Rancho Research Institute

Functional and Structural Brain Connectivity Alterations in Post-stroke Lower Urinary Tract Dysfunction - 1 2 Project Summary 3 Stroke Impairs More Than Movement and Speech—it Damages the Brain Circuits That Keep the Bladder 4 Continent. Up to 30% of Survivors Live With Chronic Urinary Incontinence, Eroding Quality of Life and Increasing 5 Caregiver Burden. Existing Treatments Act at the Bladder Wall and Often Fail or Cause Side Effects Because They 6 Do Not Address the Upstream Neurological Injury. 7 Neuromodulation Offers a Disease-targeted Alternative. Our Group Has Piloted Transcutaneous Spinal Cord 8 Stimulation (TSCS) – a Non-invasive Therapy That Reduced Incontinence in Stroke Survivors – Yet Only a Subset 9 of Patients Respond and No Biomarkers Guide Selection. This Project Will Close That Gap by Linking Stroke-induced 10 Network Injury to TSCS Outcome. 11 Aim 1 Uses Task-based and Resting-state Fmri to Map How Basal-ganglia, Pontine, and Occipital Strokes 12 Differentially Disrupt Connectivity Among Key Bladder-control Hubs (insula, Acc, Sma, Pontine Micturition Center) 13 and How These Losses Relate to Urodynamic Severity. 14 Hypothesis: Greater Loss of Connectivity Within Salience, Executive, and Sensorimotor Networks Will Correlate With 15 Worse Urodynamic Measures of Storage and Voiding. 16 Aim 2 Applies Diffusion-mri Tractography to Define the White-matter Pathways That Anchor Those Networks and 17 Tests Whether Tract Injury Mediates Functional Disconnection and Symptoms. 18 Hypothesis: Lower Fractional Anisotropy and Higher Diffusivity in These Tracts Will Mediate the Functional 19 Disconnection Identified in Aim 1 and Independently Predict Lut Symptom Severity. 20 Aim 3 Delivers a 12-WEEK TSCS Course to Determine Whether Baseline Network/tract Integrity and Therapy- 21 Induced Connectivity Changes Predict Objective Clinical Improvement, Creating a Prospectively Validated 22 Biomarker Panel. 23 Hypothesis: Responders Will Show Better-preserved Baseline Network and Tract Integrity and Will Exhibit TSCS- 24 Induced Restoration of Supraspinal Information Flow; These Imaging Signatures Will Predict Clinical Improvement 25 With High Accuracy. 26 by Integrating Functional and Structural Neuroimaging With Objective Bladder Metrics, We Will Create the First 27 Personalized, Brain-based Framework for Treating Post-stroke Incontinence. the Resulting Biomarkers Will Enable 28 Precise Patient Selection, Shorten Therapeutic Trials, and Accelerate Adoption of TSCS and Future 29 Neuromodulation Approaches in Routine Stroke Care. 30 Internal