Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions.
Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions.
复制标题
盆底肌张力的运动皮质神经调节：对泌尿系统疾病治疗的潜在影响。
DOI：
10.1002/nau.24014
复制
发表时间：
2019
影响因子：
2
通讯作者：
Kutch,JasonJ
中科院分区：
文献类型：
--
作者：
Yani,MohebS;Fenske,SonjaJ;Rodriguez,LarissaV;Kutch,JasonJ
目的在人脑中，辅助运动区（SMA）参与控制骨盆底肌肉（PFMs）。SMA功能障碍与几种涉及PFM的疾病有关，包括尿失禁和泌尿系统疼痛。在这里，我们的目的是提供一个概念验证的研究，以证明调节静息PFM活动（音）以及SMA活动与非侵入性刺激的SMA.MethodsWe研究了6例患者（3名女性+ 3名男性）泌尿系慢性盆腔疼痛综合征的可行性。排尿后立即对SMA进行重复经颅磁刺激（rTMS）。我们测试了两种rTMS方案：高频（HF-rTMS）通常是兴奋性的，低频（LF-rTMS）通常是抑制性的。在rTMS期间使用肌电图测量PFM活动。使用功能磁共振imaging.ResultsThe rTMS协议有显着不同的影响静息活动在PFMs（P= 0.03）：HF-rTMS降低和LF-rTMS增加骨盆底张力之前和之后立即测量脑活动。SMA活性表现出明显的趋势（P= 0.06）对预期的差异变化：HF-rTMS增加和LF-rTMS减少SMA activity.ConclusionsWe解释的差异效应rTMS在大脑和肌肉水平作为新的支持SMA活动对盆底张力排尿后的重要抑制影响。这项初步研究为设计未来的研究提供了一个框架，以确定SMA的神经调节是否可以增强慢性泌尿系统疾病的治疗。
AimsIn the human brain, supplementary motor area (SMA) is involved in the control of pelvic floor muscles (PFMs). SMA dysfunction has been implicated in several disorders involving PFMs, including urinary incontinence and urologic pain. Here, we aimed to provide a proof‐of‐concept study to demonstrate the feasibility of modulating resting PFM activity (tone) as well as SMA activity with noninvasive stimulation of SMA.MethodsWe studied six patients (3 women + 3 men) with Urologic Chronic Pelvic Pain Syndrome. Repetitive transcranial magnetic stimulation (rTMS) was applied to SMA immediately after voiding. We tested two rTMS protocols: high‐frequency (HF‐rTMS) which is generally excitatory, and low‐frequency (LF‐rTMS) which is generally inhibitory. PFM activity was measured during rTMS using electromyography. Brain activity was measured immediately before and after rTMS using functional magnetic resonance imaging.ResultsThe rTMS protocols had significantly different effects on resting activity in PFMs (P= 0.03): HF‐rTMS decreased and LF‐rTMS increased pelvic floor tone. SMA activity showed a clear trend (P= 0.06) toward the expected differential changes: HF‐rTMS increased and LF‐rTMS decreased SMA activity.ConclusionsWe interpret the differential effects of rTMS at the brain and muscle level as novel support for an important inhibitory influence of SMA activity on pelvic floor tone after voiding. This preliminary study provides a framework for designing future studies to determine if neuromodulation of SMA could augment therapy for chronic urologic conditions.