title: Long-term effect on quality of life of repeat detrusor injections of botulinum neurotoxin-A for detrusor overactivity in patients with multiple sclerosis.
abstract: OBJECTIVE
  We studied the effect of repeat detrusor botulinum neurotoxin type A injections on urinary symptoms, health and quality of life in patients with refractory neurogenic detrusor overactivity secondary to multiple sclerosis.
  
  
  METHODS
  This was a prospective, open label, single center study in 137 patients with multiple sclerosis treated with detrusor injections of botulinum neurotoxin type A with observations made from 2002 to 2009. A minimally invasive outpatient technique was used for injection. Patients were asked to contact the department if and when they required repeat treatment. Recurrent detrusor overactivity was then identified on urodynamics. The primary outcomes measured were the change in symptoms and quality of life, as assessed by the Urogenital Distress Inventory, Incontinence Impact Questionnaire and EuroQol-5 Dimensions questionnaires (www.ion.ucl.ac.uk/departments/repair/themes/uroneurology) before and 4 weeks after botulinum treatment. Continence status, the need for clean intermittent self-catheterization before and after injections, and interinjection intervals were also analyzed.
  
  
  RESULTS
  Mean Urogenital Distress Inventory and Incontinence Impact Questionnaire 7 scores showed considerable improvement 4 weeks after each treatment even when repeated 6 times. Almost all patients relied on clean intermittent self-catheterization after treatment. Before the first treatment 83% of patients were incontinent but 4 weeks after the first treatment 76% (104 of 137) became completely dry. This efficacy was sustained with repeat injections. The median interval between re-treatments remained constant at 12 to 13 months.
  
  
  CONCLUSIONS
  Repeated detrusor botulinum neurotoxin type A injections for refractory neurogenic detrusor overactivity in patients with multiple sclerosis have a consistent effect on bladder control, resulting in sustained improvement in quality of life.
authors.affiliation: Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals National Health Service Foundation Trust, London, United Kingdom. drshahidkhan@yahoo.com
authors.forename: Shahid
authors.initials: S
authors.lastname: Khan
authors.forename: Xavier
authors.initials: X
authors.lastname: Game
authors.forename: Vinay
authors.initials: V
authors.lastname: Kalsi
authors.forename: Gwen
authors.initials: G
authors.lastname: Gonzales
authors.forename: Jalesh
authors.initials: J
authors.lastname: Panicker
authors.forename: Sohier
authors.initials: S
authors.lastname: Elneil
authors.forename: Apostolos
authors.initials: A
authors.lastname: Apostolidis
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Kessler
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
mesh_terms: D000283:Administration, Intravesical; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011446:Prospective Studies; D011788:Quality of Life; D019233:Retreatment; D013997:Time Factors; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology; D055815:Young Adult
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A