Botulinum toxin A modulates afferent fibers in neurogenic detrusor overactivity
Autor: | A, Conte, A, Giannantoni, S, Proietti, S, Giovannozzi, G, Fabbrini, A, Rossi, M, Porena, A, Berardelli |
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Rok vydání: | 2012 |
Předmět: |
Adult
Male Afferent Pathways Analysis of Variance Electromyography Urinary Bladder Overactive Statistics as Topic Parkinson Disease Ultrasonography Doppler Middle Aged H-Reflex Urodynamics Neuromuscular Agents Humans Female Botulinum Toxins Type A Muscle Skeletal Spinal Cord Injuries Aged Follow-Up Studies Pain Measurement |
Zdroj: | European journal of neurology. 19(5) |
ISSN: | 1468-1331 |
Popis: | Although botulinum toxin (BoNT/A) injected into the detrusor muscle improves overactive bladder symptoms in patients with neurogenic detrusor overactivity, how it does so remains unclear. In this study, we investigated whether BoNT/A improves detrusor overactivity by modulating bladder afferent activity. To do so, during urodynamic assessment, we tested the soleus muscle Hoffmann (H) reflex during bladder filling before and after intradetrusor BoNT/A in patients with Parkinson's disease (PD) and in patients with complete chronic spinal cord lesion (SCI) and detrusor overactivity refractory to conventional therapy. Healthy subjects underwent H reflex studies during urodynamic assessment and acted as controls. Our findings show that BoNT/A injected into the detrusor muscle effectively reduces clinical overactive bladder symptoms in patients with PD and SCI. In healthy subjects and patients with PD, bladder filling [at maximum cystometric capacity, (MCC)] significantly decreased the H reflex size, whereas in patients with SCI, it slightly facilitated the H reflex size. At MCC, in patients with PD, BoNT/A significantly reduced the expected H reflex inhibition, whereas in those with SCI, BoNT/A turned the H reflex facilitation at maximum bladder filling into a slight inhibition. These findings show that BoNT/A injected into the detrusor muscle in patients with PD and SCI modulates bladder afferent activity. Modulation of bladder afferents possibly explains why BoNT/A improves detrusor overactivity. |
Databáze: | OpenAIRE |
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