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Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study.

Conte A, Giannantoni A, Gubbiotti M, Pontecorvo S, Millefiorini E, Francia A, Porena M, Berardelli A - Toxins (Basel) (2015)

Bottom Line: In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly.Volumes at the first, normal and strong desire to void and MCC increased significantly.Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy. simona.pontecorvo@yahoo.it.

ABSTRACT
Patients with multiple sclerosis (MS) often complain of urinary disturbances characterized by overactive bladder syndrome and difficulties in bladder emptying. The aim of the study was to investigate the pathophysiology of bladder dysfunction and the neurophysiological effects of intradetrusorial incobotulinum toxin A (BoNT/A) in patients with MS having both brain and spinal MS-related lesions. Twenty-five MS patients with neurogenic detrusor overactivity (NDO) underwent clinical evaluation and soleus Hoffmann reflex (H reflex) study during urodynamics. Of the 25 patients, 14 underwent a further session one month after intradetrusorial BoNT/A injection. Eighteen healthy subjects acted as the control. In healthy subjects, the H reflex size significantly decreased at maximum cystometric capacity (MCC), whereas in MS patients with NDO, the H reflex remained unchanged. In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly. Volumes at the first, normal and strong desire to void and MCC increased significantly. Despite its efficacy in improving bladder symptoms and in increasing volumes for first desire, normal and strong desire to void, BoNT/A left the H reflex modulation during bladder filling unchanged. In the MS patients we studied having both brain and spinal MS-related lesions, the H reflex size remained unchanged at maximum bladder filling. Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions. BoNT/A improves bladder dysfunction by changing bladder afferent input, as shown by urodynamic findings on bladder filling sensations, but its effects on H reflex modulation remain undetectable.

No MeSH data available.


Related in: MedlinePlus

Changes in H reflex size during bladder filling in healthy subjects and patients with multiple sclerosis (MS); * indicates statistical significance.
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toxins-07-03424-f001: Changes in H reflex size during bladder filling in healthy subjects and patients with multiple sclerosis (MS); * indicates statistical significance.

Mentions: Between group repeated-measures ANOVA for changes in the H reflex size during bladder filling at the baseline assessment in patients with MS and healthy subjects showed a significant effect of factor bladder filling (F1,41 = 27.67; p < 0.0001), a significant two-way interaction between factors bladder filling and group (F1,41 = 31.71; p < 0.0001) and a non-significant factor group (F1,41 = 3.97; p = 0.05). Post hoc analysis showed that in healthy subjects, the H reflex size was significantly inhibited at MCC (p < 0.001), whereas in patients with MS, it remained almost unchanged (p = 0.71) (Figure 1; Table 2). Unlike the H reflex, the M wave remained unchanged throughout the experiments (bladder filling: F1,41 = 0.11; p = 0.73; bladder filling and group interaction: F1,41 = 1.57; p = 0.22) (Table 2).


Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study.

Conte A, Giannantoni A, Gubbiotti M, Pontecorvo S, Millefiorini E, Francia A, Porena M, Berardelli A - Toxins (Basel) (2015)

Changes in H reflex size during bladder filling in healthy subjects and patients with multiple sclerosis (MS); * indicates statistical significance.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4591651&req=5

toxins-07-03424-f001: Changes in H reflex size during bladder filling in healthy subjects and patients with multiple sclerosis (MS); * indicates statistical significance.
Mentions: Between group repeated-measures ANOVA for changes in the H reflex size during bladder filling at the baseline assessment in patients with MS and healthy subjects showed a significant effect of factor bladder filling (F1,41 = 27.67; p < 0.0001), a significant two-way interaction between factors bladder filling and group (F1,41 = 31.71; p < 0.0001) and a non-significant factor group (F1,41 = 3.97; p = 0.05). Post hoc analysis showed that in healthy subjects, the H reflex size was significantly inhibited at MCC (p < 0.001), whereas in patients with MS, it remained almost unchanged (p = 0.71) (Figure 1; Table 2). Unlike the H reflex, the M wave remained unchanged throughout the experiments (bladder filling: F1,41 = 0.11; p = 0.73; bladder filling and group interaction: F1,41 = 1.57; p = 0.22) (Table 2).

Bottom Line: In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly.Volumes at the first, normal and strong desire to void and MCC increased significantly.Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy. simona.pontecorvo@yahoo.it.

ABSTRACT
Patients with multiple sclerosis (MS) often complain of urinary disturbances characterized by overactive bladder syndrome and difficulties in bladder emptying. The aim of the study was to investigate the pathophysiology of bladder dysfunction and the neurophysiological effects of intradetrusorial incobotulinum toxin A (BoNT/A) in patients with MS having both brain and spinal MS-related lesions. Twenty-five MS patients with neurogenic detrusor overactivity (NDO) underwent clinical evaluation and soleus Hoffmann reflex (H reflex) study during urodynamics. Of the 25 patients, 14 underwent a further session one month after intradetrusorial BoNT/A injection. Eighteen healthy subjects acted as the control. In healthy subjects, the H reflex size significantly decreased at maximum cystometric capacity (MCC), whereas in MS patients with NDO, the H reflex remained unchanged. In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly. Volumes at the first, normal and strong desire to void and MCC increased significantly. Despite its efficacy in improving bladder symptoms and in increasing volumes for first desire, normal and strong desire to void, BoNT/A left the H reflex modulation during bladder filling unchanged. In the MS patients we studied having both brain and spinal MS-related lesions, the H reflex size remained unchanged at maximum bladder filling. Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions. BoNT/A improves bladder dysfunction by changing bladder afferent input, as shown by urodynamic findings on bladder filling sensations, but its effects on H reflex modulation remain undetectable.

No MeSH data available.


Related in: MedlinePlus