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Motor cortical neuromodulation of pelvic floor muscle tone: Potential implications for the treatment of urologic conditions
Author(s) -
Yani Moheb S.,
Fenske Sonja J.,
Rodriguez Larissa V.,
Kutch Jason J.
Publication year - 2019
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.24014
Subject(s) - sma* , transcranial magnetic stimulation , medicine , neuromodulation , supplementary motor area , pelvic floor , muscle tone , pelvic floor muscle , excitatory postsynaptic potential , electromyography , physical medicine and rehabilitation , inhibitory postsynaptic potential , neurostimulation , functional magnetic resonance imaging , stimulation , anatomy , radiology , mathematics , combinatorics
Aims In the human brain, supplementary motor area (SMA) is involved in the control of pelvic floor muscles (PFMs). SMA dysfunction has been implicated in several disorders involving PFMs, including urinary incontinence and urologic pain. Here, we aimed to provide a proof‐of‐concept study to demonstrate the feasibility of modulating resting PFM activity (tone) as well as SMA activity with noninvasive stimulation of SMA. Methods We studied six patients (3 women + 3 men) with Urologic Chronic Pelvic Pain Syndrome. Repetitive transcranial magnetic stimulation (rTMS) was applied to SMA immediately after voiding. We tested two rTMS protocols: high‐frequency (HF‐rTMS) which is generally excitatory, and low‐frequency (LF‐rTMS) which is generally inhibitory. PFM activity was measured during rTMS using electromyography. Brain activity was measured immediately before and after rTMS using functional magnetic resonance imaging. Results The rTMS protocols had significantly different effects on resting activity in PFMs ( P = 0.03): HF‐rTMS decreased and LF‐rTMS increased pelvic floor tone. SMA activity showed a clear trend ( P = 0.06) toward the expected differential changes: HF‐rTMS increased and LF‐rTMS decreased SMA activity. Conclusions We interpret the differential effects of rTMS at the brain and muscle level as novel support for an important inhibitory influence of SMA activity on pelvic floor tone after voiding. This preliminary study provides a framework for designing future studies to determine if neuromodulation of SMA could augment therapy for chronic urologic conditions.