MovDisordV3, PascalFrancis, Corpus, bibRecord, 001944

Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test

Identifieur interne : 001944 ( PascalFrancis/Corpus ); précédent : 001943; suivant : 001945

Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test

Auteurs : Carla Cordivari ; Vijay Peter Misra ; Angela Vincent ; Santiago Catania ; Kailash P. Bhatia ; Andrew John Lees

Source :

Movement disorders [ 0885-3185 ] ; 2006.

RBID : Pascal:06-0538598

Descripteurs français

Pascal (Inist)
- Système nerveux pathologie, Dystonie, Bontoxilysin, Electromyographie.

English descriptors

KwdEn :
- Bontoxilysin, Dystonia, Electromyography, Nervous system diseases.

Abstract

We studied 20 patients with cervical dystonia who had started to respond poorly to botulinum toxin A (BTXA) injections after an initial good response. All patients had extensor digitorum brevis (EDB) tests performed in addition to BTXA immunoprecipition assay (IPA) and mouse bioassay (MBA) antibody testing. The patients were reex-amined and then treated with carefully placed electromyogram (EMG)-guided BTXA. Nine patients had a good clinical response to EMG-guided injections and all of these patients showed an obvious decrement on the EDB test. All were BTXA blocking antibodies (Abs)-negative via IPA and MBA (apart from one patient who had low BTXA antibodies titers using IPA but no antibodies by MBA). In the other 11 patients, there was a poor clinical response to EMG-guided BTXA injections. Seven of these 11 had small EDB decrement and BTXA antibodies using IPA, suggesting resistance to BTXA. Of the remaining four patients, two had obvious EDB decrement and low antibody titers via IPA (one of them had no antibodies via MBA), while the other two patients showed obvious decrement on the EDB test and no antibodies via IPA. This study shows that the EDB test correlates better with the clinical response than the antibody assays and that EDB decrement does not always correlate quantitatively with the BTXA antibody titers. In patients with secondary nonresponsiveness, it is recommended that an EDB test is the initial investigation of choice. In those patients where the EDB test does not demonstrate resistance to BTXA, a reexamination of the patients and carefully placed injections under EMG guidance may improve results.

Notice en format standard (ISO 2709)

Pour connaître la documentation sur le format Inist Standard.

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A03		`1`		`@0 Mov. disord.`
A05				`@2 21`
A06				`@2 10`
A08	`01`	`1`	`ENG`	`@1 Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test`
A11	`01`	`1`		`@1 CORDIVARI (Carla)`
A11	`02`	`1`		`@1 MISRA (Vijay Peter)`
A11	`03`	`1`		`@1 VINCENT (Angela)`
A11	`04`	`1`		`@1 CATANIA (Santiago)`
A11	`05`	`1`		`@1 BHATIA (Kailash P.)`
A11	`06`	`1`		`@1 LEES (Andrew John)`
A14	`01`			`@1 Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery @2 London @3 GBR @Z 1 aut. @Z 2 aut.`
A14	`02`			`@1 Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital @2 Oxford @3 GBR @Z 3 aut.`
A14	`03`			`@1 Essex Centre for Neurology & Neurosurgery, Oldchurch Hospital @2 Essex @3 GBR @Z 4 aut.`
A14	`04`			`@1 Institute of Neurology @2 London @3 GBR @Z 5 aut.`
A14	`05`			`@1 Reta Lila Weston Institute of Neurological Studies, University College of London @2 London @3 GBR @Z 6 aut.`
A20				`@1 1737-1741`
A21				`@1 2006`
A23	`01`			`@0 ENG`
A43	`01`			`@1 INIST @2 20953 @5 354000158877800280`
A44				`@0 0000 @1 © 2006 INIST-CNRS. All rights reserved.`
A45				`@0 12 ref.`
A47	`01`	`1`		`@0 06-0538598`
A60				`@1 P @3 CC`
A61				`@0 A`
A64	`01`	`1`		`@0 Movement disorders`
A66	`01`			`@0 USA`
C01	`01`		`ENG`	@0 We studied 20 patients with cervical dystonia who had started to respond poorly to botulinum toxin A (BTXA) injections after an initial good response. All patients had extensor digitorum brevis (EDB) tests performed in addition to BTXA immunoprecipition assay (IPA) and mouse bioassay (MBA) antibody testing. The patients were reex-amined and then treated with carefully placed electromyogram (EMG)-guided BTXA. Nine patients had a good clinical response to EMG-guided injections and all of these patients showed an obvious decrement on the EDB test. All were BTXA blocking antibodies (Abs)-negative via IPA and MBA (apart from one patient who had low BTXA antibodies titers using IPA but no antibodies by MBA). In the other 11 patients, there was a poor clinical response to EMG-guided BTXA injections. Seven of these 11 had small EDB decrement and BTXA antibodies using IPA, suggesting resistance to BTXA. Of the remaining four patients, two had obvious EDB decrement and low antibody titers via IPA (one of them had no antibodies via MBA), while the other two patients showed obvious decrement on the EDB test and no antibodies via IPA. This study shows that the EDB test correlates better with the clinical response than the antibody assays and that EDB decrement does not always correlate quantitatively with the BTXA antibody titers. In patients with secondary nonresponsiveness, it is recommended that an EDB test is the initial investigation of choice. In those patients where the EDB test does not demonstrate resistance to BTXA, a reexamination of the patients and carefully placed injections under EMG guidance may improve results.
C02	`01`	`X`		`@0 002B17`
C02	`02`	`X`		`@0 002B02C`
C02	`03`	`X`		`@0 002B17H`
C03	`01`	`X`	`FRE`	`@0 Système nerveux pathologie @5 01`
C03	`01`	`X`	`ENG`	`@0 Nervous system diseases @5 01`
C03	`01`	`X`	`SPA`	`@0 Sistema nervioso patología @5 01`
C03	`02`	`X`	`FRE`	`@0 Dystonie @5 02`
C03	`02`	`X`	`ENG`	`@0 Dystonia @5 02`
C03	`02`	`X`	`SPA`	`@0 Distonía @5 02`
C03	`03`	`X`	`FRE`	`@0 Bontoxilysin @2 FE @2 FR @5 09`
C03	`03`	`X`	`ENG`	`@0 Bontoxilysin @2 FE @2 FR @5 09`
C03	`03`	`X`	`SPA`	`@0 Bontoxilysin @2 FE @2 FR @5 09`
C03	`04`	`X`	`FRE`	`@0 Electromyographie @5 10`
C03	`04`	`X`	`ENG`	`@0 Electromyography @5 10`
C03	`04`	`X`	`SPA`	`@0 Electromiografía @5 10`
C07	`01`	`X`	`FRE`	`@0 Metalloendopeptidases @2 FE`
C07	`01`	`X`	`ENG`	`@0 Metalloendopeptidases @2 FE`
C07	`01`	`X`	`SPA`	`@0 Metalloendopeptidases @2 FE`
C07	`02`	`X`	`FRE`	`@0 Peptidases @2 FE`
C07	`02`	`X`	`ENG`	`@0 Peptidases @2 FE`
C07	`02`	`X`	`SPA`	`@0 Peptidases @2 FE`
C07	`03`	`X`	`FRE`	`@0 Hydrolases @2 FE`
C07	`03`	`X`	`ENG`	`@0 Hydrolases @2 FE`
C07	`03`	`X`	`SPA`	`@0 Hydrolases @2 FE`
C07	`04`	`X`	`FRE`	`@0 Enzyme @2 FE`
C07	`04`	`X`	`ENG`	`@0 Enzyme @2 FE`
C07	`04`	`X`	`SPA`	`@0 Enzima @2 FE`
C07	`05`	`X`	`FRE`	`@0 Extrapyramidal syndrome @5 37`
C07	`05`	`X`	`ENG`	`@0 Extrapyramidal syndrome @5 37`
C07	`05`	`X`	`SPA`	`@0 Extrapiramidal síndrome @5 37`
C07	`06`	`X`	`FRE`	`@0 Mouvement involontaire @5 38`
C07	`06`	`X`	`ENG`	`@0 Involuntary movement @5 38`
C07	`06`	`X`	`SPA`	`@0 Movimiento involuntario @5 38`
C07	`07`	`X`	`FRE`	`@0 Muscle strié pathologie @5 39`
C07	`07`	`X`	`ENG`	`@0 Striated muscle disease @5 39`
C07	`07`	`X`	`SPA`	`@0 Músculo estriado patología @5 39`
C07	`08`	`X`	`FRE`	`@0 Trouble neurologique @5 40`
C07	`08`	`X`	`ENG`	`@0 Neurological disorder @5 40`
C07	`08`	`X`	`SPA`	`@0 Trastorno neurológico @5 40`
C07	`09`	`X`	`FRE`	`@0 Electrophysiologie @5 41`
C07	`09`	`X`	`ENG`	`@0 Electrophysiology @5 41`
C07	`09`	`X`	`SPA`	`@0 Electrofisiología @5 41`
C07	`10`	`X`	`FRE`	`@0 Encéphale pathologie @5 42`
C07	`10`	`X`	`ENG`	`@0 Cerebral disorder @5 42`
C07	`10`	`X`	`SPA`	`@0 Encéfalo patología @5 42`
C07	`11`	`X`	`FRE`	`@0 Système nerveux central pathologie @5 43`
C07	`11`	`X`	`ENG`	`@0 Central nervous system disease @5 43`
C07	`11`	`X`	`SPA`	`@0 Sistema nervosio central patología @5 43`
N21				`@1 353`
N44	`01`			`@1 OTO`
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Format Inist (serveur)

NO :	PASCAL 06-0538598 INIST
ET :	Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test
AU :	CORDIVARI (Carla); MISRA (Vijay Peter); VINCENT (Angela); CATANIA (Santiago); BHATIA (Kailash P.); LEES (Andrew John)
AF :	Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery/London/Royaume-Uni (1 aut., 2 aut.); Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital/Oxford/Royaume-Uni (3 aut.); Essex Centre for Neurology & Neurosurgery, Oldchurch Hospital/Essex/Royaume-Uni (4 aut.); Institute of Neurology/London/Royaume-Uni (5 aut.); Reta Lila Weston Institute of Neurological Studies, University College of London/London/Royaume-Uni (6 aut.)
DT :	Publication en série; Courte communication, note brève; Niveau analytique
SO :	Movement disorders; ISSN 0885-3185; Etats-Unis; Da. 2006; Vol. 21; No. 10; Pp. 1737-1741; Bibl. 12 ref.
LA :	Anglais
EA :	We studied 20 patients with cervical dystonia who had started to respond poorly to botulinum toxin A (BTXA) injections after an initial good response. All patients had extensor digitorum brevis (EDB) tests performed in addition to BTXA immunoprecipition assay (IPA) and mouse bioassay (MBA) antibody testing. The patients were reex-amined and then treated with carefully placed electromyogram (EMG)-guided BTXA. Nine patients had a good clinical response to EMG-guided injections and all of these patients showed an obvious decrement on the EDB test. All were BTXA blocking antibodies (Abs)-negative via IPA and MBA (apart from one patient who had low BTXA antibodies titers using IPA but no antibodies by MBA). In the other 11 patients, there was a poor clinical response to EMG-guided BTXA injections. Seven of these 11 had small EDB decrement and BTXA antibodies using IPA, suggesting resistance to BTXA. Of the remaining four patients, two had obvious EDB decrement and low antibody titers via IPA (one of them had no antibodies via MBA), while the other two patients showed obvious decrement on the EDB test and no antibodies via IPA. This study shows that the EDB test correlates better with the clinical response than the antibody assays and that EDB decrement does not always correlate quantitatively with the BTXA antibody titers. In patients with secondary nonresponsiveness, it is recommended that an EDB test is the initial investigation of choice. In those patients where the EDB test does not demonstrate resistance to BTXA, a reexamination of the patients and carefully placed injections under EMG guidance may improve results.
CC :	002B17; 002B02C; 002B17H
FD :	Système nerveux pathologie; Dystonie; Bontoxilysin; Electromyographie
FG :	Metalloendopeptidases; Peptidases; Hydrolases; Enzyme; Extrapyramidal syndrome; Mouvement involontaire; Muscle strié pathologie; Trouble neurologique; Electrophysiologie; Encéphale pathologie; Système nerveux central pathologie
ED :	Nervous system diseases; Dystonia; Bontoxilysin; Electromyography
EG :	Metalloendopeptidases; Peptidases; Hydrolases; Enzyme; Extrapyramidal syndrome; Involuntary movement; Striated muscle disease; Neurological disorder; Electrophysiology; Cerebral disorder; Central nervous system disease
SD :	Sistema nervioso patología; Distonía; Bontoxilysin; Electromiografía
LO :	INIST-20953.354000158877800280
ID :	06-0538598

Links to Exploration step

Pascal:06-0538598

Le document en format XML

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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test</title>
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<author><name sortKey="Misra, Vijay Peter" sort="Misra, Vijay Peter" uniqKey="Misra V" first="Vijay Peter" last="Misra">Vijay Peter Misra</name>
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<author><name sortKey="Vincent, Angela" sort="Vincent, Angela" uniqKey="Vincent A" first="Angela" last="Vincent">Angela Vincent</name>
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<front><div type="abstract" xml:lang="en">We studied 20 patients with cervical dystonia who had started to respond poorly to botulinum toxin A (BTXA) injections after an initial good response. All patients had extensor digitorum brevis (EDB) tests performed in addition to BTXA immunoprecipition assay (IPA) and mouse bioassay (MBA) antibody testing. The patients were reex-amined and then treated with carefully placed electromyogram (EMG)-guided BTXA. Nine patients had a good clinical response to EMG-guided injections and all of these patients showed an obvious decrement on the EDB test. All were BTXA blocking antibodies (Abs)-negative via IPA and MBA (apart from one patient who had low BTXA antibodies titers using IPA but no antibodies by MBA). In the other 11 patients, there was a poor clinical response to EMG-guided BTXA injections. Seven of these 11 had small EDB decrement and BTXA antibodies using IPA, suggesting resistance to BTXA. Of the remaining four patients, two had obvious EDB decrement and low antibody titers via IPA (one of them had no antibodies via MBA), while the other two patients showed obvious decrement on the EDB test and no antibodies via IPA. This study shows that the EDB test correlates better with the clinical response than the antibody assays and that EDB decrement does not always correlate quantitatively with the BTXA antibody titers. In patients with secondary nonresponsiveness, it is recommended that an EDB test is the initial investigation of choice. In those patients where the EDB test does not demonstrate resistance to BTXA, a reexamination of the patients and carefully placed injections under EMG guidance may improve results.</div>
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<fC01 i1="01" l="ENG"><s0>We studied 20 patients with cervical dystonia who had started to respond poorly to botulinum toxin A (BTXA) injections after an initial good response. All patients had extensor digitorum brevis (EDB) tests performed in addition to BTXA immunoprecipition assay (IPA) and mouse bioassay (MBA) antibody testing. The patients were reex-amined and then treated with carefully placed electromyogram (EMG)-guided BTXA. Nine patients had a good clinical response to EMG-guided injections and all of these patients showed an obvious decrement on the EDB test. All were BTXA blocking antibodies (Abs)-negative via IPA and MBA (apart from one patient who had low BTXA antibodies titers using IPA but no antibodies by MBA). In the other 11 patients, there was a poor clinical response to EMG-guided BTXA injections. Seven of these 11 had small EDB decrement and BTXA antibodies using IPA, suggesting resistance to BTXA. Of the remaining four patients, two had obvious EDB decrement and low antibody titers via IPA (one of them had no antibodies via MBA), while the other two patients showed obvious decrement on the EDB test and no antibodies via IPA. This study shows that the EDB test correlates better with the clinical response than the antibody assays and that EDB decrement does not always correlate quantitatively with the BTXA antibody titers. In patients with secondary nonresponsiveness, it is recommended that an EDB test is the initial investigation of choice. In those patients where the EDB test does not demonstrate resistance to BTXA, a reexamination of the patients and carefully placed injections under EMG guidance may improve results.</s0>
</fC01>
<fC02 i1="01" i2="X"><s0>002B17</s0>
</fC02>
<fC02 i1="02" i2="X"><s0>002B02C</s0>
</fC02>
<fC02 i1="03" i2="X"><s0>002B17H</s0>
</fC02>
<fC03 i1="01" i2="X" l="FRE"><s0>Système nerveux pathologie</s0>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="ENG"><s0>Nervous system diseases</s0>
<s5>01</s5>
</fC03>
<fC03 i1="01" i2="X" l="SPA"><s0>Sistema nervioso patología</s0>
<s5>01</s5>
</fC03>
<fC03 i1="02" i2="X" l="FRE"><s0>Dystonie</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="ENG"><s0>Dystonia</s0>
<s5>02</s5>
</fC03>
<fC03 i1="02" i2="X" l="SPA"><s0>Distonía</s0>
<s5>02</s5>
</fC03>
<fC03 i1="03" i2="X" l="FRE"><s0>Bontoxilysin</s0>
<s2>FE</s2>
<s2>FR</s2>
<s5>09</s5>
</fC03>
<fC03 i1="03" i2="X" l="ENG"><s0>Bontoxilysin</s0>
<s2>FE</s2>
<s2>FR</s2>
<s5>09</s5>
</fC03>
<fC03 i1="03" i2="X" l="SPA"><s0>Bontoxilysin</s0>
<s2>FE</s2>
<s2>FR</s2>
<s5>09</s5>
</fC03>
<fC03 i1="04" i2="X" l="FRE"><s0>Electromyographie</s0>
<s5>10</s5>
</fC03>
<fC03 i1="04" i2="X" l="ENG"><s0>Electromyography</s0>
<s5>10</s5>
</fC03>
<fC03 i1="04" i2="X" l="SPA"><s0>Electromiografía</s0>
<s5>10</s5>
</fC03>
<fC07 i1="01" i2="X" l="FRE"><s0>Metalloendopeptidases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="01" i2="X" l="ENG"><s0>Metalloendopeptidases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="01" i2="X" l="SPA"><s0>Metalloendopeptidases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="02" i2="X" l="FRE"><s0>Peptidases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="02" i2="X" l="ENG"><s0>Peptidases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="02" i2="X" l="SPA"><s0>Peptidases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="03" i2="X" l="FRE"><s0>Hydrolases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="03" i2="X" l="ENG"><s0>Hydrolases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="03" i2="X" l="SPA"><s0>Hydrolases</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="04" i2="X" l="FRE"><s0>Enzyme</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="04" i2="X" l="ENG"><s0>Enzyme</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="04" i2="X" l="SPA"><s0>Enzima</s0>
<s2>FE</s2>
</fC07>
<fC07 i1="05" i2="X" l="FRE"><s0>Extrapyramidal syndrome</s0>
<s5>37</s5>
</fC07>
<fC07 i1="05" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0>
<s5>37</s5>
</fC07>
<fC07 i1="05" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0>
<s5>37</s5>
</fC07>
<fC07 i1="06" i2="X" l="FRE"><s0>Mouvement involontaire</s0>
<s5>38</s5>
</fC07>
<fC07 i1="06" i2="X" l="ENG"><s0>Involuntary movement</s0>
<s5>38</s5>
</fC07>
<fC07 i1="06" i2="X" l="SPA"><s0>Movimiento involuntario</s0>
<s5>38</s5>
</fC07>
<fC07 i1="07" i2="X" l="FRE"><s0>Muscle strié pathologie</s0>
<s5>39</s5>
</fC07>
<fC07 i1="07" i2="X" l="ENG"><s0>Striated muscle disease</s0>
<s5>39</s5>
</fC07>
<fC07 i1="07" i2="X" l="SPA"><s0>Músculo estriado patología</s0>
<s5>39</s5>
</fC07>
<fC07 i1="08" i2="X" l="FRE"><s0>Trouble neurologique</s0>
<s5>40</s5>
</fC07>
<fC07 i1="08" i2="X" l="ENG"><s0>Neurological disorder</s0>
<s5>40</s5>
</fC07>
<fC07 i1="08" i2="X" l="SPA"><s0>Trastorno neurológico</s0>
<s5>40</s5>
</fC07>
<fC07 i1="09" i2="X" l="FRE"><s0>Electrophysiologie</s0>
<s5>41</s5>
</fC07>
<fC07 i1="09" i2="X" l="ENG"><s0>Electrophysiology</s0>
<s5>41</s5>
</fC07>
<fC07 i1="09" i2="X" l="SPA"><s0>Electrofisiología</s0>
<s5>41</s5>
</fC07>
<fC07 i1="10" i2="X" l="FRE"><s0>Encéphale pathologie</s0>
<s5>42</s5>
</fC07>
<fC07 i1="10" i2="X" l="ENG"><s0>Cerebral disorder</s0>
<s5>42</s5>
</fC07>
<fC07 i1="10" i2="X" l="SPA"><s0>Encéfalo patología</s0>
<s5>42</s5>
</fC07>
<fC07 i1="11" i2="X" l="FRE"><s0>Système nerveux central pathologie</s0>
<s5>43</s5>
</fC07>
<fC07 i1="11" i2="X" l="ENG"><s0>Central nervous system disease</s0>
<s5>43</s5>
</fC07>
<fC07 i1="11" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0>
<s5>43</s5>
</fC07>
<fN21><s1>353</s1>
</fN21>
<fN44 i1="01"><s1>OTO</s1>
</fN44>
<fN82><s1>OTO</s1>
</fN82>
</pA>
</standard>
<server><NO>PASCAL 06-0538598 INIST</NO>
<ET>Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test</ET>
<AU>CORDIVARI (Carla); MISRA (Vijay Peter); VINCENT (Angela); CATANIA (Santiago); BHATIA (Kailash P.); LEES (Andrew John)</AU>
<AF>Department of Clinical Neurophysiology, National Hospital for Neurology and Neurosurgery/London/Royaume-Uni (1 aut., 2 aut.); Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital/Oxford/Royaume-Uni (3 aut.); Essex Centre for Neurology & Neurosurgery, Oldchurch Hospital/Essex/Royaume-Uni (4 aut.); Institute of Neurology/London/Royaume-Uni (5 aut.); Reta Lila Weston Institute of Neurological Studies, University College of London/London/Royaume-Uni (6 aut.)</AF>
<DT>Publication en série; Courte communication, note brève; Niveau analytique</DT>
<SO>Movement disorders; ISSN 0885-3185; Etats-Unis; Da. 2006; Vol. 21; No. 10; Pp. 1737-1741; Bibl. 12 ref.</SO>
<LA>Anglais</LA>
<EA>We studied 20 patients with cervical dystonia who had started to respond poorly to botulinum toxin A (BTXA) injections after an initial good response. All patients had extensor digitorum brevis (EDB) tests performed in addition to BTXA immunoprecipition assay (IPA) and mouse bioassay (MBA) antibody testing. The patients were reex-amined and then treated with carefully placed electromyogram (EMG)-guided BTXA. Nine patients had a good clinical response to EMG-guided injections and all of these patients showed an obvious decrement on the EDB test. All were BTXA blocking antibodies (Abs)-negative via IPA and MBA (apart from one patient who had low BTXA antibodies titers using IPA but no antibodies by MBA). In the other 11 patients, there was a poor clinical response to EMG-guided BTXA injections. Seven of these 11 had small EDB decrement and BTXA antibodies using IPA, suggesting resistance to BTXA. Of the remaining four patients, two had obvious EDB decrement and low antibody titers via IPA (one of them had no antibodies via MBA), while the other two patients showed obvious decrement on the EDB test and no antibodies via IPA. This study shows that the EDB test correlates better with the clinical response than the antibody assays and that EDB decrement does not always correlate quantitatively with the BTXA antibody titers. In patients with secondary nonresponsiveness, it is recommended that an EDB test is the initial investigation of choice. In those patients where the EDB test does not demonstrate resistance to BTXA, a reexamination of the patients and carefully placed injections under EMG guidance may improve results.</EA>
<CC>002B17; 002B02C; 002B17H</CC>
<FD>Système nerveux pathologie; Dystonie; Bontoxilysin; Electromyographie</FD>
<FG>Metalloendopeptidases; Peptidases; Hydrolases; Enzyme; Extrapyramidal syndrome; Mouvement involontaire; Muscle strié pathologie; Trouble neurologique; Electrophysiologie; Encéphale pathologie; Système nerveux central pathologie</FG>
<ED>Nervous system diseases; Dystonia; Bontoxilysin; Electromyography</ED>
<EG>Metalloendopeptidases; Peptidases; Hydrolases; Enzyme; Extrapyramidal syndrome; Involuntary movement; Striated muscle disease; Neurological disorder; Electrophysiology; Cerebral disorder; Central nervous system disease</EG>
<SD>Sistema nervioso patología; Distonía; Bontoxilysin; Electromiografía</SD>
<LO>INIST-20953.354000158877800280</LO>
<ID>06-0538598</ID>
</server>
</inist>
</record>

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	Movement Disorders (revue)
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Movement Disorders (revue)

Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test

Secondary nonresponsiveness to botulinum toxin a in cervical dystonia : The role of electromyogram-guided injections, botulinum toxin a antibody assay, and the extensor digitorum brevis test

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