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Brain Targets in Patients With Bladder Emptying Difficulties

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ClinicalTrials.gov Identifier: NCT03574610
Recruitment Status : Recruiting
First Posted : July 2, 2018
Last Update Posted : July 26, 2018
Sponsor:
Collaborator:
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Information provided by (Responsible Party):
Rose Khavari, M.D., The Methodist Hospital System

Brief Summary:

The goal of this study is to identify brain centers specifically associated with "initiation of voiding" in patients with neurogenic bladder dysfunction. Currently there is no study that has evaluated brain centers involved in initiation of voiding in patients with neurogenic voiding dysfunction.

Patients with neurogenic bladder secondary to etiologies such as Multiple Sclerosis, Parkinson's disease, and Cerebrovascular accidents will be recruited in this study. Patients will be categorized into 2 groups, those who have trouble emptying their bladder and those who urinate appropriately. Our existing and unique functional magnetic resonance imaging (fMRI)/ urodynamics (UDS) platform is an ideal platform to identify brain regions involved in bladder emptying disorders as seen in patients with neurogenic bladder dysfunction and will be used for this study. After characterizing brain regions involved in bladder emptying, the investigator propose to use noninvasive transcutaneous magnetic stimulation in a subset of patients with voiding dysfunction in aim 3.


Condition or disease Intervention/treatment
Neurogenic Bladder Multiple Sclerosis Parkinson Disease Voiding Dysfunction Device: Transcranial Rotating Permanent Magnet Stimulator (TRPMS)

Detailed Description:

Difficulty in bladder emptying (Voiding dysfunction,VD) is a costly urinary condition that leads to urinary tract infections/stones, sepsis, bladder loss, and permanent kidney damage. VD can be present in patients with or without neurologic/brain disorders. Currently the only available therapies for VD include bladder catheters or intermittent self-catheterization. Catheterization is a burden especially in patients with nerve damage, hand skills may be limited. The cost and morbid side effects of catheterizations in patients (blood in the urine, pain, trauma, strictures, and infections) requires investigators to develop new therapies that are beyond the bladder. Such new therapies could target the brain (where bladder control is located).

In this proposal, investigators plan to further characterize the brain regions involved in bladder emptying for each patient and ,perform brain modulation, targeting these regions as a possible therapy for VD.

Patients with bladder dysfunction will be divided into two groups: Group 1: patients with VD; and Group 2: patients without VD. Specific Aim 1: To evaluate brain pattern in both groups and compare them to each other at the time of bladder emptying. Specific Aim 2: To evaluate reliability of the nerve fibers in the brain and see whether damage to these fibers is related to difficulty emptying the bladder. Specific Aim 3: To perform non-invasive brain stimulation on specific regions of the brain responsible for bladder control to improve bladder emptying.

This study is an interventional Study: The investigators have completed a well-powered study on twenty-seven female MS patients during their bladder storage phase. Aims 1 and 2 use the data from previously completed trial and investigators will perform additional imaging analysis on it. Aim 3 is a new and small trial in which investigators planned to modulate the regions of the brain that are related to bladder control.

Approximately 16 study participants will be enrolled at Houston Methodist, and 16 throughout the study.


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Study Type : Observational
Estimated Enrollment : 16 participants
Observational Model: Cohort
Time Perspective: Prospective
Official Title: Supraspinal Mechanisms Involved in Voiding Dysfunction.
Actual Study Start Date : July 1, 2018
Estimated Primary Completion Date : January 31, 2021
Estimated Study Completion Date : July 31, 2021

Resource links provided by the National Library of Medicine


Group/Cohort Intervention/treatment
Subjects with Multiple Sclerosis and Voiding Dysfunction
Subjects with Multiple Sclerosis (MS) and voiding dysfunction (VD). In this group 'Transcranial Rotating Permanent Magnet Stimulator (TRPMS)' device will be used.
Device: Transcranial Rotating Permanent Magnet Stimulator (TRPMS)

TRPMS is a wearable non-invasive transcranial rotating permanent magnet stimulator. It has been determined to be a Non Significant Risk device by the FDA.

The amount and frequency of therapy are prescribed by the physician, and the device is custom configured to the patient to deliver the required amount of treatment. The device does not turn on until it is time for the treatment. It consists of three main parts: Neoprene cap with microstimulator(s), stimulator console (device controller box) and the tablet with TRPMS app which activates the console. The neoprene cap prevents the microstimulator(s) from coming in direct contact with the scalp. Microstimulators deliver the magnetic stimulation to the brain based on a prescription program uploaded in the stimulator controller.


Subjects with other causes of Voiding Dysfunctions
Subjects in this group have other causes of neurogenic voiding dysfunction, VD (such as stroke)



Primary Outcome Measures :
  1. Change in Post Void Residual (mL) at Baseline Compared to Post Treatment Exposure at two weeks [ Time Frame: Two weeks ]
    Changes in post void residual in two weeks period in MS patients with voiding dysfunction to improve voiding.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Aims 1 and 2 will be analysis on our completed cohort (27 patients with MS). For aim 3 we plan to enroll 8 patients with MS and neurogenic voiding dysfunction and 8 patients with other causes of neurogenic voiding dysfunction (such as stroke).
Criteria

Inclusion Criteria:

Inclusion Criteria for subjects with neurogenic bladder:

  • Patients with clinical diagnosis of neurogenic bladder
  • History of any neurologic illness or injury (including but not limited to spinal cord injury, Multiple Sclerosis, Stroke, spina bifida, Parkinson's, major spine surgery)
  • 18 years or older

Specifics for MS patients:

Adult female patients with clinically stable MS [Expanded Disability Status Score (EDSS) ≤6.5], with bladder symptoms ≥3 months, will be screened. Patients will be considered to have VD if they have an increased Postvoid Residual (≥ 20% Maximum Cystometric Capacity). Patients who perform self-catheterization will be included in the VD category as well.

Exclusion Criteria:

Exclusion Criteria for subjects with neurogenic bladder:

  • Men (for aims 1 and 2 only), anatomical bladder outlet obstruction (anti-incontinence procedures, urethral strictures, or advanced pelvic organ prolapse). Severe debilitating MS, history of seizures, pregnancy or planning to become pregnant, contraindications to MRI, history of augmentation cystoplasty. Patients with active UTI can be treated and subsequently screened for the trial.
  • Positive urine pregnancy test at enrollment (There are no known risks to a subject's fetus. There is no known teratogenic risk associated with urodynamics or fMRI) - Cognitively impaired patients

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03574610


Contacts
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Contact: Rashmi Pande, BDS,MS,CCRP 7133639154 rpande@houstonmethodist.org
Contact: Rose Khavari, MD 7134416455 rkhavari@houstonmethodist.org

Locations
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United States, Texas
Houston Methodist Hospital Recruiting
Houston, Texas, United States, 77030
Contact: Rashmi Pande, BDS,MS,CCRP    713-363-9154    rpande@houstonmethodist.org   
Principal Investigator: Rose Khavari, MD         
Sponsors and Collaborators
Rose Khavari, M.D.
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Investigators
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Principal Investigator: Rose Khavari, MD The Methodist Hospital System

Publications of Results:

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Responsible Party: Rose Khavari, M.D., Principal Investigator, Houston Methodist Hospital Urologist and Research Director, The Methodist Hospital System
ClinicalTrials.gov Identifier: NCT03574610     History of Changes
Other Study ID Numbers: Pro00019252
K12DK083014 ( U.S. NIH Grant/Contract )
First Posted: July 2, 2018    Key Record Dates
Last Update Posted: July 26, 2018
Last Verified: July 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: Yes
Pediatric Postmarket Surveillance of a Device Product: No

Keywords provided by Rose Khavari, M.D., The Methodist Hospital System:
Neurogenic bladder
Functional Neuroimaging
Transcranial Rotating Permanent Magnet Stimulator (TRPMS)

Additional relevant MeSH terms:
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Parkinson Disease
Multiple Sclerosis
Urinary Bladder, Neurogenic
Parkinsonian Disorders
Basal Ganglia Diseases
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Movement Disorders
Neurodegenerative Diseases
Demyelinating Autoimmune Diseases, CNS
Autoimmune Diseases of the Nervous System
Demyelinating Diseases
Autoimmune Diseases
Immune System Diseases
Neurologic Manifestations
Urinary Bladder Diseases
Urologic Diseases
Signs and Symptoms