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Vaheb S, Mokary Y, Ghoshouni H, Mirmosayyeb O, Moases Ghaffary E, Shaygannejad V, Yazdan Panah M. Onabotulinum toxin A improves neurogenic detrusor overactivity following spinal cord injury: a systematic review and meta-analysis. Spinal Cord 2024; 62:285-294. [PMID: 38637637 DOI: 10.1038/s41393-024-00992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES The current study aimed to assess the efficacy and safety of Onabotulinum toxin A (OBTX-A) treatment for neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients. SETTING Iran. METHODS All relevant articles of clinical trials and cohort studies indexed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases up to September 6, 2022, that addressed OBTX-A treatment for NDO following SCI were included. The quality of eligible studies was evaluated using Cochrane criteria. Also, the weighted mean difference (WMD) was measured with a random-effect model. RESULTS Regarding the overall efficacy after OBTX-A treatment in the short term, volume per void (VV) (WMD = 118.8, 95% CI: 90.9-146.7, p < 0.01), incontinence-quality of life (IQoL) (WMD = 24.3, 95% CI: 15.8-32.8, p < 0.01), and maximum cystometric capacity (MCC) (WMD = 144.5, 95% CI: 132.3 to 156.7, p < 0.01) significantly increased, while maximum detrusor pressure during storage (MDP) (WMD = -30.5, 95% CI: -35.9 to -25.1, p < 0.01) showed a significant decrease. Furthermore, compared to the placebo group at the 200-unit dose, there was a significant increase in MCC (WMD = 113.5, 95% CI: 84.7 to 142.3, p < 0.01) and a significant decrease in MDP (WMD = -27.2, 95% CI: -39.2 to -15.1, p < 0.01). Urinary tract infection (UTI), hematuria, and autonomic dysreflexia were the most common side effects, occurring at rates of 29.6%, 14.8%, and 13.4%, respectively. CONCLUSION Our findings highlighted the effectiveness and safety of OBTX-A as a promising treatment of NDO following SCI.
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Affiliation(s)
- Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Ghoshouni
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Moases Ghaffary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Yazdan Panah
- Students Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran.
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Weber AM, Nightingale TE, Jarrett M, Lee AHX, Campbell OL, Walter M, Lucas SJE, Phillips A, Rauscher A, Krassioukov AV. Cerebrovascular Reactivity Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2024; 30:78-95. [PMID: 38799609 PMCID: PMC11123610 DOI: 10.46292/sci23-00068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background Spinal cord injuries (SCI) often result in cardiovascular issues, increasing the risk of stroke and cognitive deficits. Objectives This study assessed cerebrovascular reactivity (CVR) using functional magnetic resonance imaging (fMRI) during a hypercapnic challenge in SCI participants compared to noninjured controls. Methods Fourteen participants were analyzed (n = 8 with SCI [unless otherwise noted], median age = 44 years; n = 6 controls, median age = 33 years). CVR was calculated through fMRI signal changes. Results The results showed a longer CVR component (tau) in the grey matter of SCI participants (n = 7) compared to controls (median difference = 3.0 s; p < .05). Time since injury (TSI) correlated negatively with steady-state CVR in the grey matter and brainstem of SCI participants (RS = -0.81, p = .014; RS = -0.84, p = .009, respectively). Lower steady-state CVR in the brainstem of the SCI group (n = 7) correlated with lower diastolic blood pressure (RS = 0.76, p = .046). Higher frequency of hypotensive episodes (n = 7) was linked to lower CVR outcomes in the grey matter (RS = -0.86, p = .014) and brainstem (RS = -0.89, p = .007). Conclusion Preliminary findings suggest a difference in the dynamic CVR component, tau, between the SCI and noninjured control groups, potentially explaining the higher cerebrovascular health burden in SCI individuals. Exploratory associations indicate that longer TSI, lower diastolic blood pressure, and more hypotensive episodes may lead to poorer CVR outcomes. However, further research is necessary to establish causality and support these observations.
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Affiliation(s)
- Alexander Mark Weber
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, British Columbia, Canada
- Department of Neuroscience, University of British Columbia, Vancouver, BC, Canada
| | - Tom E. Nightingale
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Trauma Sciences Research, University of Birmingham, Edgbaston, Birmingham, UK
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Michael Jarrett
- MRI Research Centre, University of British Columbia, Vancouver, Canada
| | - Amanda H. X. Lee
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | - Olivia Lauren Campbell
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- School of Biomedical Engineering, University of British Columbia, British Columbia, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Samuel J. E. Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, UK
| | - Aaron Phillips
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- RestoreNetwork, Hotchkiss Brain Institute, Libin Cardiovascular Institute, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander Rauscher
- Division of Neurology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- MRI Research Centre, University of British Columbia, Vancouver, Canada
- Department of Astronomy and Physics, University of British Columbia, Vancouver, BC, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
- G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Calderón-Juárez M, Samejima S, Rempel L, Sachdeva R, Krassioukov A. Autonomic dysreflexia in urological practice: pathophysiology, prevention and treatment considerations. World J Urol 2024; 42:80. [PMID: 38358540 DOI: 10.1007/s00345-024-04781-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
PURPOSE Spinal cord injury (SCI) leads to sensorimotor impairments; however, it can also be complicated by significant autonomic dysfunction, including cardiovascular and lower urinary tract (LUT) dysfunctions. Autonomic dysreflexia (AD) is a dangerous cardiovascular complication of SCI often overlooked by healthcare professionals. AD is characterized by a sudden increase in blood pressure (BP) that can result in severe cardiovascular and cerebrovascular complications. In this review, we provide an overview on the clinical manifestations, risk factors, underlying mechanisms, and current approaches in prevention and management of AD. METHODS After conducting a literature research, we summarized relevant information regarding the clinical and pathophysiological aspects in the context of urological clinical practice CONCLUSIONS: The most common triggers of AD are those arising from LUT, such as bladder distention and urinary tract infections. Furthermore, AD is commonly observed in individuals with SCI during urological procedures, including catheterization, cystoscopy and urodynamics. Although significant progress in the clinical assessment of AD has been made in recent decades, effective approaches for its prevention and treatment are currently lacking.
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Affiliation(s)
- Martín Calderón-Juárez
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Soshi Samejima
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Lucas Rempel
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | - Rahul Sachdeva
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Andrei Krassioukov
- International Collaboration On Repair Discoveries, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, Canada.
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.
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Rempel L, Malik RN, Shackleton C, Calderón-Juárez M, Sachdeva R, Krassioukov AV. From Toxin to Treatment: A Narrative Review on the Use of Botulinum Toxin for Autonomic Dysfunction. Toxins (Basel) 2024; 16:96. [PMID: 38393175 PMCID: PMC10892370 DOI: 10.3390/toxins16020096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/01/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Since its regulatory approval over a half-century ago, botulinum toxin has evolved from one of the most potent neurotoxins known to becoming routinely adopted in clinical practice. Botulinum toxin, a highly potent neurotoxin produced by Clostridium botulinum, can cause botulism illness, characterized by widespread muscle weakness due to inhibition of acetylcholine transmission at neuromuscular junctions. The observation of botulinum toxin's anticholinergic properties led to the investigation of its potential benefits for conditions with an underlying etiology of cholinergic transmission, including autonomic nervous system dysfunction. These conditions range from disorders of the integument to gastrointestinal and urinary systems. Several formulations of botulinum toxin have been developed and tested over time, significantly increasing the availability of this treatment for appropriate clinical use. Despite the accelerated and expanded use of botulinum toxin, there lacks an updated comprehensive review on its therapeutic use, particularly to treat autonomic dysfunction. This narrative review provides an overview of the effect of botulinum toxin in the treatment of autonomic dysfunction and summarizes the different formulations and dosages most widely studied, while highlighting reported outcomes and the occurrence of any adverse events.
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Affiliation(s)
- Lucas Rempel
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
| | - Raza N. Malik
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Claire Shackleton
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Martín Calderón-Juárez
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Rahul Sachdeva
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries, Faculty of Medicine, The University of British Columbia, Vancouver, BC V5Z 1M9, Canada; (L.R.); (R.N.M.); (C.S.); (M.C.-J.); (R.S.)
- Division of Physical Medicine and Rehabilitation, Department of Medicine, The University of British Columbia, Vancouver, BC V5Z 2G9, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC V5Z 2G9, Canada
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Licow-Kamińska AA, Ciećwież SM, Ptak M, Kotlęga D, Brodowska A. Quality of Life in Female Patients with Overactive Bladder after Botulinum Toxin Treatment. Toxins (Basel) 2023; 16:7. [PMID: 38276531 PMCID: PMC10819285 DOI: 10.3390/toxins16010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/10/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Manifestations of OAB can considerably diminish the quality of life. Botulinum toxin has emerged as a valuable treatment option in diseases whose symptoms cannot be controlled adequately with other available therapies. The aim of the present study was to compare the subjective quality of life of patients with OAB before the injection of botulinum toxin and three and six months after the intervention. METHODS This study was based on a diagnostic survey with three validated questionnaires, ICIQ-OAB, ICIQ-OABqol, and ICIQ-LUTSqol, and an additional questionnaire developed by the authors to collect sociodemographic characteristics and selected medical data. RESULTS This study demonstrated significant differences between pre-treatment scores and those at three and six months post injection. At three and six months after the intervention, mean scores for all three instruments (ICIQ-OAB, ICIQ-OABqol, ICIQ-LUTSqol) were significantly lower than the respective pre-treatment values, implying a significant attenuation of OAB symptoms and their lower impact on the quality of life. However, the severity of OAB symptoms and their impact on the quality of life at six months post intervention were significantly higher than at three months, except for the social interaction domain. CONCLUSIONS Botulinum toxin is an effective treatment for OAB.
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Affiliation(s)
- Agnieszka A. Licow-Kamińska
- Department of Neonates, Pathology and Intensive Therapy, Independent Public Specialist Institute of Health “Zdroje”, ul. Mączna 4, 70-780 Szczecin, Poland;
- Department of Children Disease and Children Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland
| | - Sylwester M. Ciećwież
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland;
| | - Magdalena Ptak
- Independent Subdepartment of Perineological Physiotherapy, Pomeranian Medical University in Szczecin, ul. Żołnierska 54, 51-210 Szczecin, Poland;
| | - Dariusz Kotlęga
- Department of Pharmacology and Toxicology, University of Zielona Góra, ul. Licealna 9, 65-417 Zielona Góra, Poland
| | - Agnieszka Brodowska
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University in Szczecin, ul. Unii Lubelskiej 1, 71-252 Szczecin, Poland;
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Ebrahimi H, Maroufi SF, Abdollahzadegan S, Rahimi-Movaghar V. Clinical Practice Guideline Development for Autonomic Dysreflexia in Spinal Cord Injury. Med J Islam Repub Iran 2023; 37:109. [PMID: 38145189 PMCID: PMC10744198 DOI: 10.47176/mjiri.37.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Indexed: 12/26/2023] Open
Abstract
Background Autonomic Dysreflexia (AD) is a crucial emergency complication of cervical and upper thoracic spinal cord injury (SCI). Although there are several treatment options for AD, unfortunately, there is no consensus on the treatment of AD.This study aimed to present Clinical Practice Guidelines (CPG) development for AD in SCI in different conditions. Methods The project was carried out by an executive team of general practitioners and neurosurgeons. A national multidisciplinary panel of experts performed the decision-making step, which consisted of deciding on the final list of recommendations and articulating novel recommendations regarding the infrastructure and fundamental elements necessary for managing patients suffering from AD. Four appraisers evaluated the guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE II) tools. Results A total of 575 articles were found after searching different databases. After the primary screening, title, abstract, and full-text screening were performed, which yielded 9 records. Five were excluded after the AGREE II evaluation. The source guidelines' recommendations were tabulated as possible scenarios for 15 patient/population, intervention, comparison, and outcomes clinical questions. Based on the expert panel's opinion, all the recommendations were adaptable. Finally, the suggestions were transformed into a protocol for managing patients suffering from autonomic dysreflexia. Conclusion This guideline presented the treatment and pharmacotherapy of autonomic dysreflexia. However, the treatment is being updated. We suggest more educational multimedia for health care professionals, primarily in the emergency department.
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Affiliation(s)
- Hannan Ebrahimi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences,
Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran
University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Maroufi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences,
Tehran, Iran
| | - Shayan Abdollahzadegan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences,
Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences,
Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran
University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical
Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
- Spine Program, University of Toronto, Toronto, Canada
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Chen PC, Lee KH, Lee WC, Yeh TC, Kuo YC, Chiang BJ, Liao CH, Meng E, Kao YL, Lee YC, Kuo HC. Treating Neurogenic Lower Urinary Tract Dysfunction in Chronic Spinal Cord Injury Patients-When Intravesical Botox Injection or Urethral Botox Injection Are Indicated. Toxins (Basel) 2023; 15:toxins15040288. [PMID: 37104226 PMCID: PMC10145925 DOI: 10.3390/toxins15040288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/01/2023] [Accepted: 04/11/2023] [Indexed: 04/28/2023] Open
Abstract
Lower urinary tract symptoms (LUTS), such as urgency, urinary incontinence, and/or difficulty voiding, hamper the quality of life (QoL) of patients with spinal cord injury (SCI). If not managed adequately, urological complications, such as urinary tract infection or renal function deterioration, may further deteriorate the patient's QoL. Botulinum toxin A (BoNT-A) injection within the detrusor muscle or urethral sphincter yields satisfactory therapeutic effects for treating urinary incontinence or facilitating efficient voiding; however, adverse effects inevitably follow its therapeutic efficacy. It is important to weigh the merits and demerits of BoNT-A injection for LUTS and provide an optimal management strategy for SCI patients. This paper summarizes different aspects of the application of BoNT-A injection for lower urinary tract dysfunctions in SCI patients and provides an overview of the benefits and drawbacks of this treatment.
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Affiliation(s)
- Po-Cheng Chen
- Urologic Department, En Chu Kong Hospital, New Taipei City 237414, Taiwan
| | - Kau-Han Lee
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan 71004, Taiwan
| | - Wei-Chia Lee
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Ting-Chun Yeh
- Division of Urology, Department of Surgery, Taiwan Adventist Hospital, Taipei City 10556, Taiwan
| | - Yuh-Chen Kuo
- Department of Urology, Yangming Branch of Taipei City Hospital, Taipei 11146, Taiwan
- Department of Exercise and Health Sciences, University of Taipei, Taipei 111036, Taiwan
| | - Bing-Juin Chiang
- College of Medicine, Fu-Jen Catholic University, New Taipei City 24205, Taiwan
- Department of Urology, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
| | - Chun-Hou Liao
- Divisions of Urology, Department of Surgery, Cardinal Tien Hospital, New Taipei City 23148, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Yung-Chin Lee
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 97004, Taiwan
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Heart rate changes associated with autonomic dysreflexia in daily life of individuals with chronic spinal cord injury. Spinal Cord 2022; 60:1030-1036. [PMID: 35680988 DOI: 10.1038/s41393-022-00820-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 05/29/2022] [Accepted: 05/30/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Secondary data analysis. OBJECTIVE To characterize heart rate (HR) changes during autonomic dysreflexia (AD) in daily life for individuals with chronic spinal cord injury (SCI). SETTING University-based laboratory/community-based outpatient. METHODS Cardiovascular data, previously collected during a 24-h ambulatory surveillance period in individuals with chronic SCI, were assessed. Any systolic blood pressure (SBP) increase ≥20 mmHg from baseline was identified and categorized into confirmed AD (i.e., diarized trigger), unknown (i.e., no diary entry), or unlikely AD (i.e., potential exertion driven SBP increase) groups. SBP-associated HR changes were categorized as unchanged, increased or decreased compared to baseline. RESULTS Forty-five individuals [8 females, median age and time since injury of 43 years (lower and upper quartiles 36-50) and 17 years (6-23), respectively], were included for analysis. Overall, 797 episodes of SBP increase above AD threshold were identified and classified as confirmed (n = 250, 31.4%), unknown (n = 472, 59.2%) or unlikely (n = 75, 9.4%). The median number of episodes per individual within the 24-h period was 13 (8-28). HR-decrease/increase ratio was 3:1 for confirmed and unknown, and 1.5:1 for unlikely episodes. HR changes resulting in brady-/tachycardia were 34.4%/2.8% for confirmed, 39.6%/3.4% unknown, and 26.7%/9.3% for unlikely episodes, respectively. CONCLUSIONS Our findings suggest that the majority of confirmed AD episodes are associated with a HR decrease. Using wearable-sensors-derived measures of physical activity in future studies could provide a more detailed characterization of HR changes during AD and improve AD identification.
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Wang CC, Chou ECL, Chuang YC, Lin CC, Hsu YC, Liao CH, Kuo HC. Effectiveness and Safety of Intradetrusor OnabotulinumtoxinA Injection for Neurogenic Detrusor Overactivity and Overactive Bladder Patients in Taiwan-A Phase IV Prospective, Interventional, Multiple-Center Study (Restore Study). Toxins (Basel) 2021; 13:toxins13120911. [PMID: 34941748 PMCID: PMC8707051 DOI: 10.3390/toxins13120911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/16/2022] Open
Abstract
We conducted a phase IV, pre/post multi-center study to evaluate the efficacy and safety of intradetrusor onabotulinumtoxinA injection in patients with neurogenic detrusor overactivity (NDO, n = 119) or overactive bladder (OAB, n = 215). Patients received either 200U (i.e., NDO) and 100U (i.e., OAB) of onabotulinumtoxinA injection into the bladder, respectively. The primary endpoint for all patients was the change in the PPBC questionnaire score at week 4 and week 12 post-treatment compared with baseline. The secondary endpoints were the changes in subjective measures (i.e., questionnaires: NBSS for patients with NDO and OABSS for those with OAB) at week 4 and week 12 post-treatment compared with baseline. Adverse events included symptomatic UTI, de novo AUR, gross hematuria and PVR > 350mL were recorded. The results showed that compared with baseline, PPBC (3.4 versus 2.4 and 2.1, p < 0.001) and NBSS (35.4 versus 20.4 and 18.1, p < 0.001) were significantly improved at 4 weeks and 12 weeks in NDO patients. In addition, compared with baseline, PPBC (3.5 versus 2.3 and 2.0, p < 0.001) and OABSS (9.1 versus 6.2 and 5.7, p < 0.001) were significantly improved at 4 weeks and 12 weeks in OAB patients. Eight (6.7%) had symptomatic UTI and 5 (4.2%) had de novo AUR in NDO patients. Twenty (9.3%) had symptomatic UTI but no de novo AUR in OAB patients. In conclusion, we found that intradetrusor onabotulinumtoxinA injections were safe and improved subjective measures related to NDO or OAB in our cohort.
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Affiliation(s)
- Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 237414, Taiwan;
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli 320314, Taiwan
| | - Eric Chieh-Lung Chou
- Department of Urology, China Medical University Hospital, School of Medicine, China Medical University, Taichung 406040, Taiwan;
| | - Yao-Chi Chuang
- Department of Urology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan;
| | - Chih-Chieh Lin
- Shu-Tien Urological Research Center, Department of Urology, Taipei Veterans General Hospital, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
| | - Yu-Chao Hsu
- Department of Urology, Linko Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyung 333323, Taiwan;
| | - Chun-Hou Liao
- Department of Urology, Cardinal Tien Hospital, School of Medicine, Fu-Jen Catholic University, New Taipei City 242062, Taiwan;
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualiang 970374, Taiwan
- Correspondence:
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Dorey TW, Walter M, Krassioukov AV. Reduced Reflex Autonomic Responses Following Intradetrusor OnabotulinumtoxinA Injections: A Pre-/Post-study in Individuals With Cervical and Upper Thoracic Spinal Cord Injury. Front Physiol 2021; 12:796277. [PMID: 35069256 PMCID: PMC8769099 DOI: 10.3389/fphys.2021.796277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Urodynamic studies (UDS) can provoke autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI) at and above the sixth thoracic spinal segment potentially leading to profound vagally mediated heart rate (HR) reductions. In this study,1 we test the hypothesis that intradetrusor onabotulinumtoxinA injections will improve HR and its variability (HRV) responses to UDS in individuals with cervical and thoracic SCI. A total of 19 participants with chronic SCI (5 women, mean age 42.5 ± 7.9 years) with confirmed neurogenic detrusor overactivity underwent UDS before (i.e., baseline) and 1 month after intradetrusor onabotulinumtoxinA (200 U) injections (post-treatment). Continuous electrocardiography and blood pressure (BP) recordings were used to assess RR-interval, time, and frequency domain metrics of HRV (a surrogate marker of autonomic nervous system activity), and AD pre- and post-treatment. UDS pre-treatment resulted in increased RR-interval as well as time and frequency domain metrics of HRV. Vagally mediated increases in high-frequency (HF) power during UDS were larger in participants with cervical compared to upper thoracic SCI. Post-treatment, UDS had no effect on RR-interval and significantly reduced instances of bradycardia. Furthermore, intradetrusor onabotulinumtoxinA injections significantly reduced time domain metrics of HRV and HF power responses to UDS across all participants. Changes in HRV during UDS could be a potential indicator of improved autonomic cardiovascular function following interventions such as intradetrusor onabotulinumtoxinA injections.
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Affiliation(s)
- Tristan W. Dorey
- Libin Cardiovascular Institute, Department of Cardiac Sciences, Department of Physiology and Pharmacology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland
- *Correspondence: Matthias Walter, Andrei V. Krassioukov,
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- G.F. Strong Rehabilitation Centre, Vancouver, BC, Canada
- *Correspondence: Matthias Walter, Andrei V. Krassioukov,
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