Work

Does brainstem functional connectivity in bladder control regions differ between healthy women and women with multiple sclerosis and voiding dysfunction?

Year: 2026

Type: article

Abstract: Background and Purpose The brainstem contains key structures involved in regulating the lower urinary tract (LUT) and maintaining continence, but due to its small size and noise it has been difficult to study. By employing 7T magnetic resonance imaging (MRI) in conjunction with urodynamics (UDS), we performed blood oxygenation level dependent (BOLD) functional MRI (fMRI) in women with multiple sclerosis (MS) and voiding dysfunction (VD). Five regions of interest (ROIs) within the brainstem were selected. Methods We recruited and imaged 9 women with clinically stable MS and VD and 10 healthy controls. Brain imaging data was collected using a 7T MRI scanner, and functional connectivity (FC) was analyzed with five brainstem ROIs associated with bladder control. fMRI data was processed using the CONN toolbox, and FC patterns were compared between groups during both resting empty and full bladder states. Results In comparison to ten healthy controls, we found significant differences in connectivity in the MS group across four of five ROIs. Notably in the midbrain, we found changes in multiple known networks implicated in control over the LUT. Additionally, changes in the periaqueductal gray (PAG) and pontine micturition center (PMC) were observed with similar FC patterns seen in overactive bladder pathologies. Conclusion This study highlights altered brainstem connectivity in MS patients with VD, providing novel insights into the neural mechanisms underlying bladder dysfunction and identifying potential therapeutic targets for restoring continence.

Source: Continence Reports

DOI: 10.1016/j.contre.2026.100121