Levels of brain stem and diencephalon controlling micturition reflex.

The taste reactivity test. II. Mimetic responses to gustatory stimuli in chronic thalamic and chronic decerebrate rats

This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed.

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Neural Control of the Lower Urinary Tract

According to their degree of morphological specialization, the cell populations of the brain stem may be classified into three groups: isodendritic, allo-dendritic and idiodendritic. The isodendritic neurons, or generalized neurons, are the most frequently encountered. If one discards those isodendritic centers that by common definition are sensory or motor, an isodendritic core is left which displays very little histological variation throughout the whole extent of the brain stem. This core corresponds, with certain restrictions, to the regions that are usually regarded as reticular formation. It constitutes a continuum of overlapping dendritic fields that extends from the spinal cord to the diencephalon. In view of the similarities that exist between the histology of the isodendritic core and the relatively disorganized nervous system of the lower vertebrates, it is postulated that it represents a pool of pluri-potential neurons which in the course of phylogeny have remained relatively undifferentiated and in charge of processing afferent signals of very heterogeneous origin. By contrast, the allodendritic and idiodendritic centers can be regarded as relatively specialized centers from the point of view of their dendritic morphology, connections and functions. Attention is paid to the fact that the diffuse characteristics of the isodendritic core do not necessarily entail ill-defined physiological properties.

The isodendritic core of the brain stem

Nervous control of the urinary bladder of the cat.

Specific cerebral lesions have shown the crucial role of the brain in the control of micturition. The precise identification of the anatomical cerebral structures involved in micturition can contribute to a better understanding of the control of micturition and the development of therapeutic models. Various neuropathological and animal studies have referred to the medulla oblongata, pons, limbic system, superior frontal lobe and premotor cortical regions as areas implicated in micturition control. The aim of this study was to investigate whether the activity of these areas during micturition can be confirmed by PET in normal men. The distribution of the regional cerebral blood flow after bolus injection of (15)O water was used as an indirect measure of cerebral activation. PET scans were performed during the following three conditions: (i) at rest with the bladder empty; (ii) during simulated micturition after instillation of isotonic saline into the urinary bladder; and (iii) the withholding of urine (saline). Normal micturition using this model was achieved in eight out of 12 right-handed normal subjects. The changes in bladder contraction, bladder pressure and intra-abdominal pressure were monitored on-line during the whole scanning session by a cystometry device. The images were analysed using statistical parametric mapping at a significance threshold of P 3.09) without correction for multiple comparisons, we found additional activation in the medial pontine tegmentum, mesencephalon, right thalamus, right middle frontal gyrus and left insula. When urine- withholding was compared with rest, the left insula showed a tendency to activate. We conclude from this study, in which urinary bladder contraction was verified cystometrically, that the onset and maintenance of micturition in normal men is associated with a vast network of cortical and subcortical regions, confirming observations from clinical and animal studies.

Levels of brain stem and diencephalon controlling micturition reflex.

Citations

The taste reactivity test. II. Mimetic responses to gustatory stimuli in chronic thalamic and chronic decerebrate rats

Neural Control of the Lower Urinary Tract

The isodendritic core of the brain stem

Nervous control of the urinary bladder of the cat.

Cerebral activation during micturition in normal men.

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