Botox injections in the bladder muscle increase the activity of brain regions involved in the sensation of urinary urgency in female multiple sclerosis (MS) patients who have neurogenic overactive bladder (NOAB), a new study shows.
The study, “Higher Neural Correlates in Multiple Sclerosis Patients with Neurogenic Overactive Bladder Following Treatment with Intradetrusor Injection of OnabotulinumtoxinA,” was published in The Journal of Urology.
It is estimated that from 37 to 99 percent of all MS patients will experience bladder issues at some point. Urinary frequency, urgency, and incontinence are among the most common symptoms reported by these patients and usually are grouped under the global definition of neurogenic overactive bladder (NOAB).
Botox (onabotulinumtoxinA, OnabotA) is a toxin produced by the bacteria Clostridium botulinum that blocks the communication between the nerves and the muscles, resulting in short-term muscle relaxation. Once injected in the bladder muscle (the detrusor), Botox helps relieve the symptoms of NOAB and has, since its approval by the U.S. Food and Drug Administration (FDA) in August 2011, become a well-established treatment option for MS patients affected by NOAB.
Although the motor effects of Botox on the detrusor muscle have been studied extensively, not much is known regarding its sensory effects, in particular on the brain regions responsible for perception/localization of bladder fullness, urgency, and frequency.
Researchers evaluated the effects of Botox on brain activity in female MS patients with NOAB, using functional magnetic resonance imaging (fMRI) — measuring brain activity through changes in cerebral blood flow — coupled with urodynamic study (a procedure that assesses bladder functionality).
Brain activity was measured in specific regions of the brain (cingulate cortex, insula, prefrontal cortex, pons, cerebellum, thalamus, and amygdala) when patients expressed a strong urge to urinate (know as “full urge”).
“Our trial is the first study of its kind to evaluate the possible effects of intradetrusor [in the detrusor muscle] injection of OnabotA at the level of human brain where the perception and processing of fullness is located,” the authors wrote.
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