6 Botulinum toxin-A (OnaBotA Botox Allergan, Dublin, Ireland) intradetrusor injection is a highly effective treatment option for patients with NDO who are refractory to more conservative management. 5 Even though anticholinergic or β agonist drugs have limited effectiveness and adverse side effects, they are the first-line pharmacotherapy for patients with NDO if behavioural modifications and pelvic floor physical therapy are unsuccessful.
4 Urgency, frequency and neurogenic detrusor overactivity (NDO) are the most common urological findings (34–99%) during diagnostic evaluations of patients with MS. Approximately 70% of patients with MS report that their LUTS have a moderate-to-severe impact on their quality of life. Owing to the diffuse, multifocal involvement of the CNS in patients with MS, symptom severity may vary from patient to patient. 3 LUT symptoms (LUTS) experienced by patients with MS can range from urgency to urge urinary incontinence and/or hesitancy and incomplete bladder emptying. 1, 2 Classification of voiding dysfunction is based on the degree of inability to store and/or empty urine. Up to 90% of patients with MS will develop lower urinary tract (LUT) dysfunction within the first 18 years of the disease. Multiple sclerosis (MS) is a chronic multifocal demyelinating disease that can affect any part of the central nervous system (CNS). Urinary concentration of brain-derived neurotrophic factor and nerve growth factor will also be collected since it has been shown that patients with an overactive bladder have higher concentrations of these neuropeptides. Our study will use functional MRI (fMRI) and task-related blood oxygen level-dependent signals to evaluate patients with MS and neurogenic detrusor overactivity (NDO) prior to, and after, intradetrusor injection of OnaBotA with simultaneous urodynamic evaluation. The local effects of OnaBotA are well understood, but not much is known of its afferent/sensory effects while treating the end organ. If oral pharmacotherapy with anticholinergics, behavioural modifications and pelvic floor physical therapy are unsuccessful, intradetrusor injection of botulinum toxin-A (OnaBotA Botox Allergan, Dublin, Ireland) is a highly effective option for these patients. Up to 90% of patients with MS will develop lower urinary tract dysfunction within the first 18 years of the disease. Introduction Multiple sclerosis (MS) is a severe debilitating disease that affects patients' quality of life.
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