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The Patient Experience: Neurogenic detrusor overactivity (NDO) can impact on patients' quality of life in many ways

Definition of NDO: NDO is characterised by overactivity of the bladder due to a relevant neurological condition5,6

NDO can impact on patients' quality of life in many ways7

Adapted from Tubaro, 2004.7

Consequences of untreated NDO7-9

Adapted from Tubaro, 2004.7

Spinal lesions caused by a trauma, such as spinal cord injury, or by a progressive neurological condition, such as multiple sclerosis can lead to NDO10,11

Expanded Disability Status Scale12,13

Adapted from Fowler et al, 200912

  • Approximately 80% of patients with MS report some form of UI14
    • Frequency, urgency and UI are all commonly reported
  • 62% of patients with MS have NDO without bladder outlet obstruction15
  • Voiding LUTS are prevalent; in approximately 5–10% of patients, bladder symptoms are present at the onset of MS16

DDAVP: desmopressin; CIC: clean intermittent catheterisation; BoNT/A: botulinum toxin type A; IDC: indwelling catheter; LUTS: lower urinary tract symptoms; MS: multiple sclerosis; NDO: neurogenic detrusor overactivity; QoL: quality of life; UI: urinary incontinence.

BOTOX® is indicated for the management of bladder dysfunctions in adult patients who are not adequately managed with anticholinergics: neurogenic detrusor overactivity with urinary incontinence due to subcervical spinal cord  injury (traumatic or non-traumatic), or multiple sclerosis.5



  1. Allergan. Data on file. INT/0423/2016
  2. Aurora S K, Winner P et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled analyses of the 56-week PREEMPT clinical program. Headache 2011;51(9):1358-1373
  3. Blumenfeld A M, Stark R J et al. Long-term study of the efficacy and safety of OnabotulinumtoxinA for the prevention of chronic migraine: COMPEL study. J Headache Pain 2018;19(1):13
  4. Allergan. Data on file. 014
  5. BOTOX® Summary of Product Characteristics. Available at: Accessed April 2022
  6. Salvatore S et al. Pathophysiology of Urinary Incontinence, Faecal Incontinence and Pelvic Organ Prolapse. Abrams P et al. Incontinence: 6th edition. 2017:50
  7. Tubaro A. Defining overactive bladder: epidemiology and burden of disease. Urology 2004;64(suppl 6A);2–6
  8. de Seze M, Ruffion A et al. The neurogenic bladder in multiple sclerosis: review of the literature and proposal of management guidelines. Multiple Sclerosis 2007;13:915–928
  9. Goldmark E, Niver B and Ginsberg D A. Neurogenic bladder: from diagnosis to management. Curr Urol Rep 2014;15:448
  10. Abrams P et al. Incontinence: 6th Edition 2017;50
  11. European Association of Urology Guidelines on Neuro-Urology. 2019. Available at: Accessed April 2022
  12. Fowler C J, Panicker JN et al. A UK consensus on the management of the bladder in multiple sclerosis. Postgrad Mrd J 2009;85:552-559
  13. Multiple Sclerosis Trust. Expanded Disability Status Scale (EDSS). Available at: Accessed April 2022
  14. National US MS Society. Symptoms: bladder dysfunction. Autoimmune disease. Available at: Accessed April 2022
  15. Kalsi V and Fowler C J. Therapy insight: bladder dysfunction associated with multiple sclerosis. Nature Clinical Practice Urology 2005;2:492–501
  16. McCombe P A, Gordan T P and Jackson M W. Bladder dysfunction in multiple sclerosis. Expert Rev Neurotherap 2009;9:331–340

Please refer to the BOTOX® Summary of Product Characteristics for further information on adverse events, contraindications and special warnings and precautions for use.


Adverse events should be reported. Reporting forms and information can be found at

Adverse events should also be reported to AbbVie on [email protected] 


Date of preparation: April 2022. UK-BUO-220026.