Abstract: PNFBA-04
Sources of Funding: Funding provided by the National Institute of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant number P20 DK097819-01.

Introduction

Multiple sclerosis (MS) is characterized by demyelinated white matter plaque throughout the central nervous system. Patients with MS frequently experience a range of bothersome urinary symptoms. The cingulate cortex, insula cortex, and prefrontal cortex are three cortical brain regions that regulate micturition, and plaque involvement in these regions may be associated with urinary symptom severity. The aim of this study is to investigate the relationship between cerebral plaque volume, location, and urinary symptoms in women with MS.

Methods

We conducted a prospective case control study of women with MS undergoing routine yearly brain MRI. Women were administered the AUA Symptom Score (AUASS) and divided into two groups: women with severe urinary symptoms (AUASS ≥20) and women with mild symptoms (AUASS ≤7). MS plaque volume and location in the brain were determined using a validated automated white matter lesion segmentation algorithm. Mann Whitney U and Spearman's rank tests were used to investigate the relationship between plaque volume, location, and AUASS subscale scores.

Results

The study included 36 women with a median age of 50.1 years (IQR 27.1) and BMI 26.6 kg/m2 (IQR 5.8) with no significant differences between groups, p>0.05. The median total plaque volume was 2523.5mm³ (IQR 11705.5) and did not differ between the groups, p=0.52. Women with severe urinary symptoms had larger median plaque volume in the left frontal lobe (LFL) (623.5mm³ IQR 2652 vs. 184mm³ IQR 908; p=0.04) and right limbic lobe (RLL) (1.5mm³ IQR 10 vs. 0 IQR 0; p=0.02) compared to women with mild urinary symptoms. Within the RLL, women with severe symptoms had larger median plaque volume in the cingulate gyrus (median 1 IQR 4 vs. median 0 IQR 0; p=0.02). There was moderate correlation between LFL lesion volume and the AUA voiding symptom subscore (coefficient 0.4, p=0.03) as well as RLL lesion volume and the AUA voiding symptom subscore (coefficient 0.5, p=0.002). However, these regions did not correlate with the storage subscore. There were no significant relationships between symptoms severity and plaque volume in the insula, cerebellum, corpus callosum, occipital or parietal lobes (p>0.05).

Conclusions

Urinary symptom severity in women with MS is associated with plaque in the cingulate gyrus and LFL, and not total cerebral plaque volume. The voiding symptom subscore of AUASS correlated with the volume of plaque in these locations. Further research to assess spinal cord plaque characteristics is underway.

Funding

Funding provided by the National Institute of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant number P20 DK097819-01.