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Botulinum injections for the treatment of bladder symptoms of multiple sclerosis

Authors

  • Vinay Kalsi MBBS, MRCS,

    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Gwen Gonzales RGN,

    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Roshni Popat MBBS, MRCS, MSc,

    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Apostolos Apostolidis PhD, FEBU,

    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Sohier Elneil MRCOG, PhD,

    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
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  • Prokar Dasgupta MD, FRCS (Urol), FEBU,

    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
    2. Department of Urology, Guy's and St Thomas' Hospital, Kings College London School of Medicine, London, United Kingdom
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  • Clare J. Fowler FRCP

    Corresponding author
    1. Institute of Neurology and Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, London, United Kingdom
    • Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, United Kingdom
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Abstract

Objective

Our objective was to demonstrate the efficacy and impact on quality of life of detrusor injections of botulinum neurotoxin type A in the treatment of bladder dysfunction in patients with multiple sclerosis.

Methods

Forty-three patients with multiple sclerosis suffering from severe urgency incontinence were treated with detrusor injections of botulinum neurotoxin type A. Data from cystometric assessment of the bladder, voiding diaries, quality-of-life questionnaires, and procontinence medication usage were collected before treatment and 4 and 16 weeks after injection. The same data were also collected after repeat treatments.

Results

Highly significant improvements (p < 0.0001) in incontinence episodes and urinary urgency, daytime frequency and nocturia, were the symptomatic reflection of the significant improvements in urodynamically demonstrated bladder function. Although 98% of patients had to perform self-catheterization after treatment, there were sustained improvements in all quality-of-life scores. The mean duration of effect was 9.7 months. Similar results were seen with repeat treatments.

Interpretation

Minimally invasive injections of botulinum neurotoxin type A have been shown to be exceptionally effective in producing a prolonged improvement in urinary continence in patients with multiple sclerosis. This treatment is likely to have a major impact on future management. Ann Neurol 2007

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