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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 盧令一 | 年長女性膀胱過動症併有禁尿功能不良者之大腦活動 | 2012/8/30 上午 09:33:55 | 0 |
| 原 文 | 題 目 | Brain activity underlying impaired continence control in older women with overactive bladder |
| 作 者 | Stasa D. Tadic*, Derek Griffiths, Werner Schaefer, Andrew Murrin, Becky Clarkson, Neil M. Resnick | |
| 出 處 | Neurourol. Urodynam. 31:652–658 | |
| 出版日期 | Jun, 2012 | |
| 評 論 |
功能性磁振造影（fMRI）的出現，無疑的對於大腦活動的研究帶來了突破性的進展。過去對大腦控制排尿的了解只到橋腦（pons）為止；近十年來，藉由fMRI對於大腦控制排尿的區域有了前所未有的了解，尤其是橋腦以上（suprapontine）的區域，例如大腦導水管旁的灰質（periductal gray,PAG）、海馬迴附近（parahippocampal compex, PH）、某些運動區（supplementary motor area, SMA），以及額葉皮質（prefrontal cortex, PFC）其實都是腦部控尿網路的一部分。 部份膀胱過動症（OAB）的病患可以藉由尿動力檢查發現確實有逼尿肌過動（detrusor overactivity, DO）的現象，但是更多病患卻無法藉由尿動力檢查時發現逼尿肌過動，臨床上，有DO的患者病情也被認為較沒有DO者嚴重。匹茲堡大學團隊針對這個問題，提出了以下假設：「有急尿併有可測得之逼尿肌過動者，腦部負責禁尿的區域（SMA）活動會比測不到逼尿肌過動者要少，而刺激排尿的區域（PFC & PH）活動會比測不到逼尿肌過動者為高」，再登報徵求30位60歲以上膀胱過動症女性病患，嘗試利用fMRI及尿動力檢查證實有DO（n=9）與沒有DO者（n=21）大腦活動是否有差異。結果顯示有DO的病患不僅在自訴尿急程度比較嚴重、尿動力檢查膀胱容量較小、fMRI也顯示在急尿時SMA的活動反而要比沒有DO的病患強（SMA負責控制外括約肌及骨盆底肌，表示有DO者會自發代償性的企圖藉收縮外括約肌及骨盆底肌來達到禁尿的目的，此結果表示當初的假設有誤），而刺激排尿的區域只有PH活動較強，PFC並無特殊差異（此結果表示當初的假設只對了一半，可能與受測者年紀較大，部分大腦白質已經有退化的現象有關）。 長久以來一直有人質疑尿動力檢查的角色及必要性，原因主要是尿動力檢查經常無法完全呈現病人的真實情況，相信未來在fMRI的幫忙之下，可以針對尿動力檢查力有未逮之處，讓醫師及研究人員對控尿網絡有更清楚的了解。 |
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| abstract |
Aims To identify, in subjects with overactive bladder (OAB), differences in brain activity between those who maintained and those who lost bladder control during functional magnetic resonance imaging (fMRI) of the brain with simultaneous urodynamics. Methods Secondary analysis of a cohort of older women (aged >60) with proven urgency urinary incontinence, who, in the scanner, either developed detrusor overactivity and incontinence (the “DO group”) or did not (the “no DO” group). A priori hypothesis: during urgency provoked by bladder filling, without DO, activity in regions related to continence control is diminished in the DO group; specifically (1a) less activation in supplementary motor area (SMA) and (1b) less deactivation in prefrontal cortex (PFC) and parahippocampal complex (PH). We also explored phenotypic (clinical and urodynamic) differences between the groups. Results During urgency preceding DO, the DO group showed stronger activation in SMA and adjacent regions (hypothesis 1a rejected), and less deactivation in PH but no significant difference in PFC (hypothesis 1b partially accepted). These subjects were older, with more changes in brains white matter, decreased tolerance of bladder filling and greater burden of incontinence. Conclusions (1) In older women with OAB, brain activity in the SMA is greater among those with more easily elicitable DO, suggesting a compensatory response to failure of control else. (2) OAB is heterogeneous; one possible phenotype shows severe functional impairment attributable partly to age-related white matter changes. (3) Functional brain imaging coupled with urodynamics may provide CNS markers of impaired continence control in subjects with OAB. |
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