Conte Antonella, Giannantoni Antonella, Gubbiotti Marilena, Pontecorvo Simona, Millefiorini Enrico, Francia Ada, Porena Massimo, Berardelli Alfredo
Department of Neurology and Psychiatry, University of Rome Sapienza, Rome 00185, Italy.
IRCCS Neuromed, Pozzilli, Isernia 86077, Italy.
Toxins (Basel). 2015 Aug 26;7(9):3424-35. doi: 10.3390/toxins7093424.
Patients with multiple sclerosis (MS) often complain of urinary disturbances characterized by overactive bladder syndrome and difficulties in bladder emptying. The aim of the study was to investigate the pathophysiology of bladder dysfunction and the neurophysiological effects of intradetrusorial incobotulinum toxin A (BoNT/A) in patients with MS having both brain and spinal MS-related lesions. Twenty-five MS patients with neurogenic detrusor overactivity (NDO) underwent clinical evaluation and soleus Hoffmann reflex (H reflex) study during urodynamics. Of the 25 patients, 14 underwent a further session one month after intradetrusorial BoNT/A injection. Eighteen healthy subjects acted as the control. In healthy subjects, the H reflex size significantly decreased at maximum cystometric capacity (MCC), whereas in MS patients with NDO, the H reflex remained unchanged. In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly. Volumes at the first, normal and strong desire to void and MCC increased significantly. Despite its efficacy in improving bladder symptoms and in increasing volumes for first desire, normal and strong desire to void, BoNT/A left the H reflex modulation during bladder filling unchanged. In the MS patients we studied having both brain and spinal MS-related lesions, the H reflex size remained unchanged at maximum bladder filling. Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions. BoNT/A improves bladder dysfunction by changing bladder afferent input, as shown by urodynamic findings on bladder filling sensations, but its effects on H reflex modulation remain undetectable.
多发性硬化症(MS)患者常主诉以膀胱过度活动症为特征的排尿障碍以及膀胱排空困难。本研究的目的是调查MS患者脑和脊髓均有与MS相关病变时膀胱功能障碍的病理生理学以及膀胱内注射incobotulinum毒素A(BoNT/A)的神经生理学效应。25例患有神经源性逼尿肌过度活动(NDO)的MS患者在尿动力学检查期间接受了临床评估和比目鱼肌霍夫曼反射(H反射)研究。在这25例患者中,14例在膀胱内注射BoNT/A一个月后又进行了一次检查。18名健康受试者作为对照。在健康受试者中,最大膀胱测压容量(MCC)时H反射大小显著降低,而在患有NDO的MS患者中,H反射保持不变。在接受膀胱内BoNT/A注射的患者中,临床和尿动力学检查显示NDO有显著改善。首次、正常及强烈排尿欲望时的尿量以及MCC均显著增加。尽管BoNT/A在改善膀胱症状以及增加首次、正常及强烈排尿欲望时的尿量方面有效,但BoNT/A并未改变膀胱充盈期间的H反射调节。在我们研究的脑和脊髓均有与MS相关病变的MS患者中,最大膀胱充盈时H反射大小保持不变。由于这种神经生理学模式先前已在脊髓损伤患者中发现,我们认为膀胱功能障碍源于与MS相关的脊髓病变。如膀胱充盈感觉的尿动力学检查结果所示,BoNT/A通过改变膀胱传入输入来改善膀胱功能障碍,但其对H反射调节的影响仍无法检测到。