Sensorimotor impairments in men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome: relationship of resting state brain activity to pelvic floor muscle activation

慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)是一种常见且经常使人虚弱的疾病。这个 CP/CPPS的根本原因尚不清楚。我们最近发表了第一项神经成像研究 比较慢性阻塞性肺疾病/慢性阻塞性肺病患者与健康男性。我们发现，最重要的是，功能连接 在激活盆底肌肉的大脑运动区和右侧的内脏感觉区之间 与健康男性相比，CP/CPPS患者的后脑岛显著减少。此之前的工作 建议理解这种感觉运动的功能联系，我们称之为骨盆运动/右- 后岛叶功能连接可能是理解CP/CPPS病理生理学的关键。 然而，我们仍然不能从根本上了解静息的大脑功能如何影响主动感觉运动控制。 在拟议的工作中，我们的目标是通过将骨盆运动/右后岛功能联系起来来填补这一知识空白。 在自愿激活非盆底肌肉的过程中与盆底肌肉自动激活的连接性 患有和不患有CP/CPPS的男性。我们将招募52名患有CP/CPPS的男性和52名健康男性。在每个参与者中， 我们将使用静息状态功能磁共振成像(RS-fMRI)来量化骨盆运动/右- 后岛功能连接，表面肌电定量盆底肌肉的自动激活 自愿臀肌激活，并用问卷量化CP/CPPS疼痛强度。RS-fMRI、肌电和 分析疼痛措施的目的有以下几点。在目标1中，我们将研究 并确定盆腔运动/右后岛功能连通性是否与 非盆腔自主激活时盆底肌肉自动激活的幅度增加 脚底肌肉。在目标2中，我们将比较健康的男性和患有CP/CPPS的男性，我们已经证明他们有 与健康人相比，静息状态下骨盆运动/右后岛功能连接性的价值降低 男性对照。我们将确定患有CP/CPPS的男性是否表现出相应的增加幅度 在自愿激活臀大肌的过程中，盆底肌肉自动激活，如果 盆底肌肉的自动激活程度与CP/CPPS疼痛的强度相关。这 据我们所知，这项工作代表了第一个将静息的大脑功能与自动的大小联系起来的研究 运动过程中肌肉的激活。这项工作也是第一个提出测试特定机制的研究。 CP/CPPS患者盆底肌肉控制改变。我们之前的工作定义了感兴趣的大脑连接 在患有CP/CPPS的男性。我们提议的工作将确定这种大脑连接是否与改变有关 移动控制。我们未来的工作将能够检查修改移动控制作为一种方法 CP/CPPS患者恢复正常脑功能。

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and often debilitating condition. The underlying cause of CP/CPPS remains unknown. We recently published the first neuroimaging study comparing men with CP/CPPS to healthy men. We found that, most importantly, the functional connectivity between a brain motor region that activates pelvic floor muscles and a viscerosensory region in the right posterior insula was significantly reduced in men with CP/CPPS compared to healthy men. This prior work suggests that understanding this sensorimotor functional connection, which we term pelvic-motor/right- posterior-insula functional connectivity, may be critical to understanding the pathophysiology of CP/CPPS. However, we still do not fundamentally know how resting brain function influences active sensorimotor control. In the proposed work, we aim to fill this knowledge gap by relating pelvic-motor/right-posterior-insula functional connectivity to automatic pelvic floor muscle activation during voluntary activation of non-pelvic floor muscles in men with and without CP/CPPS. We will recruit 52 men with CP/CPPS and 52 healthy men. In each participant, we will use resting-state functional Magnetic Resonance Imaging (rs-fMRI) to quantify pelvic-motor/right- posterior-insula functional connectivity, surface EMG to quantify automatic pelvic floor muscle activation during voluntary gluteal muscle activation, and questionnaires to quantify CP/CPPS pain intensity. rs-fMRI, EMG, and pain measures will be analyzed with the following Aims. In Aim 1, we will study inter-individual differences in men and determine if reduced pelvic-motor/right-posterior-insula functional connectivity correlates with increases in the magnitude of automatic pelvic floor muscle activation during voluntary activation of non-pelvic floor muscles. In Aim 2, we will compare healthy men and men with CP/CPPS, whom we have shown to have a reduced value of resting state pelvic-motor/right-posterior-insula functional connectivity compared to healthy male controls. We will determine if men with CP/CPPS show corresponding increases in the magnitude of automatic pelvic floor muscle activation during voluntary activation of the gluteus maximus muscle, and if the magnitude of automatic pelvic floor muscle activation is correlated with the intensity of CP/CPPS pain. This work, to our knowledge, represents the first study relating resting brain function to the magnitude of automatic muscle activation during movement. This work is also the first study proposing to test a specific mechanism of altered pelvic floor muscle control in men with CP/CPPS. Our prior work defined a brain connection of interest in men with CP/CPPS. Our proposed work will determine if this brain connection is related to altered movement control. Our future work will be able to then examine modifying movement control as an approach to restoring normal brain function in men with CP/CPPS.