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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.

 

Table 6: Anticholinergics

Author Year; Country
Score
Research Design
Sample Size
MethodsOutcome
Giannantoni et al. 1998;

Italy

Observational

N=48

Population: SCI patients.

Treatment: anticholinergic drugs.

Outcome Measures: neurological and urological examination and urodynamic evaluation with concurrent recording of blood pressure, heart rate, symptoms of AD.

1.    Presence of detrusor uninhibited contractions and bladder distension both contribute to AD crisis.

2.    Treatment with anticholinergic drugs is not sufficient to prevent AD starting from the bladder, unless it induces detrusor areflexia.

Discussion

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.

Conclusion

  • 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.