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Neutralizing antibodies in dystonic patients who still respond well to botulinum toxin type A

From the Department of Neurology, Division of Neurorehabilitation, Medical University of Vienna (G.K., T.S., B.V., P.S., E.A.); and Institute of Psychology, University of Vienna (G.S.K.), Austria.

Address correspondence and reprint requests to Dr. Gottfried Kranz, Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria gottfried.kranz{at}meduniwien.ac.at

Background: Complete secondary therapy failure due to antibodies against botulinum toxin A (BoNT/A-ABs) may raise extensive treatment difficulties. We tested whether neutralizing BoNT/A-ABs can be detected in dystonic patients with good clinical responses to botulinum toxin A (BoNT/A) treatment.

Methods: We used the ninhydrin sweat test (NST) and the mouse diaphragm test (MDT) in 28 subjects. Of 119 dystonic patients who responded well to BoNT/A, we randomly selected 14 and compared the results of the NST and MDT with 14 healthy controls.

Results: Higher BoNT/A-AB titers correlated significantly with smaller anhidrotic areas. We found seven patients with borderline antibody (AB) values (MDT 0.4 to 0.8 mU/mL) with significantly smaller anhidrotic areas (NST) compared with healthy controls and AB-negative patients. Risk factors for smaller anhidrotic areas were short injection intervals but not prolonged exposure to BoNT/A or high injection doses.

Conclusions: These data demonstrate that >40% of dystonic patients who respond well to botulinum toxin A (BoNT/A) show partial nonresponsiveness on the ninhydrin sweat test and have low titers of neutralizing BoNT/A antibodies.

Abbreviations: AB= antibody; BoNT = botulinum toxin; BoNT/A = botulinum toxin A; BoNT/A-AB = antibody against botulinum toxin A; BoNT-age = age at first BoNT therapy; BoNT-dose = mean dose per session; BoNT-duration = duration of BoNT/A treatment; BoNT-interval = mean time between injections; BoNT-number = number of treatment sessions; BoNT-sum = sum of BoNT/A dose; MDT = mouse diaphragm test; mU = mouse unit; NST = ninhydrin sweat test.

Supported by the Medical University of Vienna, Department of Neurology.

Disclosure: The authors report no conflicts of interest.

Received March 2, 2007. Accepted in final form June 25, 2007.

This article has been cited by other articles:

				M. Z. Atassi, J. Jankovic, B. Z. Dolimbek, G. Kranz, T. Sycha, B. Voller, G.S. Kranz, P. Schnider, and E. Auff NEUTRALIZING ANTIBODIES IN DYSTONIC PATIENTS WHO STILL RESPOND WELL TO BOTULINUM TOXIN TYPE A Neurology, September 23, 2008; 71(13): 1040 - 1041. [Full Text] [PDF]

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