Troubles vésicosphinctériens

Le 01/12/2022 de 15:00 à 16:30

Retour Session


Description des effets secondaires liés aux injections de toxine botulique : review systematique et metanalyse chez les patients atteints de hypertonie spastique et hyperactivité detrusorienne

Simona Ficarra (Garches, France), Celine KARABULUT (Garches, France), Pierre DENYS (Garches, France), Djamel BENSMAIL (Garches, France), Charles JOUSSAIN (Garches, France), Jonathan LEVY (Garches, France)

Objective : Adverse events can occur after botulinum neurotoxin-A (BoNT-A) injections (BNTi). The aim of this study was to identify the risk of muscular weakness following BNTi.

Material / Patients and Methods : We selected thirteen randomized controlled studies (RCTs) where BoNT-A was used as a treatment for spasticity or neurogenic detrusor overactivity (NDO) in the neurogenic adult population.
Among the adverse events identified, muscular weakness (MW) was the most frequent. We performed meta-analysis (using RevMan 5.4) to determine the odds-ratio (OR) of MW, considering a fixed effect p<0,05 as significant.

Results : We found that 4% patients developed a MW following BNTi (versus 1.2% after a placebo injection (PI)) with an OR = 2.53.

Regarding the type of BoNT-A, 4.8% developed muscular weakness following AboBoNT-A injection (versus 1.2% after PI), with an OR = 2.57. Following OnaBoNT-A injection, 4.23% developed muscular weakness (versus 1.3% with PI), with an OR=2.72. There was not enough RCTs to draw conclusion for IncoBoNT-A.

Regarding the indication of the injection, 5.58% developed muscular weakness following toxin injection for NDO (versus 2.34% after PI), with an OR = 2.38. 2.87% developed muscular weakness following toxin injection for spasticity (versus 0.6% after PI), with an OR = 2,78.

Discussion - Conclusion : There is a significant risk to develop muscular weakness following BNTi to treat either  spasticity and/or NDO, using either OnaBoNT-A or AboBoNT-A. It appears mandatory to define further the clinical elements that allow diagnosis of pseudobotulism in order to  propose adapted care for  these patients.

Keywords : pseudobotulism, botulinum toxin, injections, adverse events, spasticity, NDO