Abnormal functional connectivity in women with urgency urinary incontinence: Can we predict disease presence and severity in individual women using Rs‐fcMRI/

Nardos, Rahel; Karstens, Lisa; Carpenter, Samuel D.; Aykes, Kamari; Krisky, Christine; Stevens, Corrine; Gregory, W. Thomas; Fair, Damien A.

doi:10.1002/nau.22767

Cited by 29 publications

(51 citation statements)

References 65 publications

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“…The fMRI portion of this study is based on prior work which found that women with UUI differ in brain activation on fMRI compared to controls [7,8, 9]. FMRI uses brain oxygen level dependent (BOLD) signal on brain imaging as an indicator of neuronal activity.…”

Section: Methodsmentioning

confidence: 99%

“…FMRI researchers commonly administer stimuli, or “tasks”, to elicit change in BOLD signal to compare differences between patients and controls [14]. UUI researchers have commonly used bladder filling as that task [7,8,14]. In addition to task oriented brain activation, specific brain regions also demonstrate similar fluctuations in BOLD signal over time that are intrinsic in nature [15].…”

Section: Methodsmentioning

confidence: 99%

“…Recently, brain imaging studies have reported differences in brain activity in patients with functional disorders, including those with IBS [5,6] and UUI [7,8,9], indicating existence of a brain-body connection. These findings raise the possibility that brain-body interventions may play a role in their treatment.…”

Section: Introductionmentioning

confidence: 99%

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Methodology for a trial of brain-centered versus anticholinergic therapy in women with urgency urinary incontinence

Komesu¹,

Rogers²,

Sapién³

et al. 2016

Int Urogynecol J

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Introduction This paper describes the rationale and methodology a study which investigates mind-body treatment versus pharmacotherapy for women with urgency urinary incontinence (UUI). To explore brain associations in UUI, a subset of patients will also undergo functional magnetic resonance imaging (fMRI). We hypothesize that hypnotherapy a mind-body intervention, will be at least as effective pharmacotherapy in treating UUI. We also hypothesize that fMRI findings will change following treatment, with changes potentially differing between groups. Methods The purpose of this manuscript is to recount the development and design challenges of a study evaluating the efficacy of hypnotherapy compared to conventional pharmacotherapy in UUI treatment. The study randomizes women to either of these treatments and outcome measures include bladder diaries and validated questionnaires. Sample size estimates, based on a non-inferiority test (alpha=.025, beta=0.20), after considering drop-out/loss to follow-up, indicated approximately 150 woman would be required to test the hypothesis that hypnotherapy is non-inferior to pharmacotherapy within a 5% non-inferiority margin. The study will also evaluate fMRI change in a subset of participants before and after therapy. Study challenges included designing a study with a mind-body therapy and a comparison treatment equally acceptable to participants, standardizing the interventions, confronting the reality that trials are time-consuming for participants and making appropriate accommodations. Results Study enrollment began March 2013 and is ongoing. Conclusions This manuscript details the design a of randomized controlled trial (RCT) comparing mind-body therapy to medications in treatment of UUI and describes the challenges encountered in its planning.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Methodology for a trial of brain-centered versus anticholinergic therapy in women with urgency urinary incontinence

Komesu¹,

Rogers²,

Sapién³

et al. 2016

Int Urogynecol J

View full text Add to dashboard Cite

show abstract

“…Only one prior work has addressed resting state functional connectivity in UUI, assessing connectivity in over 50 brain sites (seed points) in 16 participants with UUI. 16 That study successfully demonstrated numerous areas of connectivity, but did not attempt to relate connectivity to specific functional networks.…”

Section: Commentsmentioning

confidence: 99%

“…In order to accomplish this, as far as we know, we compared the largest cohort of UUI participants and comparably aged controls yet published. 16,17 …”

Section: Introductionmentioning

confidence: 99%

Urgency urinary incontinence and the interoceptive network: a functional magnetic resonance imaging study

Ketai

Komesu

Dodd

et al. 2016

American Journal of Obstetrics and Gynecology

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Background Treatment of urgency urinary incontinence has focused on pharmacologically treating detrusor overactivity. Recent recognition that altered perception of internal stimuli (interoception) plays a role in urgency urinary incontinence suggests that exploration of abnormalities of brain function in this disorder could lead to better understanding of urgency incontinence and its treatment. Objectives 1) To evaluate the relationship between bladder filling, perceived urgency and activation at brain sites within the interoceptive network in urgency urinary incontinence 2) To identify coactivation of other brain networks that could affect interoception during bladder filling in urgency incontinence 3) To demonstrate interaction between these sites prior to bladder filling by evaluating their resting state connectivity Study Design We performed an observational cohort study using functional magnetic resonance imaging to compare brain function in 53 women with urgency urinary incontinence and 20 Controls. Whole-brain voxel-wise ANCOVAs were performed to examine differences in functional brain activation between groups during a task consisting of bladder filling, hold (static volume) and withdrawal phases. The task was performed at three previously established levels of baseline bladder volume, the highest exceeding strong desire to void volume. All women continuously rated their urge on a 0–10 point Likert scale throughout the task and a mixed measures ANOVA was used to test for differences in urge ratings. Empirically derived regions of interest from analysis of activation during the task were used as seeds for examining group differences in resting state functional connectivity. Results In both urgency urinary incontinent participants and Controls changes in urge ratings were greatest during bladder filling initiated from a high baseline bladder volume and urgency incontinent participants’ rating changes were greater than Controls. During this bladder filling phase urgency incontinent participant’s activation of the interoceptive network was greater than Controls, including in the left insula and the anterior and middle cingulate cortex. Urgency Incontinent Participant’s activation was also greater than Controls at sites in the Ventral Attention Network and Posterior Default Mode Network. Urgency incontinent participant’s connectivity was greater than Controls between a middle cingulate seed point and the Dorsal Attention Network, a “top down” attentional network. Control connectivity was greater between the mid-cingulate seed point and the Ventral Attention Network, a “bottom up” attentional network, Conclusions Increasing urge was associated with greater urgency incontinent participant than Control activation of the interoceptive network and activation in networks that are determinants of self-awareness (Default Mode Network) and of response to unexpected external stimuli (Ventral Attention Network). Differences in connectivity between interoceptive networks and opposing attentional networks (Ventra...

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Classification of multiple sclerosis women with voiding dysfunction using machine learning: Is functional connectivity or structural connectivity a better predictor?

Tran¹,

Salazar

Boone

et al. 2023

BJUI Compass

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Introduction: Machine learning (ML) is an established technique that uses sets of training data to develop algorithms and perform data classification without using human intervention/supervision. This study aims to determine how functional and anatomical brain connectivity (FC and SC) data can be used to classify voiding dysfunction (VD) in female MS patients using ML. Methods: Twenty-seven ambulatory MS individuals with lower urinary tract dysfunction were recruited and divided into two groups (Group 1: voiders [V, n = 14]; Group 2: VD [n = 13]). All patients underwent concurrent functional MRI/urodynamics testing.Results: Best-performing ML algorithms, with highest area under the curve (AUC), were partial least squares (PLS, AUC = 0.86) using FC alone and random forest (RF) when using SC alone (AUC = 0.93) and combined (AUC = 0.96) as inputs. Our results show 10 predictors with the highest AUC values were associated with FC, indicating that although white matter was affected, new connections may have formed to preserve voiding initiation.Conclusions: MS patients with and without VD exhibit distinct brain connectivity patterns when performing a voiding task. Our results demonstrate FC (grey matter) is of higher importance than SC (white matter) for this classification. Knowledge of these centres may help us further phenotype patients to appropriate centrally focused treatments in the future.

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Abnormal functional connectivity in women with urgency urinary incontinence: Can we predict disease presence and severity in individual women using Rs‐fcMRI/

Cited by 29 publications

References 65 publications

Methodology for a trial of brain-centered versus anticholinergic therapy in women with urgency urinary incontinence

Methodology for a trial of brain-centered versus anticholinergic therapy in women with urgency urinary incontinence

Urgency urinary incontinence and the interoceptive network: a functional magnetic resonance imaging study

Classification of multiple sclerosis women with voiding dysfunction using machine learning: Is functional connectivity or structural connectivity a better predictor?

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