Response and immunoresistance to botulinum toxin injections

Jankovic, Joseph; Schwartz, Kenneth S.

doi:10.1212/wnl.45.9.1743

Cited by 304 publications

(225 citation statements)

References 6 publications

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“…The interval between injections was established according to the duration of effect observed on previous injections. Both the dosage and interval between each application respected the general recommendations for minimizing the risk of BTX antibody formation in the treatment of neurological conditions [6][7][8] . General rules for each procedure were: usage of minimum dose that achieved best efficacy; avoidance of booster injections; longest interval tolerated and not shorter than 3 months.…”

Section: Methodsmentioning

confidence: 99%

Botulinum toxin A in the treatment of blepharospasm: a 10-year experience

Silveira‐Moriyama

Gonçalves

Chien

et al. 2005

Arq. Neuro-Psiquiatr.

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To evaluate the long-term effect of botulinum toxin type A (BTX) in the treatment of blepharospasm, a retrospective analysis was conducted from the patients seen at the Movement Disorders Clinic of the Department of Neurology, Hospital das Clínicas, University of São Paulo School of Medicine from 1993 to 2003. A total of 379 treatments with BTX were administered to 30 patients with blepharospasm. Sixty six per cent of the subjects had used oral medication for dystonia and only 15% of them reported satisfactory response to this treatment. Ninety three per cent of the patients showed significant improvement after the first BTX injection. There was no decrement in response when compared the first and the last injection recorded. Adverse effects, mostly minor, developed at least once in 53% of patients. Six patients (20%) discontinued the treatment but there was no case of secondary resistance.

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Section: Methodsmentioning

confidence: 99%

Botulinum toxin A in the treatment of blepharospasm: a 10-year experience

Silveira‐Moriyama

Gonçalves

Chien

et al. 2005

Arq. Neuro-Psiquiatr.

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“…Using an older formulation, it was estimated to occur in at least 5%-10% of patients with cervical dystonia (11). Factors that increase the risk for antibody formation include higher doses and short intervals between doses (12)(13)(14). With the new formulation and the relatively low doses used in migraine treatment (see below), this complication is unlikely to occur.…”

Section: Btx Type a (Btx-mentioning

confidence: 99%

Botulinum Toxin and Other New Approaches to Migraine Therapy

Ashkenazi

Silberstein

2004

Annu. Rev. Med.

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The number of migraine treatments and our understanding of migraine pathophysiology are both increasing. Newer treatments focus on migraine prevention. Botulinum toxin (BTX) is a potent neurotoxin used primarily to treat diseases associated with increased muscle activity. Recently, BTX was found to have antinociceptive effects that are probably independent of its muscle-relaxant action. Clinical trials support the efficacy of BTX type A (and possibly also type B) in the treatment of migraine. The anticonvulsant topiramate was recently shown to be effective for migraine prevention. At the low doses used for this indication, cognitive side effects are not a major concern. Another new approach to migraine prevention is angiotensin type 1 (AT1) receptor blockade. The high tolerability of the AT1 receptor blocker candesartan warrants further studies to assess its role in migraine prevention.

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“…Additionally, the passive immunity conferred by antitoxin could have been augmented by the acquisition of active immunity. The immunogenicity of botulinum toxin has been previously demonstrated by the development of neutralizing antibodies both in animals (15) and in patients receiving repeated therapeutic toxin type A for dystonia (7). Our case differs in that, instead of intermittent exposure to therapeutic toxin injections, the patient could have been exposed to continuous ongoing toxin production; no data describe the acquisition of immunity in this scenario.…”

mentioning

confidence: 77%

Wound Botulism Complicating Internal Fixation of a Complex Radial Fracture

Taylor

Wolfe

Dixon³

et al. 2010

J Clin Microbiol

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Botulism developed in a patient following surgical repair of an open radial fracture. Symptoms resolved after treatment with antitoxin and antibiotics, and hardware excision was deferred. Subsequent osteomyelitis necessitated hardware exchange, and wound cultures grew Clostridium argentinense. This case highlights the management of botulism associated with orthopedic hardware. CASE REPORTA 34-year-old man without significant past medical history presented with double vision. Three weeks prior to admission he suffered a compound fracture of his right radius and ulna during a soccer game. He was admitted to the orthopedic service for open reduction and internal fixation with a midulnar and radial plate (see Fig. 1). During the procedure, grass and dirt were noted in the surgical bed. He was treated perioperatively with cefazolin and gentamicin, was discharged, and completed 10 days of cephalexin treatment. Eighteen days following surgical repair he noted both double vision and difficulty opening both eyes. He presented three days later after worsening of symptoms and the development of slurred speech and difficulty swallowing.On admission, he denied fevers or chills, wound breakdown, paresthesias, or any other symptoms and asserted adherence to his postoperative antibiotics. The patient had no significant past medical history, took no other medications, and denied recreational drug use. His speech was dysphonic, and he had bilateral ptosis with notable diplopia. There was severe upper and lower bifacial weakness, and only trace extraocular movement was seen. His pupils were large and minimally reactive to light or accommodation. There was notable tongue and pharyngeal weakness. His right arm showed a healing surgical wound on the volar surface of his forearm. The results of the rest of his examination were unremarkable, as were his laboratory results.A nerve conduction study and electromyogram procedure were conducted, and the interpretation documented "low baseline amplitudes, especially in proximal musculature, with significant facilitation"; the interpreting neurologist noted that in the appropriate clinical context, the features were consistent with wound botulism. The patient was promptly administered a dose of botulinum antitoxin obtained from the CDC (7,500 units of antitoxin A and 5,500 units of antitoxin type B in 100 ml of normal saline solution over 1 h). Infectious disease consultants recommended commencing high-dosage intravenous penicillin G treatment and planning for surgical debridement and removal of the implanted hardware. After receiving botulinum antitoxin, his clinical symptoms improved overnight, and surgical excision was deferred. A blood sample obtained prior to the administration of botulinum antitoxin was negative for Clostridium botulinum toxin when tested by the CDC after trypsinization by use of a mouse bioassay. His symptoms improved, and he was discharged to complete 6 weeks of oral metronidazole and clindamycin treatment.Radiographs obtained 6 weeks after discharge were indicative o...

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Response and immunoresistance to botulinum toxin injections

Cited by 304 publications

References 6 publications

Botulinum toxin A in the treatment of blepharospasm: a 10-year experience

Botulinum toxin A in the treatment of blepharospasm: a 10-year experience

Botulinum Toxin and Other New Approaches to Migraine Therapy

Wound Botulism Complicating Internal Fixation of a Complex Radial Fracture

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