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Neurogenic detrusor overactivity (NDO) can be debilitating and negatively affect patients’ quality of life5

Spinal lesions caused by trauma, such as spinal cord injury (SCI), or by a progressive neurological condition, such as multiple sclerosis (MS) can lead to NDO6,7

The consequences of untreated NDO can result in hospitalisation with life-threatening conditions such as renal failure5,8,9

Urinary dysfunction is very common in patients with MS and SCI

Up to 80% of patients with MS report some form of urinary incontinence10

81% of patients with SCI report some degree of bladder dysfunction within 1 year of injury11

Bladder symptoms are often inadequately managed

  • Patients with MS have bladder symptoms that are often not adequately managed12
  • Approximately 51% of patients with moderate to severe LUTS are on anticholinergic therapy13

• <14% of patients started on oxybutynin and tolterodine (two of the most common oral OAB medications) continued treatment
for 1 year14
• Median of 31 days until discontinuation14

  • Poor oral therapy adherence may be linked to:12

• UTI, retention and obstruction
• Systemic complications
• Increased hospitalisation rates

  • Urologists/urogynaecologists should work closely with neurologists in order to optimally manage NDO

Spectrum of treatments for NDO7,15

Adapted from EAU Guidelines 2020 and NICE Guidelines 20127,15

NB: not all treatments mentioned here are licensed for NDO in the UK.

OAB: overactive bladder; LUTS: lower urinary tract symptoms; MS: multiple sclerosis; NDO, neurogenic detrusor overactivity; SCI: spinal cord injury; UTI: urinary tract infection.

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.16



  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 Ltd. Data on file 014
  5. Tubaro A. Defining overactive bladder: epidemiology and burden of disease. Urology 2004;64(suppl 6A);2–6
  6. Abrams P et al. Incontinence: 6th Edition 2017;50
  7. European Association of Urology Guidelines on Neuro-Urology. 2019. Available at: Accessed April 2022
  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. National US MS Society. Available at: Accessed April 2022
  11. Ginsberg D. The epidemiology and pathophysiology of neurogenic bladder. Am J Manag Care 2013;19:S191-S196
  12. Manack A, Motsko S P et al. Epidemiology and healthcare utilization of neurogenic bladder patients in a US claims database. Neurourol Urodyn 2011;30:395–401 
  13. Mahajan S T, Patel P B et al. Under treatment of overactive bladder symptoms in patients with multiple sclerosis: an ancillary analysis of the NARCOMS Patient Registry. J Urol 2010;183:1432–1437
  14. Watanabe J H, Campbell J D et al. Cost analysis of interventions for antimuscarinic refractory patients with overactive bladder. Urology 2010;76:835–840
  15. National Institute for Health and Care Excellence (NICE). CG148: Urinary incontinence in neurological disease. Available at: Accessed April 2022
  16. BOTOX® Summary of Product Characteristics. Available at: Accessed April 2022

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-220021.