Brain control of normal and overactive bladder
Brain control of normal and overactive bladder
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DOI：
10.1097/01.ju.0000177450.34451.97
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发表时间：
2005-11-01
影响因子：
6.6
通讯作者：
Resnick, N
中科院分区：
文献类型：
--
作者：
Griffiths, D;Derbyshire, S;Resnick, N
目的：膀胱控制问题很常见，但其原因往往不清楚。许多研究人员都在下泌尿道寻找原因，但在脊髓上控制系统中寻找的原因较少。我们使用功能磁共振成像 (fMRI) 来确定膀胱控制正常和膀胱控制不良（逼尿肌过度活动）受试者对膀胱充盈的大脑反应。材料和方法：记录了 1 名男性和 11 名女性对膀胱输注的大脑反应，这些受试者没有明显的神经系统异常，年龄为 26 至 83 岁。六名患者的膀胱控制良好，六名患者之前的尿动力学控制不佳。在反复向膀胱注入和抽出液体并监测膀胱内压力的同时进行功能磁共振成像。对小膀胱和大膀胱体积进行了测量。结果：功能磁共振成像检测到许多参与膀胱控制的大脑区域的激活，包括导水管周围灰质、丘脑、岛叶、背侧前扣带回和腹内侧小脑。亚组分析中可见眶额皮质、脑桥排尿中枢和视前下丘脑。激活超过了失活，并且在大膀胱体积下反应变得更强。在控制良好的受试者中，这种反应的加强在眶额皮质中最为突出。在那些控制能力较差的人中，膀胱体积较大时，皮质反应会被夸大，但眶额皮质除外，该皮质反应仍处于微弱激活状态。这种差异不是由于同时逼尿肌活动造成的。结论：膀胱控制不良与眶额皮质激活不足特别相关。临床上，额叶皮质病变会导致膀胱控制问题。这项研究表明，在没有明显神经损伤的情况下，膀胱控制不良也有类似的神经生理学基础。
Purpose: Bladder control problems are common but their cause is often unclear. Many investigators have sought causes in the lower urinary tract, but fewer in the supraspinal control system. We have used functional magnetic resonance imaging (fMRI) to determine brain responses to bladder filling in subjects with normal and with poor bladder control (detrusor overactivity).Materials and Methods: Cerebral responses to bladder infusion were recorded in 1 male and 11 females without overt neurological abnormality, aged 26 to 83 years. Six had good bladder control and 6 had poor control on prior urodynamics. fMRI was performed while repeatedly infusing and withdrawing liquid into and out of the bladder, and monitoring intravesical pressure. Measurements were made at small and large bladder volumes.Results: fMRI detected activation of many brain regions involved in bladder control, including periaqueductal gray, thalamus, insula, dorsal anterior cingulate, and ventromedial cerebellum. Orbitofrontal cortex, pontine micturition center and preoptic hypothalamus were visible in subgroup analyses. Activations outweighed deactivations and responses became stronger at large bladder volumes. Among subjects with good control, this strengthening of response was prominent in the orbitofrontal cortex. Among those with poor control cortical responses were exaggerated at larger bladder volumes, except in the orbitofrontal cortex, which remained weakly activated. This difference was not due to concurrent detrusor activity.Conclusions: Poor bladder control is specifically associated with inadequate activation of orbitofrontal cortex. Clinically, frontal cortical lesions cause bladder control problems. This study suggests a similar neurophysiological basis for poor bladder control in the absence of overt neurological lesion.