Anticholinergics are a class of medications that inhibit the binding of the neurotransmitter acetylcholine to its receptors. Acetylcholine is released by the parasympathetic nerve fibers innervating the urinary bladder and contributes to detrusor contraction and activation of the bladder afferents. These afferent stimuli activate spinal sympathetic circuits that trigger AD. In theory, anticholinergic agents could therefore decrease afferent activation, and consequently AD.
Only one study, employing an observational cross-sectional design (n=48), has examined the use of anticholinergics (Giannantoni et al. 1998). These authors did not observe a correlation between anticholinergic drugs and reduced incidence of AD, unless treatment resulted in detrusor areflexia.
- There is level 5 evidence that anticholinergics (from 1 observational study) (Giannantoni et al. 1998) are not associated with reduced incidence of AD episodes.
Anticholinergics do not appear to be sufficient for the management of AD in SCI.