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Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study

Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy
IRCCS Neuromed, Pozzilli, Isernia 86077, Italy
Department of Surgical and Biomedical Sciences, Urology and Andrology Clinic, University of Perugia, Perugia 06156, Italy
Author to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editor: Michel R. Popoff
Toxins 2015, 7(9), 3424-3435;
Received: 3 July 2015 / Revised: 18 August 2015 / Accepted: 19 August 2015 / Published: 26 August 2015
(This article belongs to the Section Bacterial Toxins)
PDF [462 KB, uploaded 28 August 2015]


Patients with multiple sclerosis (MS) often complain of urinary disturbances characterized by overactive bladder syndrome and difficulties in bladder emptying. The aim of the study was to investigate the pathophysiology of bladder dysfunction and the neurophysiological effects of intradetrusorial incobotulinum toxin A (BoNT/A) in patients with MS having both brain and spinal MS-related lesions. Twenty-five MS patients with neurogenic detrusor overactivity (NDO) underwent clinical evaluation and soleus Hoffmann reflex (H reflex) study during urodynamics. Of the 25 patients, 14 underwent a further session one month after intradetrusorial BoNT/A injection. Eighteen healthy subjects acted as the control. In healthy subjects, the H reflex size significantly decreased at maximum cystometric capacity (MCC), whereas in MS patients with NDO, the H reflex remained unchanged. In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly. Volumes at the first, normal and strong desire to void and MCC increased significantly. Despite its efficacy in improving bladder symptoms and in increasing volumes for first desire, normal and strong desire to void, BoNT/A left the H reflex modulation during bladder filling unchanged. In the MS patients we studied having both brain and spinal MS-related lesions, the H reflex size remained unchanged at maximum bladder filling. Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions. BoNT/A improves bladder dysfunction by changing bladder afferent input, as shown by urodynamic findings on bladder filling sensations, but its effects on H reflex modulation remain undetectable. View Full-Text
Keywords: multiple sclerosis; bladder dysfunction; H reflex; botulinum toxin; viscerosomatic reflex multiple sclerosis; bladder dysfunction; H reflex; botulinum toxin; viscerosomatic reflex

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Conte, A.; Giannantoni, A.; Gubbiotti, M.; Pontecorvo, S.; Millefiorini, E.; Francia, A.; Porena, M.; Berardelli, A. Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study. Toxins 2015, 7, 3424-3435.

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