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Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury

View Article: PubMed Central - PubMed

ABSTRACT

Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed autonomic dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant autonomic dysreflexia and neurogenic detrusor overactivity, underwent blood pressure monitoring during urodynamics and over a 24 h period using ambulatory blood pressure monitoring pre- and 1 month post-treatment. Post-onabotulinumtoxinA, autonomic dysreflexia severity was reduced during urodynamics (systolic blood pressure increase: 42 ± 23 mm Hg vs. 20 ± 10 mm Hg, p < 0.001) and during bladder-related events across the 24 h period (systolic blood pressure increase: 49 ± 2 mm Hg vs. 26 ± 22 mm Hg, p = 0.004). Frequency of 24 h bladder-related autonomic dysreflexia events was also decreased post-onabotulinumtoxinA (4 ± 2 events vs. 1 ± 1 events, p < 0.001). Autonomic dysreflexia and incontinence quality of life indices were also improved post-onabotulinumtoxinA (p < 0.05). Intradetrusor injections of onabotulinumtoxinA for the management of neurogenic detrusor overactivity in individuals with high level spinal cord injuries decreased the severity and frequency of bladder-related episodes of autonomic dysreflexia, and improved bladder function and quality of life.

No MeSH data available.


Individual systolic blood pressure (SBP) responses during urodynamic studies (UDS) pre- and post-Botox. Panel A: SBP at the participant's first urge to perform a clean intermittent catheterization (CIC). Panel B: SBP at maximum bladder infusion. Panel C: Maximum SBP reached during UDS.
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f1: Individual systolic blood pressure (SBP) responses during urodynamic studies (UDS) pre- and post-Botox. Panel A: SBP at the participant's first urge to perform a clean intermittent catheterization (CIC). Panel B: SBP at maximum bladder infusion. Panel C: Maximum SBP reached during UDS.

Mentions: SBP and HR values during UDS are presented in Table 2, and individual SBP responses are illustrated in Figure 1. SBP and HR at baseline were unchanged between pre- and post-Botox assessments. However, SBP at the first urge to perform CIC, at the maximum volume infused, and the overall maximum SBP during UDS, were all decreased 1 month post-Botox. The change in SBP from baseline (ΔSBP) was used to quantify the severity of AD. All participants presented with AD pre-Botox (ΔSBP ≥20 mm Hg), whereas post-Botox it was eliminated in 10 (59%). AD severity was attenuated in the remaining seven. The majority of participants also experienced AD during the first urge to perform CIC and maximum infusion, and the severity of AD during these time points was significantly reduced post-Botox. Pre-Botox UDS, 15 participants (88%) reported at least one symptom of AD including goosebumps, chills/tingles, flushing, or headache. Post-Botox, self-reported symptoms decreased (p = 0.034), with only 9 (53%) reporting symptoms. The ΔHR was only reduced post-Botox at maximum infusion and maximum SBP. Of the 17 participants, 14 experienced the typical reduction in HR during AD whereas the other 3 participants experienced an increase in HR.


Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury
Individual systolic blood pressure (SBP) responses during urodynamic studies (UDS) pre- and post-Botox. Panel A: SBP at the participant's first urge to perform a clean intermittent catheterization (CIC). Panel B: SBP at maximum bladder infusion. Panel C: Maximum SBP reached during UDS.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5035837&req=5

f1: Individual systolic blood pressure (SBP) responses during urodynamic studies (UDS) pre- and post-Botox. Panel A: SBP at the participant's first urge to perform a clean intermittent catheterization (CIC). Panel B: SBP at maximum bladder infusion. Panel C: Maximum SBP reached during UDS.
Mentions: SBP and HR values during UDS are presented in Table 2, and individual SBP responses are illustrated in Figure 1. SBP and HR at baseline were unchanged between pre- and post-Botox assessments. However, SBP at the first urge to perform CIC, at the maximum volume infused, and the overall maximum SBP during UDS, were all decreased 1 month post-Botox. The change in SBP from baseline (ΔSBP) was used to quantify the severity of AD. All participants presented with AD pre-Botox (ΔSBP ≥20 mm Hg), whereas post-Botox it was eliminated in 10 (59%). AD severity was attenuated in the remaining seven. The majority of participants also experienced AD during the first urge to perform CIC and maximum infusion, and the severity of AD during these time points was significantly reduced post-Botox. Pre-Botox UDS, 15 participants (88%) reported at least one symptom of AD including goosebumps, chills/tingles, flushing, or headache. Post-Botox, self-reported symptoms decreased (p = 0.034), with only 9 (53%) reporting symptoms. The ΔHR was only reduced post-Botox at maximum infusion and maximum SBP. Of the 17 participants, 14 experienced the typical reduction in HR during AD whereas the other 3 participants experienced an increase in HR.

View Article: PubMed Central - PubMed

ABSTRACT

Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed autonomic dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant autonomic dysreflexia and neurogenic detrusor overactivity, underwent blood pressure monitoring during urodynamics and over a 24 h period using ambulatory blood pressure monitoring pre- and 1 month post-treatment. Post-onabotulinumtoxinA, autonomic dysreflexia severity was reduced during urodynamics (systolic blood pressure increase: 42 ± 23 mm Hg vs. 20 ± 10 mm Hg, p < 0.001) and during bladder-related events across the 24 h period (systolic blood pressure increase: 49 ± 2 mm Hg vs. 26 ± 22 mm Hg, p = 0.004). Frequency of 24 h bladder-related autonomic dysreflexia events was also decreased post-onabotulinumtoxinA (4 ± 2 events vs. 1 ± 1 events, p < 0.001). Autonomic dysreflexia and incontinence quality of life indices were also improved post-onabotulinumtoxinA (p < 0.05). Intradetrusor injections of onabotulinumtoxinA for the management of neurogenic detrusor overactivity in individuals with high level spinal cord injuries decreased the severity and frequency of bladder-related episodes of autonomic dysreflexia, and improved bladder function and quality of life.

No MeSH data available.