Improvement in autonomic dysreflexia after detrusor onabotulinumtoxinA injections in patients with chronic spinal cord injuries

ObjectivesTo investigate the therapeutic effects of repeated detrusor onabotulinumtoxinA (BoNT-A) injections on autonomic dysreflexia (AD) in patients with chronic spinal cord injuries (SCI).Materials and MethodsA total of 49 patients with SCI were enrolled to receive two sets of 200 U BoNT-A injections into the detrusor at baseline and 6 months later. The primary end points were improvement in the severity of AD and net change in the grade of incontinence. Secondary end points included net changes in the scores of the Urogenital Distress Inventory (UDI-6), Incontinence Impact Questionnaire, and quality of life index as well as urodynamic parameters.ResultsA total of 31 men and 18 women with cervical (n = 27) or thoracic (n = 22) SCI were enrolled. They had a mean age of 41.6 years and duration of injury of 8 years. Fifteen patients did not have AD at baseline or after treatment. AD was completely resolved in three patients, and improved in 18; treatment made no difference in three patients and AD was exacerbated in 10. There were no significant differences in any urodynamic variables between patients with and without AD. A significantly greater improvement in the UDI-6 was noted in patients without AD and those in whom AD improved than in those with AD. The occurrence of AD was also not significantly associated with persistent urinary incontinence after the BoNT-A injections. There was no significant difference in the quality of life index between patients with and without AD at the end point.ConclusionDetrusor BoNT-A injections improved AD in 62% of SCI patients with AD at baseline.