Injection Of Botulinum Neurotoxin Type Research Articles

81 Botulinum toxin for treatment of non‐neurogenic bladders in children – a case series

Objective: Several studies have shown that intradetrusor injections of botulinum neurotoxin type A may effectively treat intractable spinal neurogenic detrusor overactivity, but fewer reports exist on the use of Botulinum toxin in children with non‐neurogenic detrusor overactivity. The purpose of this study was to investigate the effect of Botulinum injections in the treatment of non‐neurogenic bladders in children.Methods: Six children with overactive bladder symptoms were treated. Their disorder had been refractory to anticholinergics, bladder training and neuromodulation. Urodynamic studies confirmed idiopathic detrusor overactivity. Total of 300 U Botox A was injected into the dome of the bladder as 30 × 10 U injections. For follow up a bladder diary and validated urgency and incontinence charts were completed by patients at 1, 3 6 months.Results: Bladder diaries indicated clear reduction in daytime frequency and nocturia and reduction in pad use. Maximal voiding volume increased significantly. All 6 patients were dry after 6 months. No side effects occurred specifically urinary tract infections or retention. Time Dry Partial Response Nil Response 2 weeks 1 4 1 4 weeks 3 3 0 12 weeks 6 Conclusions: Botox A injection has positive effects in treating non‐neurogenic bladder overactivity in children.

Quality of Life Changes in Patients with Neurogenic versus Idiopathic Detrusor Overactivity after Intradetrusor Injections of Botulinum Neurotoxin Type A and Correlations with Lower Urinary Tract Symptoms and Urodynamic Changes

ObjectiveLittle published data exist on the effect of intradetrusor botulinum neurotoxin type A (BoNT/A) on the quality of life (QOL) of patients with overactive bladder. We examined post-BoNT/A QOL changes of patients with neurogenic detrusor overactivity (NDO) in comparison to those with idiopathic detrusor overactivity (IDO), and their correlations with respective changes in lower urinary tract symptoms (LUTS) and urodynamic parameters. MethodsPatients with urodynamically proven intractable DO were assessed for changes in QOL 4 and 16 wk after treatment with intradetrusor BOTOX® injections (NDO 300U; IDO 200U) using the short forms of the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7). Percent changes in total QOL score were correlated to respective changes in clinical parameters recorded by bladder diaries and voiding cystometry. ResultsForty-eight treated patients (32 NDO, 16 IDO) had QOL data in at least one follow-up. Highly significant decreases (p<0.0001) in mean±standard error QOL score at 4 wk were maintained at 16 wk for both the NDO and IDO subgroups. Percent improvement in QOL score was similar for NDO versus IDO at 4 (67.6±4.5 versus 70.3±7.7, p=0.74) and 16 wk (65.2±5.5 versus 71.9±8.8, p=0.51). Percent changes in QOL score of the whole patient group correlated with changes in 24-h micturition frequency, number of voids associated with urgency, and number of urge incontinence episodes, but not with urodynamic parameters. ConclusionsIntradetrusor BoNT/A produces comparable, significant improvements in the QOL of patients with either NDO or IDO at least up to 16 wk after treatment. In contrast to urodynamic parameters, changes in LUTS appear to be the major determinants of improvements in the patients’ QOL.

A COMPARISON BETWEEN THE RESPONSE OF PATIENTS WITH IDIOPATHIC DETRUSOR OVERACTIVITY AND NEUROGENIC DETRUSOR OVERACTIVITY TO THE FIRST INTRADETRUSOR INJECTION OF BOTULINUM-A TOXIN

Several studies have shown that intradetrusor injections of botulinum neurotoxin type A (BoNT/A) may effectively treat intractable spinal neurogenic detrusor overactivity (NDO), but fewer reports exist on the use of BoNT/A in patients with idiopathic detrusor overactivity (IDO). The purpose of this study was to investigate whether comparable efficacy could be displayed in the response of patients with IDO to those with NDO. In a prospective, open label study, patients with urgency, and/or urgency incontinence due to urodynamically proven intractable detrusor overactivity received 300 units (NDO) or 200 units (IDO) of Botox injected into the bladder with a minimally invasive outpatient technique. Urodynamic maximum cystometric capacity and maximum detrusor pressure during filling, frequency of voids (frequency), number of incontinence episodes (leak) and number of voids associated with urgency per 24 hours (urgency) from 4-day voiding diaries were compared between the 2 groups at baseline and for changes at 4 and 16 weeks after treatment. A total of 44 patients with spinal NDO and 31 with IDO were treated. At 16 weeks, mean +/- standard error maximum cystometric capacity increased from 229.1 +/- 24.8 to 427.0 +/- 26.9 ml, p <0.0001 in NDO and from 193.6 +/- 24.0 to 327.1 +/- 36.1 ml, p=0.0008 in IDO. Maximum detrusor pressure during filling decreased from 60.7 +/- 6.8 to 26.1 +/- 3.7 cm H2O, p <0.0001 in NDO and from 62.1 +/- 10.8 to 45.1 +/- 8.1 cm H2O, p=0.027 in IDO. Frequency decreased from 12.3 +/- 0.7 to 6.6 +/- 0.6 voids per 24 hours, p <0.0001 in NDO and from 13.6 +/- 1.1 to 8.3 +/- 0.7, p=0.0002 in IDO. Leak decreased from 3.9 +/- 0.5 to 0.7 +/- 0.2 incontinence episodes per 24 hours, p <0.0001 in NDO and from 3.2 +/- 0.8 to 0.6 +/- 0.3, p=0.0017 in IDO, and urgency decreased from 7.5 +/- 0.6 to 1.44 +/- 0.3 episodes per 24 hours, p <0.0001 in NDO and from 10.9 +/- 1.7 to 4.9 +/- 1.1, p <0.0001 in IDO. The 2 groups were comparable for baseline data, but percent improvement in urgency was greater in patients with NDO at 4 weeks (78.2% vs 56.3%, p=0.019) and 16 weeks (78.3% vs 50.7%, p=0.013). Of patients with NDO 69% required self-catheterization de novo posttreatment compared with 19.3% of those with IDO. Patients with intractable IDO respond to intradetrusor BoNT/A with equally significant improvements in urodynamic and lower urinary tract symptom parameters as those with spinal NDO, despite the lower dose of toxin used.

Passive Length-tensile Properties of Extraocular Muscles Under Botulinum Toxin Type C

Purpose: Passive length-tension of the extraocular muscle was measured after injection of botulinum neurotoxin type C (BoNT-C) to evaluate its chemo-denervation effect. Methods: BoNT-C was injected unilaterally at 5.0 or 2.5 units in the superior rectus muscle of the albino rabbit. The muscle was separated several times at its original insertion between 3 days to 8 weeks after injection, and the passive length-tension produced by stretching the muscle from its physiologic length was measured. The length-tension curve was analyzed, and the passive load was determined from early components. The compliance was determined by approximating the entire ascending curve by an exponential function. Results: In the 5.0-unit group, the passive load increased significantly 2 weeks after injection but decreased to the level of the control group after 4 weeks and remained at that level until after 8 weeks after injection. In the 2.5-unit group, also, there were changes similar to those in the 5.0-unit group, but the changes were not significant compared to the control group. No significant change was observed in the compliance in either group. Conclusions: Persistent chemo-denervation effect was not observed in passive length-tension at the doses of BoNT-C used in this study. The increase in the passive load soon after injection was suggested to have been caused by the same mechanism as BoNT-A.