Botulinum toxin A for overactive bladder and detrusor muscle overactivity in patients with Parkinson's disease and multiple system atrophy.
OBJECTIVE
Urinary disturbances are common in patients with Parkinson's disease and multiple system atrophy. We investigated the effectiveness and safety of botulinum toxin type A injected into the detrusor muscle in patients with Parkinson's disease and multiple system atrophy who had refractory overactive bladder symptoms and detrusor overactivity.


METHODS
All participants underwent clinical and urodynamic assessment, and completed a quality of life questionnaire before botulinum toxin type A treatment, and 1 and 3 months thereafter. Four patients with Parkinson's disease and 2 with multiple system atrophy were enrolled in the study. All patients received 200 U botulinum toxin type A injected into the detrusor muscle at 20 sites under cystoscopic guidance at a single session on an inpatient basis. Outcome measures were clinical assessment (a voiding diary including daytime and nighttime urinary frequency, and episodes of urgency and urge urinary incontinence), urodynamic assessment (including first volume and maximum pressure of uninhibited detrusor contractions, and maximum cystometric capacity) and pressure flow studies.


RESULTS
One and 3 months after botulinum toxin type A injection all patients reported that daytime and nighttime urinary frequency had decreased and quality of life scores improved. No patients had further episodes of urgency and urge urinary incontinence during the 5-month followup. Urodynamics showed improvement in all urinary function variables tested. No systemic side effects were recorded during or after treatment. In all patients post-void urinary residual volume increased and intermittent catheterization was required only in those with multiple system atrophy.


CONCLUSIONS
The new beneficial effect that we report in a small study sample encourages larger trials to confirm botulinum toxin type A injection into the detrusor muscle as an effective and safe treatment for refractory overactive bladder symptoms and detrusor overactivity related to Parkinson's disease and multiple system atrophy.
Giannantoni
Antonella
A
Department of Urology and Andrology, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy. agianton@libero.it
Rossi
Aroldo
A
Mearini
Ettore
E
Del Zingaro
Michele
M
Porena
Massimo
M
Berardelli
Alfredo
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019578:Multiple System Atrophy / Q000150:complications*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000150:complications*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A