{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:03:07Z","timestamp":1789585387166,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T00:00:00Z","timestamp":1639526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>\n                    Urodynamic studies (UDS) can provoke autonomic dysreflexia (AD) in individuals with spinal cord injury (SCI) at and above the sixth thoracic spinal segment potentially leading to profound vagally mediated heart rate (HR) reductions. In this study,\n                    <jats:xref>\n                      <jats:sup>1<\/jats:sup>\n                    <\/jats:xref>\n                    we test the hypothesis that intradetrusor onabotulinumtoxinA injections will improve HR and its variability (HRV) responses to UDS in individuals with cervical and thoracic SCI. A total of 19 participants with chronic SCI (5 women, mean age 42.5\u2009\u00b1\u20097.9 years) with confirmed neurogenic detrusor overactivity underwent UDS before (i.e., baseline) and 1\u2009month after intradetrusor onabotulinumtoxinA (200\u2009U) injections (post-treatment). Continuous electrocardiography and blood pressure (BP) recordings were used to assess RR-interval, time, and frequency domain metrics of HRV (a surrogate marker of autonomic nervous system activity), and AD pre- and post-treatment. UDS pre-treatment resulted in increased RR-interval as well as time and frequency domain metrics of HRV. Vagally mediated increases in high-frequency (HF) power during UDS were larger in participants with cervical compared to upper thoracic SCI. Post-treatment, UDS had no effect on RR-interval and significantly reduced instances of bradycardia. Furthermore, intradetrusor onabotulinumtoxinA injections significantly reduced time domain metrics of HRV and HF power responses to UDS across all participants. Changes in HRV during UDS could be a potential indicator of improved autonomic cardiovascular function following interventions such as intradetrusor onabotulinumtoxinA injections.\n                  <\/jats:p>","DOI":"10.3389\/fphys.2021.796277","type":"journal-article","created":{"date-parts":[[2021,12,15]],"date-time":"2021-12-15T09:35:23Z","timestamp":1639560923000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":7,"title":["Reduced Reflex Autonomic Responses Following Intradetrusor OnabotulinumtoxinA Injections: A Pre-\/Post-study in Individuals With Cervical and Upper Thoracic Spinal Cord Injury"],"prefix":"10.3389","volume":"12","author":[{"given":"Tristan W.","family":"Dorey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Walter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrei V.","family":"Krassioukov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1111\/j.1464-410X.2008.07457.x","article-title":"A proposed guideline for the urological management of patients with spinal cord injury","volume":"101","author":"Abrams","year":"2008","journal-title":"BJU Int."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1111\/j.1469-8986.1997.tb02140.x","article-title":"Heart rate variability: origins methods, and interpretive caveats","volume":"34","author":"Berntson","year":"1997","journal-title":"Psychophysiology"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.autneu.2017.02.004","article-title":"Alterations in cardiac autonomic control in spinal cord injury","volume":"209","author":"Biering-S\u00f8rensen","year":"2018","journal-title":"Auton. Neurosci. Basic Clin."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"329","DOI":"10.1007\/BF02309623","article-title":"Heart rate variability is altered following spinal cord injury","volume":"8","author":"Bunten","year":"1998","journal-title":"Clin. Auton. Res."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"H668","DOI":"10.1152\/ajpheart.00869.2007","article-title":"Clinical correlates of frequency analyses of cardiovascular control after spinal cord injury","volume":"294","author":"Claydon","year":"2008","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1016\/j.hrthm.2020.03.014","article-title":"Altered heart rate variability in angiotensin II\u2013mediated hypertension is associated with impaired autonomic nervous system signaling and intrinsic sinoatrial node dysfunction","volume":"17","author":"Dorey","year":"2020","journal-title":"Hear. Rhythm"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1016\/j.autneu.2019.01.004","article-title":"The influence of aerobic fitness on electrocardiographic and heart rate variability parameters in young and older adults","volume":"217","author":"Dorey","year":"2019","journal-title":"Auton. Neurosci. Basic Clin."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability","volume":"93","year":"1996","journal-title":"Circulation"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"1651","DOI":"10.1089\/neu.2015.4278","article-title":"Reduction in bladder-related autonomic dysreflexia after OnabotulinumtoxinA treatment in spinal cord injury","volume":"33","author":"Fougere","year":"2016","journal-title":"J. Neurotrauma"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1038\/nrn2401","article-title":"The neural control of micturition","volume":"9","author":"Fowler","year":"2008","journal-title":"Nat. Rev. Neurosci."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"61","DOI":"10.4103\/aian.AIAN_453_17","article-title":"Correlation between heart rate variability and bladder sensations during filling and voiding phase of urodynamic study in patients with myelopathy","volume":"22","author":"Gomez","year":"2019","journal-title":"Ann. Indian Acad. Neurol."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1016\/j.eururo.2015.07.071","article-title":"Summary of European Association of Urology (EAU) guidelines on neuro-urology","volume":"69","author":"Groen","year":"2016","journal-title":"Eur. Urol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1093\/brain\/70.4.361","article-title":"Effects of bladder distension on autonomic mechanisms after spinal cord injuries","volume":"70","author":"Guttmann","year":"1947","journal-title":"Brain"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e0161976","DOI":"10.1371\/journal.pone.0161976","article-title":"Comparison of autonomic reactions during urodynamic examination in patients with spinal cord injuries and able-bodied subjects","volume":"11","author":"Huang","year":"2016","journal-title":"PLoS One"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2483","DOI":"10.1016\/j.juro.2007.08.036","article-title":"Autonomic nervous system activity during bladder filling assessed by heart rate variability analysis in women with idiopathic overactive bladder syndrome or stress urinary incontinence","volume":"178","author":"Hubeaux","year":"2007","journal-title":"J. Urol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S0079-6123(05)52034-X","article-title":"Autonomic dysfunction in spinal cord injury: clinical presentation of symptoms and signs","volume":"152","author":"Karlsson","year":"2006","journal-title":"Prog. Brain Res."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1179\/204577211X13207446293695","article-title":"International standards for neurological classification of spinal cord injury (revised 2011)","volume":"34","author":"Kirshblum","year":"2011","journal-title":"J. Spinal Cord Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1161\/CIRCULATIONAHA.106.180200","article-title":"Recommendations for the standardization and interpretation of the electrocardiogram: part I: The electrocardiogram and its technology: A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society","volume":"115","author":"Kligfield","year":"2007","journal-title":"Circulation"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1682\/JRRD.2005.10.0159","article-title":"Assessment of autonomic dysfunction following spinal cord injury: rationale for additions to international standards for neurological assessment","volume":"44","author":"Krassioukov","year":"2007","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"682","DOI":"10.1016\/j.apmr.2008.10.017","article-title":"A systematic review of the management of autonomic dysreflexia after spinal cord injury","volume":"90","author":"Krassioukov","year":"2009","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1161\/01.CIR.0000047275.25795.17","article-title":"Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients","volume":"107","author":"La Rovere","year":"2003","journal-title":"Circulation"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"275","DOI":"10.5213\/inj.1836118.059","article-title":"Efficacy and safety of OnabotulinumtoxinA in patients with neurogenic detrusor overactivity caused by spinal cord injury: A systematic review and meta-analysis","volume":"22","author":"Li","year":"2018","journal-title":"Int. Neurourol. J."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1016\/j.hrthm.2017.02.015","article-title":"Cardiac electrophysiology of patients with spinal cord injury","volume":"14","author":"Manogue","year":"2017","journal-title":"Heart Rhythm"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1016\/j.expneurol.2016.06.022","article-title":"Effects of onabotulinumtoxinA on cardiac function following intradetrusor injections","volume":"285","author":"Mehnert","year":"2016","journal-title":"Exp. Neurol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1002\/nau.20641","article-title":"Heart rate variability: An objective measure of autonomic activity and bladder sensations during urodynamics","volume":"28","author":"Mehnert","year":"2009","journal-title":"Neurourol. Urodyn."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/j.hrthm.2009.01.006","article-title":"Power spectral analysis of heart rate variability and autonomic nervous system activity measured directly in healthy dogs and dogs with tachycardia-induced heart failure","volume":"6","author":"Piccirillo","year":"2009","journal-title":"Hear. Rhythm"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1097\/00002060-199110000-00008","article-title":"Atrial fibrillation associated with autonomic dysreflexia","volume":"70","author":"Pine","year":"1991","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref28","article-title":"Autonomic Regulation of the Bladder.","author":"Purves","year":"2001"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1007\/s10286-012-0166-6","article-title":"Electrocardiogram-based predictors for arrhythmia after spinal cord injury","volume":"22","author":"Ravensbergen","year":"2012","journal-title":"Clin. Auton. Res."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"535","DOI":"10.3389\/fnins.2019.00535","article-title":"The central autonomic network and regulation of bladder function","volume":"13","author":"Roy","year":"2019","journal-title":"Front. Neurosci."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1002\/nau.10066","article-title":"Good urodynamic practices: Uroflowmetry, filling cystometry, and pressure-flow studies","volume":"21","author":"Sch\u00e4fer","year":"2002","journal-title":"Neurourol. Urodyn."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.ijcard.2009.09.543","article-title":"The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors","volume":"141","author":"Thayer","year":"2010","journal-title":"Int. J. Cardiol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s12916-018-1040-8","article-title":"Prediction of autonomic dysreflexia during urodynamics: A prospective cohort study","volume":"16","author":"Walter","year":"","journal-title":"BMC Med."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2023","DOI":"10.1089\/neu.2020.7115","article-title":"Intradetrusor OnabotulinumtoxinA injections ameliorate autonomic Dysreflexia while improving lower urinary tract function and urinary incontinence-related quality of life in individuals with cervical and upper thoracic spinal cord injury","volume":"37","author":"Walter","year":"2020","journal-title":"J. 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