Urgency urinary incontinence and the interoceptive network: a functional magnetic resonance imaging study.
Urgency urinary incontinence and the interoceptive network: a functional magnetic resonance imaging study.
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DOI：
10.1016/j.ajog.2016.04.056
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发表时间：
2016-10
影响因子：
9.8
通讯作者：
Mayer AR
中科院分区：
文献类型：
--
作者：
Ketai LH;Komesu YM;Dodd AB;Rogers RG;Ling JM;Mayer AR
急迫性尿失禁的治疗主要集中在逼尿肌过度活动的治疗上。最近认识到，改变感知的内部刺激（interoception）起着重要作用，在紧迫性尿失禁表明，探索这种疾病的大脑功能异常可能会导致更好地了解紧迫性尿失禁及其治疗。1)为了评价膀胱充盈、紧迫性尿失禁中内感受网络内的感知紧迫性和大脑部位的激活2）为了识别在紧迫性尿失禁中膀胱充盈期间可能影响内感受的其他大脑网络的共激活3）为了通过评估这些部位的静息状态连接来证明膀胱充盈前这些部位之间的相互作用，我们使用功能性磁共振成像比较了53名患有紧迫性尿失禁的女性和20名对照组的脑功能。进行全脑体素ANCOVA以检查在由膀胱充盈、保持（静态容量）和撤回阶段组成的任务期间组间功能性脑激活的差异。该任务在三个先前建立的基线膀胱容量水平下进行，最高超过强烈的排尿量需求。在整个任务中，所有女性都在0-10分的Likert量表上连续评定她们的冲动，并使用混合测量ANOVA来测试冲动评级的差异。经验推导出的区域的兴趣从分析的激活过程中的任务被用作种子检查组的差异，在静息状态下的功能连接。在尿急性尿失禁参与者和对照组中，在从高基线膀胱容量开始的膀胱充盈期间，急迫性评级的变化最大，并且尿急性尿失禁参与者的评级变化大于对照组。在这个膀胱充盈阶段，尿急失禁参与者的内感受网络的激活大于对照组，包括左前扣带皮层和前扣带皮层和中扣带皮层。急迫性失禁参与者的激活也大于控制在大脑注意力网络和后默认模式网络的网站。急迫性失禁参与者的连接性大于控制之间的中间扣带种子点和背侧注意力网络，一个“自上而下”的注意力网络。控制连接之间的中间扣带种子点和大脑注意网络，一个“自下而上”的注意网络，增加的冲动与更大的紧迫性失禁参与者比控制激活的内感受网络和激活的网络，是自我意识的决定因素（默认模式网络）和对意外的外部刺激的反应（大脑注意网络）。甚至在膀胱充盈之前（在静息状态下），内感受性网络和相对的注意力网络之间的连接性差异（双侧注意力网络与背部注意力网络）就存在。这些研究结果是一个强有力的证据，中枢神经系统组成的紧迫性尿失禁，可以介导的大脑定向治疗。
Treatment of urgency urinary incontinence has focused on pharmacologically treating detrusor overactivity. Recent recognition that altered perception of internal stimuli (interoception) plays a role in urgency urinary incontinence suggests that exploration of abnormalities of brain function in this disorder could lead to better understanding of urgency incontinence and its treatment. 1) To evaluate the relationship between bladder filling, perceived urgency and activation at brain sites within the interoceptive network in urgency urinary incontinence 2) To identify coactivation of other brain networks that could affect interoception during bladder filling in urgency incontinence 3) To demonstrate interaction between these sites prior to bladder filling by evaluating their resting state connectivity We performed an observational cohort study using functional magnetic resonance imaging to compare brain function in 53 women with urgency urinary incontinence and 20 Controls. Whole-brain voxel-wise ANCOVAs were performed to examine differences in functional brain activation between groups during a task consisting of bladder filling, hold (static volume) and withdrawal phases. The task was performed at three previously established levels of baseline bladder volume, the highest exceeding strong desire to void volume. All women continuously rated their urge on a 0–10 point Likert scale throughout the task and a mixed measures ANOVA was used to test for differences in urge ratings. Empirically derived regions of interest from analysis of activation during the task were used as seeds for examining group differences in resting state functional connectivity. In both urgency urinary incontinent participants and Controls changes in urge ratings were greatest during bladder filling initiated from a high baseline bladder volume and urgency incontinent participants’ rating changes were greater than Controls. During this bladder filling phase urgency incontinent participant’s activation of the interoceptive network was greater than Controls, including in the left insula and the anterior and middle cingulate cortex. Urgency Incontinent Participant’s activation was also greater than Controls at sites in the Ventral Attention Network and Posterior Default Mode Network. Urgency incontinent participant’s connectivity was greater than Controls between a middle cingulate seed point and the Dorsal Attention Network, a “top down” attentional network. Control connectivity was greater between the mid-cingulate seed point and the Ventral Attention Network, a “bottom up” attentional network, Increasing urge was associated with greater urgency incontinent participant than Control activation of the interoceptive network and activation in networks that are determinants of self-awareness (Default Mode Network) and of response to unexpected external stimuli (Ventral Attention Network). Differences in connectivity between interoceptive networks and opposing attentional networks (Ventral Attention Network versus Dorsal Attention Network) were present even before bladder filling (in the resting state). These findings are strong evidence for a central nervous system component of urgency urinary incontinence that could be mediated by brain directed therapies.
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DOI：
10.1177/1073858411403316
发表时间：
2012-06
期刊：
The Neuroscientist : a review journal bringing neurobiology, neurology and psychiatry
影响因子：
--
作者：
Andrews-Hanna JR
通讯作者：
Andrews-Hanna JR
影响因子：
3.7
作者：
Pujol J;López-Solà M;Ortiz H;Vilanova JC;Harrison BJ;Yücel M;Soriano-Mas C;Cardoner N;Deus J
通讯作者：
Deus J
影响因子：
5.7
作者：
Bzdok D;Heeger A;Langner R;Laird AR;Fox PT;Palomero-Gallagher N;Vogt BA;Zilles K;Eickhoff SB
通讯作者：
Eickhoff SB
影响因子：
5.7
作者：
Labus, Jennifer S.;Naliboff, Bruce D.;Berman, Steve M.;Suyenobu, Brandall;Vianna, Eduardo P.;Tillisch, Kirsten;Mayer, Emeran A.
通讯作者：
Mayer, Emeran A.
影响因子：
--
作者：
Cheng Y;Mansfield KJ;Allen W;Chess-Williams R;Burcher E;Moore KH
通讯作者：
Moore KH