Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury

Renée J Fougere, Katharine D Currie, Mark K Nigro, Lynn Stothers, Daniel Rapoport, Andrei V Krassioukov, Renée J Fougere, Katharine D Currie, Mark K Nigro, Lynn Stothers, Daniel Rapoport, Andrei V Krassioukov

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.

Keywords: Botox; ambulatory blood pressure monitoring; blood pressure; cardiovascular; neurogenic bladder.

Conflict of interest statement

Author Disclosure Statement No competing financial interests exist.

Figures

FIG. 1.
FIG. 1.
Individual systolic blood pressure (SBP) responses during urodynamic studies (UDS) pre- and post-Botox. Panel A: SBP at the participant's first urge to perform a clean intermittent catheterization (CIC). Panel B: SBP at maximum bladder infusion. Panel C: Maximum SBP reached during UDS.
FIG. 2.
FIG. 2.
Overview of the incidence of autonomic dysreflexia (AD) during bladder-related events during a 24 h period pre- and post-Botox. Open bars represent the number of bladder events (i.e., require participant to perform clean intermittent catheterization [CIC]). Black bars represent the number of these events which elicited AD (i.e., Δsystolic blood pressure [SBP] ≥20 mm Hg). Data are presented as mean ± SD. *p < 0.001 vs. pre-Botox for both number of bladder events, and AD during bladder event.

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