Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study.
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.
Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy. simona.pontecorvo@yahoo.it.|IRCCS Neuromed, Pozzilli, Isernia 86077, Italy. simona.pontecorvo@yahoo.it.
Antonella
A
Conte
Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia 06156, Italy. agianton@libero.it.
Antonella
A
Giannantoni
Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia 06156, Italy. marilena.gubbiotti@gmail.com.
Marilena
M
Gubbiotti
IRCCS Neuromed, Pozzilli, Isernia 86077, Italy. simonapontecorvo@yahoo.it.
Simona
S
Pontecorvo
Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy. enrico.millefiorini@uniroma1.it.
Enrico
E
Millefiorini
Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy. ada.francia@uniroma1.it.
Ada
A
Francia
Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia 06156, Italy. massimo.porena@unipg.it.
Massimo
M
Porena
Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy. alfredo.berardelli@uniroma1.it.|IRCCS Neuromed, Pozzilli, Isernia 86077, Italy. alfredo.berardelli@uniroma1.it.
Alfredo
A
Berardelli
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D013119:Spinal Cord Injuries / Q000188:drug therapy; D001743:Urinary Bladder / Q000187:drug effects / Q000473:pathology; D053201:Urinary Bladder, Overactive / Q000188:drug therapy; D014563:Urodynamics / Q000187:drug effects
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
H reflex; bladder dysfunction; botulinum toxin; multiple sclerosis; viscerosomatic reflex