title: Subthalamic stimulation modulates cortical control of urinary bladder in Parkinson's disease.
abstract: 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.
authors.affiliation: Department of Neurology, Christian Albrechts University, Kiel, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Herzog
authors.forename: Peter H
authors.initials: PH
authors.lastname: Weiss
authors.forename: Ann
authors.initials: A
authors.lastname: Assmus
authors.forename: Björn
authors.initials: B
authors.lastname: Wefer
authors.forename: Christoph
authors.initials: C
authors.lastname: Seif
authors.forename: Peter M
authors.initials: PM
authors.lastname: Braun
authors.forename: Hans
authors.initials: H
authors.lastname: Herzog
authors.forename: Jens
authors.initials: J
authors.lastname: Volkmann
authors.forename: Günther
authors.initials: G
authors.lastname: Deuschl
authors.forename: Gereon R
authors.initials: GR
authors.lastname: Fink
mesh_terms: 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
chemical_list: D000978:Antiparkinson Agents