Assessment of sacral spinal excitability using stimulus-response curves of the bulbocavernosus reflex

Abstract

Objective: To analyze and quantify sacral spinal excitability through bulbocavernosus reflex (BCR) stimulus-response curves.

Methods: Thirty subjects with upper motor neuron lesions (UMN) and nine controls were included in this prospective, monocentric study. Sacral spinal excitability was assessed using stimulus-response curves of the BCR, modeled at different bladder filling volumes relative to the desire to void (as defined by the International Continence Society) during a cystometry. Variations in α (i.e. the slope of the stimulus-response curve) were considered as an indicator of the modulation of sacral spinal excitability.

Results: In all subjects, α increased during bladder filling suggesting the modulation of spinal sacral excitability during the filling phase. This increase was over 30% in 96.7% of neurological subjects and 88.9% of controls. The increase was higher before the first sensation to void in the neurological population (163.15%), compared to controls, (29.91%), p < 0.001.

Conclusions: We showed the possibility of using BCR stimulus-response curves to characterize sacral spinal response with an amplification of this response during bladder filling as well as a difference in this response amplification in patients with UMN in comparison with a control group.

Significance: BCR, through stimulus-response curves, might be an indicator of pelvic-perineal exaggerated reflex response and possibly a tool for evaluating treatment effectiveness.

Keywords: Bulbocavernosus reflex; Neurogenic overactive bladder; Pathophysiology; Perineal spasticity; Sacral spinal excitability; Stimulus-response curves.