Purpose: Neurogenic detrusor overactivity (NDO. The muscle controlling bladder contraction is over active = urinary incontinence) is common in patients who suffer from multiple sclerosis (MS). When the usual pharmacological treatment fails, botulinum toxin type A (BTX-A=Botox) 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.
Materials and Methods: Seventy-one patients with MS underwent their first BTX-A injection for refractory (doesn't respond to therapy) NDO. They had bladder function assessed 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 = when you've gotta, you've gotta go).
BoTox Injection Sites
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 vladder 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 (inhibit acetyl choline that is a nerve transmitter chemical) drugs fail to reduce NDO.
More confirmatory evidence for the value of Botox...its not just about fixing foreheads but it can be a valuble medicine. Please leave a look at previous posts