Functional imaging of structures involved in neural control of the lower urinary tract.
Functional imaging of structures involved in neural control of the lower urinary tract.
复制标题
DOI：
10.1016/b978-0-444-63247-0.00007-9
复制
发表时间：
2015-01-01
影响因子：
--
通讯作者：
Griffiths, Derek
中科院分区：
文献类型：
--
作者：
Griffiths, Derek
最近的功能性脑成像研究，建立在早期的观察，提出了一个工作模式的大脑控制下尿路。它包括几个脑神经回路，在存储阶段，作用于中脑导水管周围灰质，以抑制长环，脊髓延髓排尿反射，从而促进排尿。回路1集中在内侧前额叶皮层，似乎与排尿和排尿的有意识控制有关。回路2集中在背侧前扣带（中扣带）和辅助运动区，与膀胱控制的情感方面有关：排尿或急迫的欲望，伴随尿道括约肌激活以延迟泄漏。皮层下回路3的研究较少。电路1是双侧的，具有右侧偏好。关于控制网络连通性的零散研究表明，白质损伤可能导致尿失禁。一些研究证实，孤立的大脑病变，如果在内侧前额叶皮层或其连接途径，可能会导致失禁。其他神经系统疾病（正常压力脑积水，帕金森病和多系统萎缩）的下尿路功能障碍似乎与工作模型一致，甚至脊髓或外周病变也有中枢效应。然而，这个模型忽略了在一些成像研究中已经观察到的大脑区域的贡献，因此肯定是过于简化了。
Recent functional brain imaging studies, building on earlier observations, suggest a working model of brain control of the lower urinary tract. It comprises a few cerebral neural circuits that, during the storage phase, act on the midbrain periaqueductal gray to inhibit the long-loop, spinobulbospinal voiding reflex, thus promoting continence. Circuit 1, centered on the medial prefrontal cortex, appears to be concerned with conscious control of both continence and voiding. Circuit 2, centered on the dorsal anterior cingulate (midcingulate) and supplementary motor area, is concerned with emotional aspects of bladder control: desire to void or urgency with concomitant urethral sphincter activation to delay leakage. A subcortical circuit 3 has been less well studied. Circuit 1 is bilateral with a right-sided preference. Scattered studies of the connectivity of the control network suggest that white-matter damage may contribute to urinary incontinence. A few studies confirm that isolated cerebral lesions, if in the medial prefrontal cortex or its connecting pathways, may lead to incontinence. Lower urinary tract dysfunction in other neurologic diseases (normal-pressure hydrocephalus, Parkinson's disease, and multiple systems atrophy) appears consistent with the working model, and even spinal or peripheral lesions have central effects. However, this model omits the contributions of brain regions already observed in some imaging studies and therefore is certainly oversimplified.