Subthalamic stimulation modulates cortical control of urinary bladder in Parkinson's disease.
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective therapy for off-period motor symptoms and dyskinesias in advanced Parkinson's disease. Clinical studies have shown that STN-DBS also ameliorates urinary bladder function in Parkinson's disease patients by delaying the first desire to void and increasing bladder capacity. This study aimed at investigating the effect of STN-DBS on the neural mechanisms underlying cerebral bladder control. Using PET to measure changes in regional cerebral blood flow (rCBF), 11 patients with bilateral STN-DBS were studied during urodynamic bladder filling in STN-DBS ON and OFF condition. A filled bladder led to a significant increase of rCBF in the anterior cingulate cortex, which was further enhanced during STN-DBS OFF. A significant interaction between bladder state and STN-DBS was observed in lateral frontal cortex with increased rCBF when the bladder was filled during STN-DBS OFF. The data suggest that STN-DBS ameliorates bladder dysfunction and that this modulation may result from facilitated processing of afferent bladder information.
Herzog
Jan
J
Department of Neurology, Christian Albrechts University, Kiel, Germany.
Weiss
Peter H
PH
Assmus
Ann
A
Wefer
Björn
B
Seif
Christoph
C
Braun
Peter M
PM
Herzog
Hans
H
Volkmann
Jens
J
Deuschl
Günther
G
Fink
Gereon R
GR
D000328:Adult; D000368:Aged; D000978:Antiparkinson Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000503:physiopathology; D002540:Cerebral Cortex / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology; D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D049268:Positron-Emission Tomography / Q000379:methods; D020531:Subthalamic Nucleus / Q000503:physiopathology*; D001743:Urinary Bladder / Q000503:physiopathology*; D014554:Urination / Q000502:physiology; D014563:Urodynamics / Q000502:physiology
D000978:Antiparkinson Agents