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.