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(1995)
Autoimmune and dystonia distribution characteristics of cervical dystonia patients with initial resistance versus delayed resistance versus responsiveness to botulinum toxin therapy
Immunoresistance (Ab+) to botulinum toxin type A (BTX‐A) has been a serous concern since the introduction of BTX‐A in the treatment of dystonia and other disorders associated with abnormal muscle contractions. We studied seven patients who developed Ab+ and later reverted to antibodynegative (Ab‐) status. These seven patients, six women (mean age, 56 years; range, 41–80 years), with an average duration of dystonia for all patients of 197 months (range, 84–360 months), received a total mean cumulative dose of 1659 units (U) (range,810‐1975 U), with an average dose of 207 U per visit. All of these patients became unresponsive to BTX‐A treatment and became Ab+ as determined by mouse bioassay. Their response to BTX‐A after they revertedd to Ab‐ was analyzed. The average latency between the initial BTX‐A treatment and development of Ab+ was 27 months (range, 15–43 months). The average duration between the detection of Ab+ status and subsequent reversal to Ab‐ status was 30 months (range, 10–78 months). Six of these Ab‐ patients were reinjected with BTX‐A, and all six benefited from repeat injections comparable with their earlier response. Three patients lost their clinical response to subsequent injections and were found to be again Ab+. Two of the five patients who became immunoresistant to BTX‐A received botulinum toxin type F (BTX‐F) injections and one patient received a single session of BTX‐B with improvement in their symptoms. In conclusion, this unique group of patients who were Ab+ and became Ab‐ responded favorably to repeat BTX‐A injections, but some lost the benefit with subsequent injections. These observations suggest that the anamnestic immunologic response to BTX‐A can wane, but can be reactivated by repeat BTX‐A treatments. The presence of antibodies did not interfere with the response to BTX‐F or BTX‐B injections, thus confirming the antigenic specificity of various BTX serotypes.
Movement Disorders – Wiley
Published: Jan 1, 1998
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