Zusammenfassung
Die willentliche Miktion unterliegt der zentralnervösen Kontrolle im pontinen Miktionszentrum und hängt vom geordneten Ablauf eines komplexen Wechselspiels aus Hemmung und Aktivierung verschiedener kortikaler sowie subkortikaler Hirnregionen ab. Ziel der vorliegenden Untersuchung war es, Unterschiede in der Aktivierung verschiedener Kortexregionen während der Miktion bzw. einer versuchten Miktion aufzuzeigen und andererseits Hinweise auf Unterschiede in der kortikalen Aktivierung zwischen Probanden, die eine Miktion durchführen und solchen, denen es unter experimentellen Bedingungen nicht gelingt zu miktionieren, zu erlangen. Weiterhin sollten Effekte der intravesikalen Elektrostimulation (IVES) auf die kortikale Aktivierung untersucht werden. Vierzehn Patienten (10 Männer, 4 Frauen) vor und nach IVES und 36 gesunde Rechtshänder (22 Männer, 14 Frauen) nahmen an der Untersuchung teil. Das EEG wurde nach dem internationalen 10–20 System unter Ruhebedingungen und während der Miktion bzw. eines Miktionsversuches abgeleitet. Achtzehn Probanden konnten während der Untersuchung miktionieren und 18 Probanden war eine Miktion unter Testbedingungen nicht möglich. Diese beiden Subgruppen wurden separat mit den Patienten verglichen, welche alle nach IVES miktionieren konnten.
Die Patienten zeigten nach IVES eine EEG-Aktivität wie die Probanden der Kontrollgruppe welchen eine Miktion möglich war. Diese beiden Subgruppen unterschieden sich signifikant von den Probanden welche unter Testbedingungen nicht miktionieren konnten. Generell kommt es während der „Miktion“, aber auch während des „Versuches zu miktionieren“ zu einer Abnahme der Alphabandleistung, was als Zunahme an kortikaler Aktivierung verstanden werden kann. Probanden, denen die Miktion unter experimentellen Bedingungen nicht gelingt, zeigen ein höheres Aktivierungsniveau als Probanden, denen die Miktion gelingt und als Patienten, die die geringste Aktivierung aufweisen. Geschlechtsunterschiede wurden nicht gefunden.
Aufgrund unserer Untersuchung glauben wir, daß es ein für die Miktion typisches EEG Muster während der Miktion bei gesunden Personen gibt und, daß die IVES Auswirkungen auf höhere Miktionszentren hat.
Purpose: The pontine micturition center plays a central role in regulating the micturition reflex, but the precise neural mechanisms are unclear. The cerebral cortex is involved in coordinating micturition but there is little knowledge on specific evolutionary higher brain regions. The present study aimed to investigate whether cortical activation during micturition can be demonstrated by EEG power spectra patterns and to explore whether specific cortical regions involved in the interaction of inhibition and release during the micturition reflex can be discerned. We also aimed to test whether intravesical electrostimulation (IVES) therapy in patients with micturition disorders has an effect on patterns of cortical activity.
Methods: The healthy control group was divided into those who were able to void when requested (6 women, 12 men) and those who were not (8 women, 10 men). These subgroups were compared separately with the 14 patients before and after IVES for voiding dysfunction. Following IVES all patients were able to void spontaneously. Mean age of the patients and healthy volunteers was 52 and 30 years, respectively. At the beginning of the study all subjects had a bladder volume of approximately 250 mL as measured by sonography. The EEG was obtained at rest and during the attempt to void. In the patients' group EEG was obtained before IVES treatment and at the day of the last stimulation.The measurement period lasted about 6 minutes. At the beginning of the recording the proband was asked to close his/her eyes. During the resting period after 1 minute the patient was asked to open his/her eyes. After 10 seconds he/she was asked to close his/her eyes again. Then, with eyes still closed, the patient was asked to void. During the entire EEG recording the patient was seated in a comfortable, electrically isolated chair in a darkened room and separated from the examiner by a partition. The subject was asked to relax and not move his/her eyes. The EEG was recorded from the 19 standard points (10–20 System) versus an averaged mastoid electrode with a gold-plated cup electrode ¶(Glass). An EOG was recorded simultaneously to register eye artefacts. The amplification chain was calibrated with a 10-Hz 100-μVSS sinus signal generated with a biosignal amplifier. The transitional resistances of all EEG channels were less than 5 kOhm and established as soon as possible. EEG and EOG signals were amplified and recorded with a B.E.S.T. Brain Mapping System. The recording frequency was 256 Hz and the resolution of the analog digital conversion was 12 bit. A high pass and a low pass filter were set to 0.53 Hz and 70 Hz, respectively. All recordings were inspected visually before computer analysis. Artefacts were marked and excluded from the further analysis. None of the EEG recordings showed clinical abnormalities. As expected, the EEGs during voiding attempts showed some muscle potentials and slow motion artefacts. For each subject two artefact-free resting segments of about 20 seconds, one from the resting phase and one from the voiding attempt, were defined by hand for automated analysis. Relative power spectra (μV2) were calculated for the defined segments. From the spectra the relative alpha band power (7.5–13.0 Hz) was calculated for each subject for rest and voiding. Group (patients vs. voiding probands vs. probands unable to void) and sex were independent variables. The alpha power of the 17 electrode positions of the 10–20 system (without Fp1 and Fp2) during rest and attempted voiding were repeated measurement variables. The frontopolar electrode was not used because of its susceptibility to artefacts. The number of dependent variables was due to the explorative nature of the study. With interactions of variables with more than two factor levels a Greenhouse-Geisser correction was performed. Interactions were subjected to contrast analysis and Newman-Keuls-Post tests.
Results: Significant effects were seen for BEDINGUNG (F(1,46) = 91.07, P < 0.01) and electrode POSITION (F(16,736) = 35.07, P < 0.01). The alpha level was higher at rest than during attempted micturition, which reflects lower activation. Electrode POSITION was not analyzed further because we were interested mainly in the groups. There was a significant interaction between GROUP and electrode POSITIONS (F(32,736) = 1.83, P < 0.05). The contrast analysis showed that this interaction was due to both activation differences in the individual positions of the probands able to void (F(16,736) = 11.08, P < 0.01), the probands unable to void (F(16,736) = 12.72, ¶P < 0.01), and the patients (F(16,736) = 14.89, ¶P < 0.01) and to differences among the groups. Most of the significant differences were seen between patients (PA) and healthy controls unable to void (MV). With the exception of O2 there were no differences between patients after stimulation therapy (PA) and healthy controls able to void (M). The alpha band power of patients after IVES (PA) and controls able to void (M) was similar whereas controls unable to void had a markedly higher activation level (less alpha power). The comparison of the power spectra of the patients before (PA/v) and after (PA) stimulation reveals significant differences that are nearly identical to the differences between groups M and MV.
Conclusions: There are typical electrophysiologic cerebral changes during micturition in healthy volunteers. Intravesical stimulation is not only effective to induce voiding but also induces electrical changes on higher micturition centers measurable by EEG.
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Colombo, T., Wieselmann, G., Pichler-Zalaudek, K. et al. Zentralnervöse Kontrolle der Miktion bei Patienten mit Blasenfunktionsstörung im Vergleich zu gesunden Kontrollpersonen . Urologe [A] 39, 160–165 (2000). https://doi.org/10.1007/s001200050025
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DOI: https://doi.org/10.1007/s001200050025