Botulinum Toxin in the Treatment of Detrusor Overactivity in Woman Patients with Multiple Sclerosis

Česká verzia

Authors: J. Krhut ¹; R. Zachoval ²; P. Hradílek ³; O. Havránek ¹; O. Zapletalová ³
Authors place of work: Urologické oddělení FN Ostrava ¹; Urologické oddělení 3. LF UK a FTNsP Praha ²; Neurologická klinika FN Ostrava ³
Published in the journal: Cesk Slov Neurol N 2008; 71/104(4): 429-434
Category: Original Paper

Summary

Introduction:
Botulinum toxin A has been used with success in the therapy of both neurogenic and non-neurogenic detrusor overactivity in patients who do not respond to anticholinergic therapy. The goal of the study is to analyse the results of treatment of detrusor overactivity with botulinum toxin (btx) in a set of patients with multiple sclerosis (MS).

Patient set and method:
The set of patients consisted of a total of nine woman patients with multiple sclerosis (MS) and detrusor overactivity refractory to oral anticholinergic therapy. The patients were treated with 1,000 UI intradetrusor Dysport injection, and their bladders were emptied with intermittent catheterisation after treatment. After the application of btx, all oral anticholinergic drugs were withdrawn. The median age of the patient set was 41.6 years (from 31 to 52 years), the median of the EDSS value was 5.2 (3.5–7). Subjective satisfaction and quality of life prior to and three months after the application of btx was evaluated with the use of the King’s Health Questionnaire (KHQ), and the Incontinence – Quality of Life Questionnaire (I-QoL). Data from bladder diaries and urodynamic parametres were evaluated every three months while the effect of the therapy lasted.

Results:
The evaluation of the I-QoL index showed an increase from 16.7 (6.8–25.0) prior to therapy to 72.4 (46.4–93.2) three months after therapy. A significant reduction of the impact of the lower urinary tract dysfunctions on the quality of life three months after therapy was recorded in all sections of the KHQ questionnaire. The frequency of bladder emptying three months after therapy decreased from 19.4/24 hours to 6.8/24 hours, while the voided volume grew from 122.6 to 378.9 ml. Similar results were recorded 6, 9 and 12 months after therapy. Urodynamic measurements three months after therapy showed an increase in cystometric capacity from 175.4 to 450.6 ml, and a decrease in the maximum detrusor pressure from 52.2 cm H₂O to 10.4 cm H₂O. The improvement lasted for 6, 9 and 12 months after therapy. The duration of effect was 12.3 (10–15) months in the set.

Conclusion:
The application of botulinum toxin is an efficient method of treatment of neurogenic detrusor overactivity in woman patients with MS.

Key words:
multiple sclerosis – botulinum toxin – neurogenic bladder – detrusor overactivity

Zdroje

1. Ford HL, Gerry E, Johnson M, Williams R. A prospective study of the incidence, prevalence and mortality of multiple sclerosis in Leeds. J Neurol 2002; 249(3): 260–265.

2. Andersen JT, Bradley WE. Abnormalities of detrusor and sphincter function in multiple sclerosis. Br J Urol 1976; 48(3): 193–198.

3. Ivers RR, Goldstein NP. Multiple sclerosis: a current appraisal of symptoms and signs. Proc Start Meet Mayo Clin 1963; 38: 457–466.

4. Miller H, Simpson CA, Yeates WK. Bladder dysfunction in multiple sclerosis. Br Med J 1965; 1(5445): 1265–1269.

5. Litwiller SE, Frohman EM, Zimmern PE. Multiple sclerosis and the urologist. J Urol 1999; 161(3): 743–757.

6. Zámečník L, Novák K, Soukup V, Havrdová E, Nováková I, Horáková D. Závisí vývoj dysfunkce mikce u roztroušené sklerózy na typu neurologické léčby? Cesk Slov Neurol N 2007; 70/103(6): 687–691.

7. Zachoval R, Pitha J, Medova E, Heracek J, Lukes M, Zalesky M et al. Augmentation cystoplasty in patients with multiple sclerosis. Urol Int 2003; 70(1): 21–26.

8. Montecucco C, Schiavo G. Structure and function of tetanus and botulinum neurotoxins. Q Rev Biophys 1995; 28(4): 423–472.

9. Apostolidis A, Popat R, Yiangou Y, Cockayne D, Ford AP, Davis JB et al. Decreased sensory receptors P2X3 and TRPV1 in suburothelial nerve fibers following intradetrusor injections of botulinum toxin for human detrusor overactivity. J Urol 2005; 174(3): 977–982.

10. Scott AB. Botulinum toxin injection of eye muscles to correct strabismus. Trans Am Ophthalmol Soc 1981; 79: 734–770.

11. Jost WH, Kohl A. Botulinum toxin: evidence-based medicine criteria in rare indications. J Neurol 2001; 248(Suppl 1): 39–44.

12. Bagi P, Biering-Sørensen F. Botulinum toxin A for treatment of neurogenic detrusor overactivity and incontinence in patients with spinal cord lesions. Scand J Urol Nephrol 2004; 38(6): 495–498.

13. Lucioni A, Rapp DE, Gong EM, Fedunok P, Bales GT. Intravesical botulinum type A toxin injection in patients with overactive bladder: Trigone versus trigone-sparing injection. Can J Urol 2006; 13(5): 3291–3295.

14. Kessler TM, Danuser H, Schumacher M, Studer UE, Burkhard FC. Botulinum A toxin injections into the detrusor: an effective treatment in idiopathic and neurogenic detrusor overactivity? Neurourol Urodyn 2005; 24(3): 231–236.

15. Kelleher CJ, Cardozo LD, Khullar V, Salvatore S. A new questionnaire to assess the quality of life of urinary incontinent women. Br J Obstet Gynaecol 1997; 104(12): 1374–1379.

16. Wagner TH, Patrick DL, Bavendam TG, Martin ML, Buesching DP. Quality of life of persons with urinary incontinence: development of a new measure. Urology 1996; 47(1): 67–71.

17. Schurch B, Stöhrer M, Kramer G, Schmid DM, Gaul G, Hauri D. Botulinum–A toxin for treating detrusor hyperreflexia in spinal cord injured patients: a new alternative to anticholinergic drugs? Preliminary results. J Urol 2000; 164(3 Pt 1): 692–697.

18. Reitz A, Stöhrer M, Kramer G, Del Popolo G, Chartier-Kastler E, Pannek J et al. European experience of 200 cases treated with botulinum-A toxin injections into the detrusor muscle for urinary incontinence due to neurogenic detrusor overactivity. Eur Urol 2004; 45(4): 510–515.

19. Schulte-Baukloh H, Michael T, Stürzebecher B, Knispel HH. Botulinum-a toxin detrusor injection as a novel approach in the treatment of bladder spasticity in children with neurogenic bladder. Eur Urol 2003; 44(1): 139–143.

20. Schulte–Baukloh H, Schobert J, Stolze T, Stürzebecher B, Weiss C, Knispel HH. Efficacy of botulinum-A toxin bladder injections for the treatment of neurogenic detrusor overactivity in multiple sclerosis patients: an objective and subjective analysis. Neurourol Urodyn 2006; 25(2): 110–115.

21. Greene P, Fahn S, Diamond B. Development of resistence to botulinumtoxin type A in patients with torticollis. Mov Disord 1994; 9(2): 213–217.

22. Krhut J, Kopecký J, Hradílek P, Zapletalová O, Tvrdík J. Výsledky léčby neurogenních dysfunkcí dolních cest močových aplikací botulinumtoxinu do detruzoru. Česká urologie 2007; 11(3): 154–158.

23. Apostolidis A, Dasgupta P, Fowler CJ. Proposed mechanism for the efficacy of injected botulinum toxin in the treatment of human detrusor overactivity. Eur Urol 2006; 49(4): 644–650.