Higher Neural Correlates in Patients with Multiple Sclerosis and Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA

Khavari, Rose; Elias, Saba; Pande, Rashmi; Wu, Katherine; Boone, Timothy B.; Karmonik, Christof

doi:10.1016/j.juro.2018.07.066

Cited by 24 publications

(23 citation statements)

References 29 publications

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“…Using a region‐of‐interest based analysis of the pons in 42 MS‐patients, Weissbart et al found associations between the pontine lesion volume and lower urinary tract symptoms. Khavari et al demonstrated diverging cerebral activation patterns in functional MRI in MS‐patients with urinary dysfunction compared with controls . Functional imaging revealed activation of areas involved in the micturition cycle like the frontal lobe, cingulate gyrus, and basal ganglia in these patients .…”

Section: Discussionmentioning

confidence: 99%

“…Functional imaging revealed activation of areas involved in the micturition cycle like the frontal lobe, cingulate gyrus, and basal ganglia in these patients . The use of botulinum toxin in overactive bladder treatment increased the activity of supraspinal centers known to be involved in bladder control in female MS‐patients with urinary dysfunction . However, especially the role and patterns of supratentorial lesions in the pathogenesis of urinary incontinence in MS remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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Voxel‐wise lesion mapping of self‐reported urinary incontinence in multiple sclerosis

Fröhlich

Wang

Bobinger

et al. 2019

Neurourology and Urodynamics

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Aims: Besides spinal lesions, urinary incontinence may be attributed to particular cerebral lesion sites in multiple sclerosis (MS) patients. We intended to determine the contribution of suprapontine lesions to urinary incontinence in MS using a voxel-wise lesion analysis. Methods: In this retrospective study, we sought MS patients with documented urinary incontinence in a local database. We established a control group of MSpatients without documented urinary incontinence matched for gender, age, and disease severity. Patients with urinary incontinence due to local diseases of the urinary tract were excluded. The MS lesions were analyzed on T2-weighted magnetic resonance imaging scans (1.5 or 3T). After manual delineation and transformation into stereotaxic space, we determined the lesion overlap and compared the presence or absence of urinary incontinence voxel-wise between patients with and without lesions in a given voxel performing the Liebermeister test with 4000 permutations. Results: A total of 56 patients with urinary incontinence and MS fulfilled the criteria and were included. The analysis yielded associations between urinary incontinence and MS in the frontal white matter, temporo-occipital, and parahippocampal regions. Conclusions:Our voxel-wise analysis indicated associations between selfreported urinary incontinence and lesions in the left frontal white matter and right parahippocampal region. Thus, our data suggest that dysfunction of supraspinal bladder control due to cerebral lesions may contribute to the pathophysiology of urinary incontinence in MS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Voxel‐wise lesion mapping of self‐reported urinary incontinence in multiple sclerosis

Fröhlich

Wang

Bobinger

et al. 2019

Neurourology and Urodynamics

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“…A recent breakthrough study using concurrent functional magnetic resonance imaging (fMRI) and urodynamic studies in female patients with multiple sclerosis and neurogenic overactive bladders reported that an intradetrusor injection of BTX-A increased the activity of most brain regions (cingulate body, prefrontal cortex, insula, and pontine micturition center) involved in the sensation and process of urinary urgency [86]. This was a pilot study to evaluate the possible effects of BTX-A at the level of the brain where sensory awareness is located.…”

Section: Btx Effects In Central Nervous Systemmentioning

confidence: 99%

Effect of Botulinum Toxin A on Bladder Pain—Molecular Evidence and Animal Studies

Yeh

Chen

et al. 2020

Toxins

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Botulinum toxin A (BTX-A) is a powerful neurotoxin with long-lasting activity that blocks muscle contractions. In addition to effects on neuromuscular junctions, BTX-A also plays a role in sensory feedback loops, suggesting the potentiality for pain relief. Although the only approved indications for BTX-A in the bladder are neurogenic detrusor overactivity and refractory overactive bladder, BTX-A injections to treat bladder pain refractory to conventional therapies are also recommended. The mechanism of BTX-A activity in bladder pain is complex, with several hypotheses proposed in recent studies. Here we comprehensively reviewed properties of BTX-A in peripheral afferent and efferent nerves, the inhibition of nociceptive neurotransmitter release, the reduction of stretch-related visceral pain, and its anti-inflammatory effects on the bladder urothelium. Studies have also revealed possible effects of BTX-A in the human brain. However, further basic and clinical studies are warranted to provide solid evidence-based support in using BTX-A to treat bladder pain.

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“…A recent study of patients with neurogenic DO secondary to MS undergoing intravesical BTX-A treatment has demonstrated the potential of fMRI to phenotype patients and optimise therapy based upon baseline activation patterns (40), but whether this tool can also be used to predict outcome from BTX-A treatment for idiopathic OAB remains to be determined.…”

Section: The Role Of Functional Mrimentioning

confidence: 99%

Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI‐RS 2019?

Malde

Apostilidis

Selai

et al. 2019

Neurourology and Urodynamics

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Botulinum toxin A (BTX-A) is a well-established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short-term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalisation of therapy and optimisation of outcomes. At the ICI-RS meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX-A treatment. Methods The Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX-A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy. Results Idiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a CNS mechanism of action of intravesically-injected BTX-A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimise patient selection for therapy. Conclusions Advances in basic science research into the mechanism of action of BTX-A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.

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Higher Neural Correlates in Patients with Multiple Sclerosis and Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA

Cited by 24 publications

References 29 publications

Voxel‐wise lesion mapping of self‐reported urinary incontinence in multiple sclerosis

Voxel‐wise lesion mapping of self‐reported urinary incontinence in multiple sclerosis

Effect of Botulinum Toxin A on Bladder Pain—Molecular Evidence and Animal Studies

Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI‐RS 2019?

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