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UBC Theses and Dissertations

OnabotulinumtoxinA treatment for neurogenic detrusor overactivity and the prevention of autonomic dysreflexia following spinal cord injury Fougere, Renée Julia


Individuals with high-level (>T₆) spinal cord injury (SCI) are prone to the development of a dangerous episodic hypertensive condition called autonomic dysreflexia (AD). The urinary bladder is the number one trigger of AD and is attributed to a condition called neurogenic detrusor overactivity (NDO). Intravesical injections of OnabotulinumtoxinA (Botox) into the detrusor muscle of the bladder in a dose of 200 Units (U) provides effective treatment for NDO. Following Botox, a few studies observed a reduction in AD during urodynamic studies (UDS). In this dissertation, I quantitatively assessed the efficacy of 200 U of intravesical injected Botox into 20 sites of the detrusor muscle on reducing AD severity, frequency and impact on AD-related quality of life (QoL) and bladder-related QoL. A total of 14 individuals (11 male; 3 female), mean age 45 ± 11 years, injury duration of 21 ± 12 years with a traumatic, chronic (> 1 year) SCI at ≥T₆ level underwent arterial blood pressure (BP) and heart rate (HR) monitoring according to an AD cut-off criteria of an increase in systolic BP (SBP) by ≥20 mm Hg above baseline SBP during UDS and 24-hr ambulatory BP monitoring (ABPM). Visit #1 consisted of a UDS pre-screening assessment with BP and HR monitoring. Participants who met the AD cut-off criteria were enrolled and completed 24-hr ABPM, the AD questionnaire, and bladder questionnaire. During Visit #2 (one week later), participants received the Botox injections by the urologist. During Visit #3 (one month later), participants repeated all components of Visit #1. During post-Botox UDS #2, there was a significant reduction in AD severity as per average SBP change (∆) (P = <0.001) and maximum SBP (P = <0.001). There was a significant reduction in bladder-related AD severity SBP∆ (P = 0.001) and frequency (P< 0.001) as well as overall AD severity (P = 0.005) and frequency (P = 0.001) during post-Botox 24-hr ABPM. Significant improvements were found in AD-related QoL (P = 0.0015) and bladder-related QoL (P = 0.0005). AD was abolished in 8/14 (57%). Botox may prove a viable treatment option to reduce AD severity and frequency due to NDO.

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