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Effects of pedunculopontine nucleus stimulation on human bladder function
Author(s) -
Roy Holly A.,
Pond Debbie,
Roy Christopher,
Forrow Beth,
Foltynie Thomas,
Zrinzo Ludvic,
Akram Harith,
Aziz Tipu Z.,
FitzGerald James J.,
Green Alexander L.
Publication year - 2018
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.23321
Subject(s) - urination , deep brain stimulation , pedunculopontine nucleus , medicine , stimulation , subthalamic nucleus , overactive bladder , urology , neuroscience , anesthesia , parkinson's disease , urinary system , anatomy , psychology , pathology , disease , alternative medicine
Aims The pedunculopontine nucleus (PPN) is a deep brain stimulation target for Parkinson's disease (PD). Unilateral PPN stimulation has been described in a previous case report to provoke urinary frequency, urgency and detrusor overactivity, due to probable activation of the pontine micturition center. Our aim was to evaluate the effect of bilateral PPN DBS on urodynamic parameters and to investigate the likely mechanisms using probabilistic tractography. Methods Six male PD subjects with bilateral PPN deep brain stimulators were recruited. Urodynamic bladder filling assessments were carried out with the stimulators ON and OFF. Two subjects also had diffusion‐weighted and T1‐weighted MRI scans performed and probabilistic tractography was carried out to describe white matter connections with the stimulated area. Results Five subjects completed urodynamic testing. PPN DBS did not give rise to detrusor overactivity or lower sensory thresholds during bladder filling. However, there was a significant increase in maximal bladder capacity with stimulation: mean bladder volume at maximal capacity was 199 mL (range 103‐440) ON stimulation compared with 131 mL (range 39‐230) OFF stimulation. Tractography demonstrated extensive connectivity to cortical and subcortical regions, some of which have been implicated in bladder control. Fiber pathways also passed close to the vicinity of the pontine micturition center. Conclusions Bilateral PPN DBS did not have a detrimental effect on urodynamic filling parameters or produce detrusor overactivity, but did slightly increase maximal capacity. Possible mechanisms include long‐range connectivity or local effects at the pontine micturition center.