A 7-tesla study of cerebellar alterations relating to bladder control in women with multiple sclerosis voiding dysfunction using functional connectivity.

Background and purpose: Neurogenic lower urinary tract dysfunction (NLUTD) affects over 80% of individuals with multiple sclerosis (MS), leading to significant morbidity and mortality due to storage and voiding dysfunction. This study aims to investigate the altered functional connectivity (FC) in cerebellar regions involved in bladder control in women with MS and NLUTD, compared to healthy controls, in both empty and full bladder states using concurrent urodynamics and functional magnetic resonance imaging (fMRI).

Methods: We recruited 11 women with clinically stable MS and NLUTD and 10 healthy controls. Brain imaging data was collected using 7T MRI scanners, and functional connectivity was analyzed with three cerebellar regions of interest (ROIs) associated with bladder control. Functional connectivity data was processed using the CONN toolbox, and FC patterns were compared between groups during both resting empty and full bladder states.

Results: In the empty bladder state, MS patients exhibited stronger intracerebellar FC, particularly in the right Crus 1, suggesting decreased motor control of the pelvic floor. Additionally, decreased FC was observed in the precuneus and prefrontal cortex, regions associated with bladder control. During the full bladder state, MS patients showed decreased FC in temporal, occipital, and prefrontal cortex, indicating impaired executive control over voiding.

Conclusion: This study highlights altered cerebellar connectivity in MS patients with NLUTD, providing novel insights into the neural mechanisms underlying bladder dysfunction and identifying potential therapeutic targets for restoring continence.