Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury
| Autor: | Per Bagi, Niels Klarskov, Katrine P. Hebert, Fin Biering-Sørensen, Marlene Elmelund |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Meningomyelocele Spinal Cord Diseases Kaplan-Meier Estimate Kaplan meier analysis Botulinum toxin a Outcome Assessment Health Care medicine Humans Continuation rate Botulinum Toxins Type A Spinal cord injury Spinal Cord Injuries Proportional Hazards Models Retrospective Studies Urinary Bladder Overactive business.industry General Medicine Middle Aged medicine.disease Discontinuation Neuromuscular Agents Neurology Anesthesia Female Neurology (clinical) business Follow-Up Studies |
| Zdroj: | Spinal Cord. 58:675-681 |
| ISSN: | 1476-5624 1362-4393 |
| DOI: | 10.1038/s41393-019-0411-0 |
| Popis: | Retrospective chart study.The aim was to examine continuation of treatment of individuals with spinal cord injury including myelomeningocele and neurogenic detrusor overactivity, treated with repeated intra-detrusor Botulinum toxin A injections, and to investigate factors associated with discontinuation of treatment.Rigshospitalet, Denmark METHODS: This study included 128 individuals with spinal cord injury and neurogenic detrusor overactivity, who were offered repeated Botulinum toxin A injections between 2001 and 2018. Continuation rates of the treatment were estimated using Kaplan Meier analysis. A Cox proportional hazard analysis was used to investigate factors predictive of discontinuation.A total of 1156 treatments were performed. The median number of treatments was six (IQR 9, range 1-51), and median follow-up was 10.6 years (IQR 8.5, range 0-16.9). All urodynamic parameters changed significantly after the first treatment (p 0.001). The continuation group had significantly higher mean maximum bladder capacity after the first injections compared with the discontinuation group, with a mean difference between the groups of 84.5 mL (95% CI 4.7-164.2) (p = 0.038). The probability of continuing treatments after 5 years was 59% (95% CI 50.0-67.8) and 50% (95% CI 40.1-59.3) after 10 years. Individuals aged 31-50 years were more likely to continue treatment compared with those aged50 years (95% CI 0.21‒0.79) (p = 0.008). No other factors predicted discontinuation.This long-term follow-up study showed that 50% of people with spinal cord injury starting intra-detrusor Botulinum toxin A for neurogenic detrusor overactivity are still receiving injections after 10 years. |
| Databáze: | OpenAIRE |
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