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發表人 | 討論主題 | 發表時間 | 討論數 |
顧明軒 | 前導性研究-使用非侵入性、個別化設計的經顱刺激裝置調節腦皮質功能,治療女性多發性硬化症相關之排尿障礙 | 2022/4/7 上午 10:41:53 | 0 |
原 文 | 題 目 | Noninvasive, Individualized Cortical Modulation Using Transcranial Rotating Permanent Magnet Stimulator for Voiding Dysfunction in Women with Multiple Sclerosis: A Pilot Trial |
作 者 | Rose Khavari, Khue Tran, Santosh A. Helekar et al. | |
出 處 | The Journal of urology, (2021) 10-1097. | |
出版日期 | March, 2022 | |
評 論 |
多發性硬化症為慢性中樞神經病變,在中樞神經系統任何位置發生去髓鞘變化,進而影響神經功能。症狀多樣,若併發排尿障礙,可能原因為膀胱功能低下,或尿道括約肌張力過強所致。傳統治療是以置放導尿管或間歇性導尿為主,但由於多發性硬化症亦容易影響肢體活動,間歇性導尿困難執行,發展新治療方式有其需要。此篇研究便是探討藉由經顱刺激裝置,調整腦部與排尿功能相關區域功能,進而改善多發性硬化症相關之排尿障礙。
此為一前導性研究,目的是探討經顱刺激裝置對於改善排尿障礙功能之效果與安全性。挑選女性病患是因男性除膀胱功能、骨盆肌肉張力等因素外,尚需考量攝護腺肥大等問題,故先以女性病患研究。 總共10位女性多發性硬化症患者進入試驗。患者首先進行功能性腦部核磁共振檢查,並同時於核磁共振檢查時,進行尿路動力檢查,當膀胱經導管灌水脹至有急尿感時,請病患解尿並同時進行腦功能性核磁共振檢查,了解啟動排尿的腦區域功能是否異常。 經顱刺激裝置為非侵入性治療,治療時病患將配戴量身設計的帽型經顱刺激裝置,此裝置可影響腦部2公分深度之區域,藉由磁場變化,可刺激或抑制腦部目標區域功能,本研究目標是藉由裝置刺激腦部啟動排尿相關區域,並抑制腦皮質控制骨盆底肌肉收縮區域功能,進而改善病患之排尿症狀。病患須於兩週內,接受10天、每次40分鐘的經顱刺激治療,並在治療後與完成治療4個月後,接受尿流速、小便後殘尿評估及問卷檢查。 安全性而言,此試驗沒有病患在接受經顱刺激治療後發生不良反應或安全性問題。 治療後與治療前比較,腦功能性核磁共振可發現腦部分與排尿相關之區域確有功能上的變化。比較小便後殘尿量、排尿問卷分數,亦可見具統計顯著性之改善程度。但追蹤四個月後再與治療前狀況比較,殘尿量接近治療前狀況,但病患主觀回答問卷的分數,有多項目仍維持統計上顯著改善,對於經顱刺激治療長期效果有賴更進一步研究證實。 此研究初步證實經顱刺激治療多發性硬化症之排尿障礙為安全且有效,未來將持續探討最適當之治療模式,或者延伸應用於其他排尿障礙,如膀胱功能低下等。 |
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abstract |
Purpose: Voiding dysfunction (VD) leading to urinary retention is a common neurogenic lower urinary tract symptom in patients with multiple sclerosis (MS). Currently, the only effective management for patients with MS with VD is catheterization.Transcranial Rotating Permanent Magnet Stimulator (TRPMS) is a noninvasive, portable, multifocal neuromodulator that simultaneously modulates multiple cortical regions and the strength of their functional connections. In this pilot trial (ClinicalTrials.gov Identifier: NCT03574610), we investigated the safety and therapeutic effects of TRPMS in modulating brain regions of interest (ROIs) engaged with voiding initiation to improve VD in MS women.
Materials and Methods: Ten MS women with VD (having % post-void residual/ bladder capacity [%PVR/BC] ≥ 40% or being in the lower 10th percentile of the Liverpool nomogram) underwent concurrent functional magnetic resonance imaging/urodynamic study (fMRI/UDS) with 3 cycles of bladder filling/emptying, at baseline and post-treatment. Predetermined ROIs and their activations at voiding initiation were identified on patients’ baseline fMRI/UDS scans, corresponding to microstimulator placement. Patients received 10 consecutive 40- minute treatment sessions. Brain activation group analysis, noninstrumented uroflow, and validated questionnaires were compared at baseline and posttreatment. Results: No treatment-related adverse effects were reported. Post-treatment, patients showed significantly increased activation in regions known to be involved at voiding initiation in healthy subjects. %PVR/BC significantly decreased. Significant improvement of bladder emptying symptoms were reported by patients via validated questionnaires. Conclusions: Both neuroimaging and clinical data suggested TRPMS effectively and safely modulated brain regions that are involved in the voiding phase of the micturition cycle, leading to clinical improvements in bladder emptying in patients with MS. |
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