Nearly instantaneously, spinal cord injury alters a life and removes much of an individual’s independence and functioning. Due to the most common mechanisms of injury – motor vehicle accident, sports injuries, and falls – spinal cord injury often occurs at a young age, making it a condition that one must face for decades.
Not only does it affect mobility and daily functioning, but spinal cord injury also frequently leads to impaired bladder and bowel function. The bladder can become overactive and lead to urinary incontinence, decreasing the individual’s quality of life. In individuals with an underlying neurologic disorder such as spinal cord injury, this condition is called neurogenic lower urinary tract dysfunction (NLUTD).
Neurogenic detrusor overactivity, one aspect of NLUTD, is one of the leading causes of life-threatening episodes of autonomic dysreflexia. This emergency, marked by a sudden increase in systolic blood pressure, is the result of an imbalanced sympathetic response, where sympathetic neurons are activated by noxious or innocuous stimuli from below the level of lesion.
The extent of systolic blood pressure increase during autonomic dysreflexia can vary but may include symptoms such as pounding headache, anxiety, bradycardia or tachycardia, flushing and sweating, malaise, and nausea. In severe cases, episodes of autonomic dysreflexia may result in myocardial infarction, stroke, or even death.
Intradetrusor onabotulinumtoxinA injections have proven to be a safe, effective, and well-tolerated second-line treatment option for neurogenic detrusor overactivity. Our pilot data suggested a beneficial effect of onabotulinumtoxinA to ameliorate autonomic dysreflexia in individuals living with a spinal cord injury.1
As a medical student involved in this research, I learned about complications from spinal cord injury that I had previously never considered. Talking with participants about their experiences was a great way for me to see the faces behind the numbers in the manuscript – an important reminder that each “n” is an individual whose life we work to improve. I feel lucky to be involved in such research that aims to ameliorate some of the symptoms associated with spinal cord injury.
A female study participant commented, “Without AD [autonomic dysreflexia], my life is so much better! Since having the Botox treatment done, I am no longer sweating before I do my catheters. I feel like I have more control over my bladder. I can finally sleep through the night, and no longer wake up covered in sweat.”
Written by: Stephanie Kran, MD, Resident; Matthias Walter, MD, PhD, FEBU, and Andrei V. Krassioukov, MD, PhD, FRCPC, Department of Family Medicine, University of British Columbia, British Columbia, Canada
- Fougere, Renée J., Katharine D. Currie, Mark K. Nigro, Lynn Stothers, Daniel Rapoport, and Andrei V. Krassioukov. "Reduction in bladder-related autonomic dysreflexia after onabotulinumtoxinA treatment in spinal cord injury." Journal of neurotrauma 33, no. 18 (2016): 1651-1657.