1713 CAN AUTONOMIC DYSREFLEXIA IMPROVE AFTER DETRUSOR ONABOTULINUMTOXIN A INJECTIONS IN PATIENTS WITH CHRONIC SPINAL CORD INJURIES?

Abstract

INTRODUCTION AND OBJECTIVES: Autonomic dysreflexia (AD) is a common problem in high level of SCI patients, and sometimes it is life threatening. Neurogenic bladder dysfunction usually aggravates and triggers this situation. In animal study, onabotulinumtoxin A (BoNT-A) intravesical injection has shown effective of control AD by reducing involuntary detrusor contraction and nerve growth factor production. This study investigated the therapeutic effects of repeated BoNT-A detrusor injections on AD in patients with chronic spinal cord injuries (SCI). METHODS: Patients with SCI were enrolled to receive two 200-U sets of BoNT-A detrusor injections at baseline and 6 months later. AD symptoms were assessed including increased spasticity, high blood pressure, sweating, flushing, and throbbing headache at baseline and at each visit. The primary end points are improvement of AD severity and net change of incontinence grade. Secondary end points included the net change in scores of the UDI-6, IIQ-7, and Quality of Life-index as well as urodynamic parameters. RESULTS: A total of 31 male and 18 female patients with cervical (n 27) or thoracic (n 22) SCI were enrolled with 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 (Table 1). There was no significant difference in any urodynamic variables between patients with AD and without AD. A significantly greater improvement in the UDI-6 was noted in patients without AD and those in whom AD improved (Table 2). 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. CONCLUSIONS: Detrusor BoNT-A injections improved AD in 62% of SCI patients with AD at baseline.