somatic stimuli in irritable bowel syndrome: a central nervous system disorder? , 2005, Gastroenterology clinics of North America.

[17]  D. Revicki,et al.  Psychometric validation of an overactive bladder symptom and health-related quality of life questionnaire: The OAB-q , 2002, Quality of Life Research.

[18]  Mark S. Cohen,et al.  Parametric Analysis of fMRI Data Using Linear Systems Methods , 1997, NeuroImage.

[19]  R W Cox,et al.  AFNI: software for analysis and visualization of functional magnetic resonance neuroimages. , 1996, Computers and biomedical research, an international journal.

[20]  W. El-Deiry,et al.  REVIEWS IN BASIC AND CLINICAL GASTROENTEROLOGY Neuroimaging of the Brain-Gut Axis: From Basic Understanding to Treatment of Functional GI Disorders , 2006 .