Researchers from the Mark and Mary Stevens Neuroimaging and Informatics Institute at the Keck School of Medicine of USC and Rancho Los Amigos National Rehabilitation Center have received a grant from the National Institutes of Health to study brain changes responsible for urinary incontinence following stroke, according to a July 27 announcement. The project aims to develop more personalized treatment approaches for stroke survivors experiencing this condition.
The research team, led by Evgeniy Kreydin, MD, will use advanced brain imaging, clinical bladder testing, and transcutaneous spinal cord stimulation—a noninvasive therapy—to identify imaging biomarkers that could predict which patients may benefit most from treatment. More than 30% of stroke survivors experience persistent bladder symptoms that can impact health, daily life, caregiver responsibilities, and independent living. Current treatments mainly address symptoms rather than disrupted signaling between the brain, spinal cord, and bladder.
Charles Liu, MD, PhD, said, "Genitourinary system dysfunction remains one of the highest priorities in neurological disease and injury, as well as in aging. Our team at USC has taken a multidisciplinary approach to restoring function by bringing together expertise in imaging, urology, neurosurgery, and biomedical engineering. This collaboration has already led to several important advances."
The study will compare stroke survivors with injuries in different areas of the brain involved in bladder control—such as the basal ganglia and pons—with those whose strokes affect other regions like the occipital lobe or with healthy participants serving as controls. Participants will undergo functional magnetic resonance imaging (fMRI) during bladder filling to observe communication among brain regions involved in bladder control.
Kay Jann said, "Bladder control depends on a coordinated conversation among multiple brain regions, and a stroke may disrupt that conversation in different ways depending on where the injury occurs. Functional MRI will help us determine which functions have been impaired...and whether those changes correspond to the symptoms and physiological problems experienced by each patient." Kirsten Lynch added that diffusion MRI would allow mapping white matter pathways connecting key regions for further analysis.
Study participants will receive 12 weeks of transcutaneous spinal cord stimulation therapy before repeating imaging tests. The researchers hope their findings can lead to individualized predictions about who is likely to benefit from this therapy based on specific biological features observed through neuroimaging. Arthur W. Toga said, "This project reflects the promise of neuroimaging to connect what we see in the brain with meaningful improvements in patients' lives...the team is working toward a future in which rehabilitation and neuromodulation therapies can be tailored to the individual rather than applied through a one-size-fits-all approach." The research may also inform treatments for other neurological conditions affecting bladder control.
