# Concomitant Botulinum Toxin Injections for Neurogenic Detrusor Overactivity and Spasticity—A Retrospective Analysis of Practice and Safety

## TL;DR

This study examines the safety of using botulinum toxin injections to treat both bladder and muscle issues in neurological patients.

## Contribution

The study is the first to describe concomitant botulinum toxin injections for spasticity and neurogenic detrusor overactivity incontinence.

## Key findings

- Concomitant injections were performed in 72 patients with spinal cord injuries and multiple sclerosis.
- Most concomitant injections were safe, with only one confirmed case of distant spread effects.
- Eleven patients discontinued injections due to surgical alternatives.

## Abstract

As multiple indications for botulinum toxin injections (BTIs) can coexist for neurological patients, there are to date no description of concomitant injections (CIs) to treat both spasticity and neurogenic detrusor overactivity incontinence (NDOI) in patients with spinal cord injuries (SCIs) and multiple sclerosis (MS). We therefore identified patients followed at our institution by health data hub digging, using a specific procedure coding system in use in France, who have been treated at least once with detrusor and skeletal muscle BTIs within the same 1-month period, over the past 5 years (2017–2021). We analyzed 72 patients representing 319 CIs. Fifty (69%) were male, and the patients were mostly SCI (76%) and MS (18%) patients and were treated by a mean number of CIs of 4.4 ± 3.6 [1–14]. The mean cumulative dose was 442.1 ± 98.8 U, and 95% of CIs were performed within a 72 h timeframe. Among all CIs, five patients had symptoms evocative of distant spread but only one had a confirmed pathological jitter in single-fiber EMG. Eleven discontinued CIs for surgical alternatives: enterocystoplasty (five), tenotomy (three), intrathecal baclofen (two) and neurotomy (one). Concomitant BTIs for treating both spasticity and NDOI at the same time appeared safe when performed within a short delay and in compliance with actual knowledge for maximum doses.