Can Brain MRI Help Predict Spinal Cord Stimulation Response for Treating Urinary Incontinence in Stroke Survivors?

Approximately 30 percent of stroke survivors have impaired bladder function, whether it is impaired sensation or incontinence with a hyperactive bladder, according to Kay Jann, PhD. In a recent interview with Diagnostic Imaging, Dr. Jann said current treatment approaches, such as medications and Botox injections into the bladder, are more focused on symptom relief.

Accordingly, Dr. Jann and his colleagues have performed multiple pilot studies to examine the potential use of transcutaneous spinal cord stimulation (TSCS) to help address impaired communication between the brain and the bladder in this patient population. More recently, Dr. Jann and his colleagues have received a grant from the National Institutes of Health (NIH) to study the use of functional MRI and diffusion-weighted MRI (DWI MRI) in identifying stroke survivors who could benefit from TSCS.

“So we have this functional MRI that tells us about the function of the the brain (and) which networks are involved. Then using diffusion weighted imaging (DWI), we can actually map the network (and) the fibers that connect these different areas of the networks. (Then we can) see if a stroke location actually disrupted a fiber, or did the stroke actually impair a specific area in the brain that then leads to this miscommunication or lack of communication between the networks in the brain and the bladder?” explained Dr. Jann, an assistant professor of research neurology at the Mark and Mary Stevens Neuroimaging and Informatics Institute with the Keck School of Medicine at the University of Southern California (USC).

With the new NIH-funded study, Dr. Jann and his colleagues hope to gain imaging insights from a larger cohort of patients who have had strokes in different areas of the brain, such as the pons, the basal ganglia and the posterior circulation. Noting that posterior circulation strokes usually do not lead to post-stroke incontinence, Dr. Jann said the research could lead to the development of imaging markers that could provide prognostic value in identifying viable candidates for the TSCS procedure.

“What we hope is to have a more personalized way to identify patients that will benefit from this new treatment and improve their quality of life,” added Dr. Jann.