There are many reasons to aggressively treat pediatric voiding dysfunction starting with the impact this has on the child?s and family?s quality of life. Epidemiology studies also suggest that childhood voiding dysfunction is a risk factor for adult overactive bladder. Treatments for this condition are limited and while office based biofeedback offers an improvement in symptom scores, it is time consuming. Understanding how the brain responds to bladder volume represents an important step in understanding the pathophysiology of these disparate types of voiding dysfunction. Our one specific aim is to characterize and quantify EEG recordings from human subjects recruited from the Voiding Disorders Clinic within the division of urology at the Children?s Hospital of Philadelphia. From this patient population we will recruit two very distinct populations of patients based upon their voiding phenotypes as well as normal controls. These patients will undergo natural bladder filling following ingestion of a standardized volume of Pedialyte within a defined time frame. Bladder volume will be assessed by ultrasound and cortical EEG activity will then be recorded and spatially localized using MagnetoEncephaloGraphy (MEG) at defined expected bladder volumes based on a percentage of the Expected Bladder Capacity (EBC). The spatial localization of these EEG signals is possible by correlating the MEG data with an MRI of the brain that is performed after the MEG study. Our goal is to better define the brain bladder connection and how the bladder signals distension during filling to the frontal cortex (and other possible areas) from which volitional control over micturition is initiated and understand how these signals are differ between two types of voiding dysfunction.
Nothing is known about the sensation of a full bladder is transmitted to the brain in healthy children, or in children with urinary incontinence. We propose to use non invasive EEG recordings to study these circuits.