Motor Cortical Representation of the Pelvic Floor Muscles
Motor Cortical Representation of the Pelvic Floor Muscles
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DOI：
10.1016/j.juro.2011.03.001
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发表时间：
2011-07-01
影响因子：
6.6
通讯作者：
Kuhtz-Buschbeck, J. P.
中科院分区：
文献类型：
--
作者：
Schrum, A.;Wolff, S.;Kuhtz-Buschbeck, J. P.
目的：骨盆底肌肉训练包括尿道外括约肌和辅助骨盆底肌肉的有节奏的自主收缩。这些肌肉在运动皮层的代表还没有被精确和明确地定位。我们使用功能性磁共振成像，以确定大脑活动缓慢和快速骨盆底contractions.Materials和方法：大脑反应记录在17名健康男性志愿者，21至47岁，正常膀胱控制。功能性磁共振成像进行了节拍器起搏缓慢（0.25赫兹）和快速（0.7赫兹）的盆底收缩，模仿排尿中断。要研究的躯体解剖学的皮质表示，屈曲伸展运动的右脚趾进行作为对照task.Results：功能磁共振成像在盆底收缩检测活动的补充运动区的内侧壁和中扣带回皮质，丘脑，后顶叶皮质，壳核，丘脑，小脑蚓部和上腹侧脑桥。慢收缩和快收缩之间的激活没有显著差异。足趾运动所涉及的中央旁小叶（即内侧初级运动皮层）的活动明显强于盆底收缩。结论：盆底肌的运动皮层代表区主要位于辅助运动区，而下肢肌的运动皮层代表区主要位于辅助运动区。它比远端腿部肌肉的代表更向腹侧和前侧延伸。
Purpose: Pelvic floor muscle training involves rhythmical voluntary contractions of the external urethral sphincter and ancillary pelvic floor muscles. The representation of these muscles in the motor cortex has not been located precisely and unambiguously. We used functional magnetic resonance imaging to determine brain activity during slow and fast pelvic floor contractions.Materials and Methods: Cerebral responses were recorded in 17 healthy male volunteers, 21 to 47 years old, with normal bladder control. Functional magnetic resonance imaging was performed during metronome paced slow (0.25 Hertz) and fast (0.7 Hertz) contractions of the pelvic floor that mimicked the interruption of voiding. To study the somatotopy of the cortical representations, flexion-extension movements of the right toes were performed as a control task.Results: Functional magnetic resonance imaging during pelvic floor contractions detected activity of the supplementary motor area in the medial wall and of the midcingulate cortex, insula, posterior parietal cortex, putamen, thalamus, cerebellar vermis and upper ventral pons. There were no significant differences in activation between slow and fast contractions. Toe movements involved significantly stronger activity of the paracentral lobule (ie the medial primary motor cortex) than did the pelvic floor contractions. Otherwise the areas active during pelvic floor and leg muscle contractions overlapped considerably.Conclusions: The motor cortical representation of pelvic floor muscles is located mostly in the supplementary motor area. It extends further ventrally and anteriorly than the representation of distal leg muscles.