Abstract Details

Title High-dose Onabotulinumtoxin Type A for Management of Severe Multiple Sclerosis-related Bladder Symptoms

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 20-012

Objective To assess the use of high-dose onabotulinumtoxin type A (Botox) for management of severe bladder symptoms in persons with MS (PwMS).

Background Multiple sclerosis (MS) is a chronic variable multifocal demyelinating disease of the central nervous system. Bladder dysfunction is reported in up to 80% of PwMS and has a well-documented impact on quality of life. Symptoms may include urinary frequency, incontinence, and bladder spasms. Initial management of neurogenic bladder includes behavioral modifications and oral medications. A low-to-moderate (100-200 units) dose of Botox administered to the bladder is frequently utilized as a third-line option, but a dose of 400U has not been established in the literature.

Design/Methods We conducted a retrospective chart review of PwMS who received 400U of Botox for severe neurological bladder dysfunction. Patients seen at CHI Health and University of Nebraska Medical Center from 2007-2025 were included. Demographic and clinical data were extracted.

Results 20 patients receiving 400 U Botox and were included in the study with a mean age of 55 years (median 59.5) on first dose (95% women, 95% White or Caucasian). All patients had significant disability at baseline, with all utilizing wheelchairs for ambulation and a minimum EDSS of 6.5 (median 8.0). A total of 118 injections of 400 U Botox were administered among all patients for a mean of 5.6 doses received (median 4, IQR 8). 19/20 utilized a chronic catheter, with one person electing to self-catheterize. A total of five minor complications were documented within one month of receiving Botox. Only one true adverse event was seen.

Conclusions Our data suggests that administration of 400 units of Botox with concomitant catheterization appears to be a safe and effective option for management of severe bladder symptoms for patients with multiple sclerosis. More research needs to be done for further evaluation of safety and efficacy.

Authors/Disclosures
Richard Cheung (Creighton University School of Medicine) PRESENTER	Mr. Cheung has nothing to disclose.
Aubrie L. Lindner, BS	Mrs. Lindner has received personal compensation for serving as an employee of Nebraska Medicine . Mrs. Lindner has received personal compensation in the range of $0-$499 for serving as a Consultant for CAN DO Multiple Sclerosis.
Peter S. Palencia, MD	Mr. Palencia has nothing to disclose.
Rana K. Zabad, MD, FAAN (University of Nebraska Medical Center)	Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Bayer. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Celgene/BMS. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genzyme. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck Serono. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Teva Neurosciences. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving as a Consultant for TG Therapeutics. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Teva. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Zabad has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for BMS. The institution of Dr. Zabad has received research support from Adamas. The institution of Dr. Zabad has received research support from Biogen. The institution of Dr. Zabad has received research support from Novartis. The institution of Dr. Zabad has received research support from Sun Pharma. The institution of Dr. Zabad has received research support from Parexel & MedDay Pharmaceuticals.
Michael P. Feloney, MD	Dr. Feloney has received personal compensation for serving as an employee of Uromedica. Dr. Feloney has stock in F&S Medical Solutions . Dr. Feloney has received intellectual property interests from a discovery or technology relating to health care.

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