Use of botulinumtoxinA for simultaneous multiple indications in neurological patients

Introduction/Background This is a preliminary retrospective cohort study to determine the occurance of all adverse events after the simultaneous treatment with botulinumtoxin A for multiple indications, with at least a urologic one for injection. A substantial number of patients may have multiple indications for botulinumtoxinA injection. The treatment for certain conditions may be delayed due to the cumulative dose limitation within a three months interval, based on FDA trials. This delay may significantly impair a patient's function, rehabilitation programme and, at least, the quality of life; because of this sometimes it is very difficult to stratify the priority of treatment. All our patients needed, at the same time, a bladder and muscoloskeletal treatment with botulinmtoxinA. Material and method Four traumatic SCI, 2 vascular SCI, 1 Arnold–Chiari malformation, 1 infant cerebral palsy. Range of age between 14 and 53 y. All patients are affected by neurogenic bladder sphincter dysfunction (NBSD) non-responder to antimuscarinic therapy. Toxin forms: 3 patients abobotulinumtoxinA, dosage range 950–1500 U; 5 patients onabotulinumtoxinA, dosage range 300–400 U. Treatment site: 3 patients bladder sphincter and lower limb; 5 patients detrusor muscle and upper and lower limb. Results We registered in only one case (abobotulinumtoxinA 950 U) as adverse event the development of a temporary hand weakness, that already occured after a previous treatment with botulinumtoxinA. Conclusion These data support the evidence of the possibility to perform - in very selected patients - a simultaneous treatment of overactive bladder and limb spasticity with botulinumtoxinA.