1000 Section - Concomitant botulinum toxin injections for neurogenic detrusor overactivity and spasticity – a retrospective analysis of practice and safety from a referral center.

Multiple indications for botulinum toxin injections (BTI), such as spasticity and neurogenic detrusor overactivity (NDO), are possible for a single patient, but its practice has never been described. We described how BTI for multiple indications were performed at a referral center for spinal cord injuries (SCI) and multiple sclerosis (MS).

Design:

We identified eligible patients in our institution’s health data hub using the following BTI codes: PCLB002 and 003 for striated muscles and JDLE332 and 900 for detrusor injections, between 01/01/2017 and 31/12/2021. Medical files were retained for analysis when both injections occurred within one month. We excluded other indications. We collected demographic, injection and safety data.

Results:

Among 164 records we included 72 patients (92 excluded because of other indication such as sialorrhea and detrusor-sphincter dyssynergia and/or delay >1mo between both indications). Fifty (69%) were male, 55 (76%) had SCI and 13 (18%) MS. Mean number of bi-injections was 4,2±3,6, ranging [1-14]. The cumulated mean dose during bi-injection sessions was 441.4U±99.1 and median delay was 1 day [1-1]. All received Onabotulinum toxin for NDO. Agreement rate regarding toxin formulation for spasticity ranged between 90,9% and 96% during the first four bi-injections, 100% afterwards. Five patients had evocative symptoms of pseudobotulism, among whom only one had pathological SFEMG, without discrepancy between formulations.  Eleven patients discontinued bi-injections with surgical alternatives: enterocystoplasty (n=5), tenotomy (n=3), intrathecal Baclofen (n=2) and neurotomy (n=1).

Conclusion:

Bi-site injections for spasticity and NDO appeared to be safe when concomitant and in compliance with professional agreement regarding cumulative doses.