Intravesical injection of botulinum toxin type a may be an effective treatment option for autonomic dysreflexia in patients with high-level spinal cord injury

Objective To evaluate the efficacy of intravesical injection of botulinum toxin type A (BTX-A) for neurogenic detrusor overactivity (DO) in reducing the frequency and severity of autonomic dysreflexia (AD). Design A cross-sectional nonrandomized trial with before (baseline) and after (follow-up) assessments. Setting A single spinal cord injury (SCI) rehabilitation center in China. Participants Twenty-five patients with SCI at or above T6 and a history of AD who underwent urodynamic studies (UDS) before and 3 months after BTX-A injection. Interventions Received bladder injection treatment wtih 200 U BTX-A. Outcome Measures The maximum detrusor pressure(Pdetmax) and voume at first DO(VFIDC), baseline and overall maximum systolic blood pressure (SBP) during UDS, and scores of Incontinence Specific Quality of Life Instrument (IQoL) were recorded before and 3 months after the injection. The change in SBP (Delta SBP) from baseline to maximum SBP during UDS was calculated to assess the severity. The frequency of AD was recorded using ambulatory blood pressure monitoring during a 24 h period before and 3 months after the injection. Results BTX-A injection decreased the Pdetmax and increased the VFIDC and mean urine volume per catheterization increased. The maximum SBP and the Delta SBP during UDS decreased significantly decreased after the injection (151.44 +/- 13.92 vs 133.32 +/- 9.20 mmHg and 49.44 +/- 12.81 vs 33.08 +/- 9.11 mmHg respectively, P < 0.05). The frequency of bladder-related ADs (i.e. performed a clean intermittent catheterization or leakage) during a 24-h period significantly decreased from 11.04 +/- 1.81-7.88 +/- 2.15 (P < 0.001). Conclusions BTX-A decreases the severity of SBP increase and the number of AD episodes 3 months after intravesical injection.