Diminishing Alpha Power in the Insular Cortex Correlates With the Symptom Score in Patients With Voiding Dysfunction
Stephen Zderic, MD, Brittney Henderson, BS, Yu-Han Chen, PhD, Jason VanBatavia, MD, Timothy Roberts, PhD.
Children's Hospital of Philadelphia, Philadelphia, PA, USA.
BACKGROUND: Voiding dysfunction remains a common reason for pediatric urology consultation. There is a wide range of variation in the sensory phenotype with some patients saying they have no warning in advance of an incontinence event. Others describe profound urgency leading up to an episode of incontinence. We hypothesized that these voiding phenotypes might be reflected in their neural circuitry.
METHODS: 32 children participated in this IRB approved study after signing informed consent. All subjects completed a validated symptom score questionnaire with a range of 0-30 (normal values are 3 or less). Subjects were classified into three groups: control, holder, and urgency. The holder and urgency groups were defined by their average voided volumes as determined by voiding diaries. Subjects were asked to void, and then consume Gatorade (15cc/kg) within a 30 minute time frame. A baseline Magnetoencephalogram (MEG) was obtained which was repeated upon verbalization of their first desire to void, and then immediately postvoid. The final voided volume was recorded as was the post void residual as measured by bladder scanner. Following the last MEG scan, an MRI was performed to allow for localization of the EEG activity obtained during the MEG scan. Data was analyzed in the waking state alpha range of 8-14 Hz.
RESULTS: 31/32 children completed the protocol; 1 child withdrew due to anxiety. There were no significant differences in age or sex distribution. The DOVE scores did distinguish among the 3 groups (+ P<0.05 across all categories). The percentage of estimated bladder capacity attained differed between the urgency and holder categories (# P < 0.05). (Table 1) 5/20 patients could not wait for scan completion at the time of first desire to void. Power loss over the insular cortex correlated with a rise in the symptom score (Figure 1) (P < 0.05 by the F-test).
CONCLUSIONS: We have identified differences in the EEG power emanating from the insular cortex in children with voiding dysfunction. The insula is thought to coordinate the visceral sensory output which might explain why these children may show a profound sense of urgency or no warning prior to their incontinence event. Perhaps these incontinence events are based on innate or acquired differences in neural circuitry.
Supported by NIH R21 HD087794
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