Evidence map›Paper›PMID 34156730›Full record

Trial reportNeuromodulation : journal of the International Neuromodulation Society2021

Effects of Translumbosacral Neuromodulation Therapy on Gut and Brain Interactions and Anorectal Neuropathy in Fecal Incontinence: A Randomized Study.

Satish S C Rao, Yun Yan, Xuelian Xiang, Amol Sharma, Deepak Ayyala, Shaheen Hamdy

Registry-linked trialAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Neuromodulation : journal of the International Neuromodulation Society, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07192328 (Randomized Cross-Over Dose-Efficacy Study of rTMS in Healthy Young Female Volunteers), which is not on this map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07192328 nacompletednot on this mapstarted 2024, after this paper: background citation

Randomized Cross-Over Dose-Efficacy Study of rTMS in Healthy Young Female Volunteers

TypeinterventionalSponsorHospital de MataróRan2024 to 2025Enrolled10ConditionsFecal Incontinence (FI), Healthy Female VolunteerArmsrTMS and rTLSMS administered using a Magstim Rapid2 repetitive stimulator at pre-identified hotspots (cortical, lumbar, and sacral regions bilaterally).
3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Controversies in fecal incontinence.World journal of gastroenterology · 2025
    Article
  2. Review
  3. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Satish S C RaoDivision of Neurogastroenterology/Motility, Medical College of Georgia, Augusta University, Augusta, GA, USA.ORCID https://orcid.org/0000-0002-4446-8452
Yun YanDivision of Neurogastroenterology/Motility, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Xuelian XiangDivision of Neurogastroenterology/Motility, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Amol SharmaDivision of Neurogastroenterology/Motility, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Deepak AyyalaDepartment of Population Health Sciences, Medical College of Georgia, Augusta University, Augusta, GA, USA.
Shaheen HamdyGI Sciences, School of Medical Sciences, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.

Funding

NEUROMODULATION THERAPY FOR FECAL INCONTINENCER21DK104127 · NIDDK · AUGUSTA UNIVERSITY · PI RAO, SATISH SC · 2015 to 2016
$395k
NIDDK NIH HHS R21 DK104127
6 · The paper itself

Abstract

objectivesTranslumbosacral neuromodulation therapy (TNT) improves symptoms of fecal incontinence (FI), but its mechanism of action is unknown. We tested the hypothesis that TNT at one or more frequency will significantly improve underlying pathophysiology of FI through modulation of ascending and/or descending signaling pathways in the gut and brain axis and anorectal sensorimotor function. MATERIALS AND

methodsWe assessed afferent anorectal-cortical evoked potentials (CEP) following electrical stimulation of anorectum, efferent cortico-anorectal and lumbo-anorectal and sacro-anorectal motor evoked potentials (MEP) after transcranial and lumbosacral magnetic stimulations, and anorectal manometry before and after six weekly TNT sessions in FI subjects, randomized to 1, 5, or 15 Hz repetitive magnetic stimulations. Neurophysiology, anorectal sensorimotor function, and symptoms were compared to examine mechanistic effects. Co-primary measures were ano-cortical CEPs, cortico-anal MEPs, and lumbosacral-anal MEPs. Baseline and post-treatment data were compared with Wilcoxon signed-rank test and changes between the three frequencies with one-way ANOVA.

resultsThirty-three FI patients participated. After TNT, the afferent anal CEP latencies significantly decreased in the 1 Hz group compared to baseline (p = 0.0029) and 5 Hz or 15 Hz groups (p = 0.032). Cortico-anal MEPs were unchanged in all three groups. Bilateral lumbo-anal and sacro-anal MEP latencies significantly decreased with 1 Hz, lumbo-anal with 15 Hz, and sacro-anal with 5 Hz compared to baseline but without group differences. The 1 Hz group showed significant increase in anal squeeze sphincter pressure (p < 0.005) and maximum tolerable volume (p < 0.019) and demonstrated higher FI responder rate (p < 0.04) compared to the other two groups. The MEP responders were significantly correlated with FI responders (p = 0.006) in 1 Hz group.

conclusionsTNT significantly improves afferent ano-cortical signaling, efferent lumbo-anal and sacro-anal neuropathy and anorectal sensorimotor function. These neurobiologic effects were most prominent with 1 Hz frequency. TNT improves FI by modifying the underlying pathophysiology possibly through neuromodulation.

Indexed as

Fecal IncontinenceAnal CanalBrainEvoked Potentials, MotorHumansManometryAnorectal functioncortical evoked potentialfecal incontinencelumbosacral neuropathyneuromodulation therapyneurophysiology

Identifiers

PMID34156730
PMCPMC8542581

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.