Concomitant Botulinum Toxin Injections for Neurogenic Detrusor Overactivity and Spasticity—A Retrospective Analysis of Practice and Safety

Toxins, 2024 · DOI: 10.3390/toxins16060252 · Published: May 28, 2024

Simple Explanation

The study investigates the safety of using botulinum toxin injections (BTIs) to treat both spasticity and neurogenic detrusor overactivity incontinence (NDOI) at the same time in patients with spinal cord injuries (SCIs) and multiple sclerosis (MS). Researchers analyzed data from 72 patients who received both detrusor and skeletal muscle BTIs within a 1-month period. The study looks at the doses used, the timing of injections, and any potential side effects. The findings suggest that this combined approach appears safe when performed within a short timeframe and with appropriate doses, offering a practical way to manage both conditions simultaneously.

Study Duration

5 years (2017–2021)

Participants

72 patients (50 male, 76% SCI, 18% MS)

Evidence Level

Retrospective, monocentric cohort study

Key Findings

1
Concomitant BTIs for treating both spasticity and NDOI at the same time appeared safe when performed within a short delay and in compliance with actual knowledge for maximum doses.
2
95% of CIs were performed within a 72 h timeframe.
3
Five patients had symptoms evocative of distant spread but only one had a confirmed pathological jitter in single-fiber EMG.

Research Summary

This study reflects the practice of a single referral center for the care and management of SCI and MS. This is the first-ever study focusing on the concomitant use of botulinum toxin for more than one indication at the same time for the same patient, which appears to be a safe practice. It opens the discussion and field for future studies about delays, cumulative doses and drug concordance.

Practical Implications

Clinical Practice

Provides a practical framework for managing patients with SCI or MS who require treatment for both spasticity and NDOI simultaneously.

Future Research

Highlights the need for further studies to investigate optimal delays, cumulative doses, and drug concordance in concomitant BTI administration.

Treatment Guidelines

The findings can inform the development of guidelines for the safe and effective use of concomitant BTIs in specialized centers.

Study Limitations

1
Single-center study, introducing a recruitment bias.
2
The data analysis period partially overlapped with the SARS-CoV-2 pandemic period.
3
Coding system, primarily used for medico-economical purposes, may vary among practitioners

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