|Title / Titel||Reorganisation of cortical representation of somatic and autonomic brain areas related to bladder control in spinal cord injured patients|
|Abstract (PDF, 14 KB)|
|Summary / Zusammenfassung||Specific cerebral lesion have shown the crucial role of the brain in the control of micturition. The precise identification of the anatomical cerebral structures involved in micturition can contribute to a better understanding of the control of micturition and the development of therapeutic models. Various neuropathological and animal studies have referred to the medulla oblongata, pons, limbic system, superior frontal lobe and premotor cortical regions as areas implicate for micturition control. Uncoordinated voiding due to detrusor sphincter dyssynergia is commonly seen in spinal cord injured patients. The fact that detrusor sphincter dyssynergia is found only on patients with well defined neurological lesions of the spinal cord suggests that coordinated voiding is regulated by neurologic centres above the spinal cord. Until recently, the existence of a pontine micturition centre was proved only in animal studies. Recent positron emission tomography (PET) studies have demonstrated that the onset maintenance and coordination of micturition in healthy volunteers is associated with a vast network of cortical and subcortical regions, confirming observation from clinical and animal studies. Unfortunately, none of these studies have looked at the role of the peripheral afferent information on the supraspinal micturition centres.
Moreover, little is known on the cortical reorganisation of the brain areas involved in the micturition reflexes following a spinal cord injury. This is of relevance not only for a better understanding of the physiopathology of the neurogenic voiding disorders that occur after a spinal cord injury, but also to the development of specific therapeutic approaches, especially in patients with incomplete spinal cord lesions.
The purpose of our study will be:
1) to assess the brain areas related to control of micturition in healthy volunteers by stimulation of different afferent nerve fibres (somatic and autonomic) arising from the lower urinary tract,
2) to evaluate the extent of reorganisation of brain areas controlling micturition in patients with incomplete spinal cord injury,
3) to examine the effect of neuromodulation using chronic peripheral pudendal nerve stimulation on the brain areas involved in micturition in healthy volunteers and in patients with incomplete spinal cord injury.
|Project leadership and contacts /
Projektleitung und Kontakte
|Funding source(s) /
International Institute for Research in Paraplegia
|Duration of Project / Projektdauer||Jan 1999 to Jun 2006|