Stroke survivors often develop lower urinary tract symptoms (NLUTS), which can be difficult to treat and have a detrimental effect on their quality of life. Studies have shown that the micturition-associated brain activity (MABA) post-stroke relies on the activation of primitive brain regions, such as the cerebellum and periaqueductal gray, with less activation of cortical regions. Transcutaneous Spinal Cord Stimulation (TSCS) is emerging as a novel electrical neuromodulation technique and is gaining increased clinical support due to its neuro-restoration potential. The aim of this study was to assess changes in brain activity using functional magnetic resonance imaging (fMRI) and patient-reported outcome measures (PROM) following twelve weeks of TSCS therapy.

This prospective study protocol was approved by the Institutional Review Board, and all participants provided informed consent. Twelve patients with newly developed lower urinary tract symptoms (LUTS) following a stroke underwent TSCS for 24 sessions. 
Patients completed a bladder diary and ICIQ-OAB questionnaire and underwent fMRI+ Urodynamic studies (UDS) before and after therapy. Changes in brain activity were assessed by detecting blood oxygen level-dependent (BOLD) signal intensity, recorded during maximum urgency, and measured 10 seconds before detrusor contraction.  Descriptive statistics and paired t-tests were used when the appropriate neuroimaging analysis was done using Statistical Parametric mapping with a p <0.01 and cluster size of 25 voxels.

A total of 12 participants (5 males and 7 females) with a mean age of 52.8 years old (SD± 9.8) completed the study. Following completion of TSCS, patients reported a decreased perception of urge per void (1.83 ± 0.34 vs. 0.92 ± 0.21: p<0.05), a reduction in the number of urge incontinence episodes (6.96 ± 2.12 vs. 4.15 ± 1.58: p <0.05), and an increased number of urge-free voids per 24 hours (0.27 ± 0.09 vs. 2.29 ± 0.91; p<0.05). ICIQ-OAB scores were significantly lower post-stimulation (9.41 vs. 4.08; p=0.001). fMRI detected increased BOLD signal intensity in the cerebellum, cuneus, and multiple frontal areas, including the inferior, medial, and middle frontal gyri, following TSCS.

Patients who had completed twelve weeks of TSCS experienced a significant reduction in PROM, such as perceived urge per void, urgency incontinence episodes, and an increase in urge-free voids per 24 hours. Similarly, ICIQ-OAB scores were significantly lower after completing the TSCS protocol. The changes observed in the PROM are consistent with symptom improvement, which could be explained by the changes in cortical regions.

TSCS shows promising results as a potential treatment for LUTD in stroke survivors. Change in cortical activation may be the mechanism by which TSCS improves LUT symptomatology in this patient population.