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Effect of intravesical botulinum toxin injection on symptoms of autonomic dysreflexia in a patient with chronic spinal cord injury: a case report

The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2017.1322738 · Published: November 1, 2019

Spinal Cord InjuryUrologyNeurology

Simple Explanation

Autonomic dysreflexia is a serious complication of spinal cord injury that causes high blood pressure and other symptoms. This case report explores a new treatment option. The patient in this study suffered from chronic cervical spinal cord injury and experienced autonomic dysreflexia. Traditional treatments were ineffective. An intravesical botulinum toxin injection was administered to the patient to control bladder spasms and mechanical irritation. The patient's blood pressure stabilized, and the underlying lung cancer could be resected.

Study Duration
More than 6 months
Participants
One 62-year-old male with chronic cervical SCI
Evidence Level
Level 4: Case Report

Key Findings

  • 1
    Intravesical botulinum toxin injection can effectively control symptoms of autonomic dysreflexia in patients with chronic SCI.
  • 2
    The botulinum toxin injection led to stabilized blood pressure, allowing for a previously impossible lung cancer resection.
  • 3
    The improvement in autonomic dysreflexia symptoms lasted for more than 6 months after the botulinum toxin injection.

Research Summary

This case report describes a 62-year-old man with chronic cervical SCI who experienced autonomic dysreflexia and was successfully treated with an intravesical botulinum toxin injection. The injection led to stabilized blood pressure, enabling the patient to undergo surgery for lung cancer removal, and the improvements lasted for over 6 months. The authors suggest that botulinum toxin is a logical treatment option for both neurogenic detrusor overactivity and autonomic dysreflexia in chronic SCI patients, warranting further research.

Practical Implications

Treatment Option

Intravesical botulinum toxin injection may be a viable treatment option for autonomic dysreflexia in patients with chronic SCI, especially when conservative management fails.

Pre-Surgical Intervention

Botulinum toxin injections can stabilize blood pressure to allow for necessary surgeries that were previously too risky due to uncontrolled autonomic dysreflexia.

Further Research

Large, prospective trials are needed to further evaluate the efficacy and safety of botulinum toxin for autonomic dysreflexia in SCI patients.

Study Limitations

  • 1
    Single case study limits generalizability.
  • 2
    Long-term effects of botulinum toxin injection not fully explored.
  • 3
    Patient had underlying conditions (diabetes, hypertension, adrenal masses) that may have influenced the results.

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