Brain activation during detrusor overactivity in patients with Parkinson's disease: a positron emission tomography study.
OBJECTIVE
Patients with Parkinson's disease often have urine storage symptoms, such as urinary urgency, frequency and incontinence, which are induced by detrusor overactivity. However, little is known of the mechanisms inducing detrusor overactivity in this disease. We have previously examined the human brain response to bladder filling in healthy male volunteers using positron emission tomography. We hypothesized that brain activation patterns in response to bladder filling would be different in patients with Parkinson's disease.


METHODS
Nine male patients with Parkinson's disease were catheterized via the urethra for bladder filling and intravesical pressure monitoring. We performed positron emission tomography, consisting of tasks 1 and 2. For task 1 the bladder was maintained empty via the urethral catheter. For task 2 room temperature water was dripped for bladder filling until the onset of detrusor overactivity. Data acquisition for task 2 was done during detrusor overactivity. Data on each scan were summed on a computer and further analyzed using a statistical parametric mapping procedure.


RESULTS
Significant brain activation during detrusor overactivity was found in the periaqueductal gray, supplementary motor area, cerebellar vermis, insula, putamen and thalamus. The most prominent activation was found in the cerebellum. The pons was not activated during detrusor overactivity.


CONCLUSIONS
Alteration in brain activation sites in response to bladder filling may be related to the pathophysiology of detrusor overactivity in patients with Parkinson's disease.
Kitta
Takeya
T
Department of Urology, Nuclear Medicine and Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. kitta@fb3.so-net.ne.jp
Kakizaki
Hidehiro
H
Furuno
Tsuyoshi
T
Moriya
Kimihiko
K
Tanaka
Hiroshi
H
Shiga
Tohru
T
Tamaki
Nagara
N
Yabe
Ichiro
I
Sasaki
Hidenao
H
Nonomura
Katsuya
K
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology*; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D049268:Positron-Emission Tomography; D001743:Urinary Bladder / Q000503:physiopathology