Botulinum Toxin Type A (Botox) Injection in Bladder Dysfunction in Patients with Multiple Sclerosis (Ain Shams experience)

Background: Bladder dysfunction is very common in patients with multiple sclerosis (MS), affecting up to 6090% of patients with MS at any stage during the course of their disease. Bladder dysfunction in MS patients can be classified into (a) Detrusor hyperreflexia or overactivity and (b) Detrusor external sphincter dyssynergia (DESD). Aim of the study: To evaluate the effect of botulinum toxin type A (BTX-A) (BOTOX) in the management of urinary dysfunction in MS patients. Methods: Fifteen (15) clinically definite MS patients, according to Poser criteria, of the relapsing–remitting type(RR) were admitted in Ain Shams University Specialized Hospital (ASUSH ) during one year period, from October 2004 to October 2005 and assessed :clinically, neurophysiologically and radiologically by MRI brain and spinal cord. Urodynamic study was done to classify the type of bladder dysfunction. Patient were treated with either 300 units of botulinum toxin type A (BTX-A) (botox) injected in the bladder base and trigone in cases of detrusor hyperreflexia or 100 to 200 units of botox injection divided in equal doses into the four quadrants of the external sphincter in cases of DESD. Results: Nine patients (60%) had detrusor hyperactivity (hyperreflexia) "Group A" and 6 patients (40%) had detrusor external sphincter dyssynergia, DESD "Group B". The maximum efficacy of BTX-A injection occurred between 7 and 21 days following the injection. Follow up duration ranged from 3-6 months with continuous symptoms improvement. In bladder wall treatment group (group A) with bladder wall hyperreflexia there were highly significant decrease in the number of micturations per 24 hours and highly significant increase in the cystometric capacity (p<0.001) after injection. In urethral treatment group (group B) with DESD there were highly significant decrease in the mean postvoid residual urine volume and in the maximum voiding pressure (P<0.001). Conclusion: Our finding showed that the urodynamic study is an essential tool in diagnosing bladder dysfunction in MS patients and botulinum toxin type A is a promising tool of management of the urinary dysfunction in patients with MS. More study should be done on the use of BTX-A in other neurological disorder with urinary disturbances. (Egypt J. Neurol. Psychiat. Neurosurg., 2006, 43(1): 539-551).