Effect of thalamic deep brain stimulation on lower urinary tract function.
OBJECTIVE
The precise mechanisms underlying cerebral regulation of lower urinary tract function are still poorly understood. In patients with disabling essential tremor (ET) refractory to pharmacotherapy, thalamic deep brain stimulation (DBS) is an effective treatment for tremor control. Here, we evaluated the effect of thalamic DBS on urodynamic parameters in patients with ET.


METHODS
We investigated seven patients (two females, five males) with ET 15-85 mo after implantation of DBS leads into the ventral intermediate nucleus of the thalamus. We compared urodynamic parameters during thalamic DBS (ON state) and 30 min after turning the stimulator off (OFF state).


RESULTS
In the ON compared with the OFF state, there was a significant decrease in bladder volume at first desire to void (median, 218 ml vs. 365 ml, p=0.031), at strong desire to void (median, 305 ml vs. 435 ml, p=0.031), and at maximum cystometric capacity (median, 345 ml vs. 460 ml, p=0.016). No significant differences between the ON and OFF state were detected for changes in detrusor pressure during filling cystometry, bladder compliance, maximum detrusor pressure, detrusor pressure at maximum flow rate, maximum flow rate, voided volume, and postvoid residual.


CONCLUSIONS
Thalamic deep brain stimulation resulted in an earlier desire to void and decreased bladder capacity, suggesting a regulatory role of the thalamus in lower urinary tract function. Therefore, the thalamus may be a promising target for the development of new therapies for lower urinary tract dysfunction.
Department of Urology, University of Bern, Inselspital, Bern, Switzerland.
Thomas M
TM
Kessler
Fiona C
FC
Burkhard
Sebastian
S
Z'Brun
Alexander
A
Stibal
Urs E
UE
Studer
Christian W
CW
Hess
Alain
A
Kaelin-Lang
D000368:Aged; D000369:Aged, 80 and over; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D020329:Essential Tremor / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013788:Thalamus; D013997:Time Factors; D016896:Treatment Outcome; D053201:Urinary Bladder, Overactive / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014551:Urinary Tract / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology*