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. 2015 Aug 26;7(9):3424-35.
doi: 10.3390/toxins7093424.

Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study

Antonella Conte  1   2 , Antonella Giannantoni  3 , Marilena Gubbiotti  4 , Simona Pontecorvo  5 , Enrico Millefiorini  6 , Ada Francia  7 , Massimo Porena  8 , Alfredo Berardelli  9   10
Affiliations

Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study

Antonella Conte et al. Toxins (Basel). .

Abstract

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.

Keywords: H reflex; bladder dysfunction; botulinum toxin; multiple sclerosis; viscerosomatic reflex.

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Figures

Figure 1
Figure 1
Changes in H reflex size during bladder filling in healthy subjects and patients with multiple sclerosis (MS); * indicates statistical significance.
Figure 2
Figure 2
Changes in H reflex size in patients with multiple sclerosis during bladder filling before and after incobotulinum toxin-A (BoNT/A) injection.
See this image and copyright information in PMC

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