title: Botulinum toxin A for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients.
abstract: OBJECTIVE
  Neurogenic detrusor overactivity (NDO) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A) injections can be proposed. The safety and efficacy of this treatment are already well known, but only a few studies focus on its use in patients with MS.
  
  
  METHODS
  Seventy-one patients with MS underwent their first BTX-A injection for refractory NDO. They had clinical and urodynamic cystometry assessment before and three months after injection. The patients were divided in three groups according to treatment efficacy: full success (total urinary continence, no overactive detrusor), improvement, or total failure (urge incontinence and overactive detrusor).
  
  
  RESULTS
  77% of the patients had clinical improvement or full success of the treatment with a reduction of their urgency and incontinence. Significant urodynamic improvement after treatment was shown on different parameters: volume at first involuntary bladder contraction (p = 0.0000001), maximum cystometric capacity (p = 0.0035), maximum detrusor pressure (p = 0.0000001). 46% of the patients were in the "full success" group. 31% of the patients had a partial improvement. 23% of the patients had no efficacy of the treatment. Duration of MS was a predictive factor of treatment failure (p = 0.015).
  
  
  CONCLUSIONS
  Despite that a full success was obtained in 46% of the cases, BTX-A injection therapy failed to treat refractory NDO in 23% of patients suffering from MS. Duration of the disease was a predictive factor for an inefficient treatment. The injection therapy should be considered as soon as oral anti cholinergic drugs fail to reduce NDO.
authors.affiliation: Service de Rééducation Neurologique et d'Explorations Périnéales, Hôpital TENON, Paris, France. stephanie.deffontaines@psl.aphp.fr
authors.forename: S
authors.initials: S
authors.lastname: Deffontaines-Rufin
authors.forename: M
authors.initials: M
authors.lastname: Weil
authors.forename: D
authors.initials: D
authors.lastname: Verollet
authors.forename: L
authors.initials: L
authors.lastname: Peyrat
authors.forename: G
authors.initials: G
authors.lastname: Amarenco
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000150:complications / Q000188:drug therapy*; D053201:Urinary Bladder, Overactive / Q000150:complications / Q000188:drug therapy*; D014563:Urodynamics
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A