title: Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury.
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.
authors.affiliation: 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Renée J
authors.initials: RJ
authors.lastname: Fougere
authors.affiliation: 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Katharine D
authors.initials: KD
authors.lastname: Currie
authors.affiliation: 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Mark K
authors.initials: MK
authors.lastname: Nigro
authors.affiliation: 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Lynn
authors.initials: L
authors.lastname: Stothers
authors.affiliation: 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .
authors.forename: Daniel
authors.initials: D
authors.lastname: Rapoport
authors.affiliation: 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|3 Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .|4 G.F. Strong Rehabilitation Centre , Vancouver, British Columbia, Canada .
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Krassioukov
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000627:therapeutic use*; D000328:Adult; D020211:Autonomic Dysreflexia / Q000188:drug therapy* / Q000209:etiology; D001794:Blood Pressure / Q000187:drug effects; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000209:etiology
chemical_list: D065087:Acetylcholine Release Inhibitors; D019274:Botulinum Toxins, Type A
keywords: Botox; ambulatory blood pressure monitoring; blood pressure; cardiovascular; neurogenic bladder