Variability of the immunologic and clinical response in dystonic patients immunoresistant to botulinum toxin injections.
Identifieur interne : 004302 ( PubMed/Checkpoint ); précédent : 004301; suivant : 004303Variability of the immunologic and clinical response in dystonic patients immunoresistant to botulinum toxin injections.
Auteurs : C. Sankhla [États-Unis] ; Joseph Jankovic [États-Unis] ; D. DuaneSource :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 1998.
English descriptors
- KwdEn :
- Aged, Aged, 80 and over, Animals, Antibody Specificity, Botulinum Toxins (immunology), Botulinum Toxins (therapeutic use), Botulinum Toxins, Type A (immunology), Botulinum Toxins, Type A (therapeutic use), Drug Resistance (immunology), Dystonia (drug therapy), Dystonia (immunology), Female, Humans, Immunologic Memory, Longitudinal Studies, Male, Mice, Middle Aged, Neuromuscular Agents (immunology), Neuromuscular Agents (therapeutic use), Treatment Outcome.
- MESH :
- chemical , immunology : Botulinum Toxins, Botulinum Toxins, Type A, Neuromuscular Agents.
- chemical , therapeutic use : Botulinum Toxins, Botulinum Toxins, Type A, Neuromuscular Agents.
- drug therapy : Dystonia.
- immunology : Drug Resistance, Dystonia.
- Aged, Aged, 80 and over, Animals, Antibody Specificity, Female, Humans, Immunologic Memory, Longitudinal Studies, Male, Mice, Middle Aged, Treatment Outcome.
Abstract
Immunoresistance (Ab+) to botulinum toxin type A (BTX-A) has been a serious 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 antibody-negative (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 reverted to Ab- was analyzed. The average latency between the initial BTX-A treatment and development of Ab+ was 27 months (range, 1543 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.
DOI: 10.1002/mds.870130128
PubMed: 9452341
Affiliations:
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pubmed:9452341Le document en format XML
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<author><name sortKey="Jankovic, J" sort="Jankovic, J" uniqKey="Jankovic J" first="J" last="Jankovic">Joseph Jankovic</name>
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<term>Botulinum Toxins, Type A (immunology)</term>
<term>Botulinum Toxins, Type A (therapeutic use)</term>
<term>Drug Resistance (immunology)</term>
<term>Dystonia (drug therapy)</term>
<term>Dystonia (immunology)</term>
<term>Female</term>
<term>Humans</term>
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<front><div type="abstract" xml:lang="en">Immunoresistance (Ab+) to botulinum toxin type A (BTX-A) has been a serious 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 antibody-negative (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 reverted to Ab- was analyzed. The average latency between the initial BTX-A treatment and development of Ab+ was 27 months (range, 1543 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.</div>
</front>
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<Abstract><AbstractText>Immunoresistance (Ab+) to botulinum toxin type A (BTX-A) has been a serious 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 antibody-negative (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 reverted to Ab- was analyzed. The average latency between the initial BTX-A treatment and development of Ab+ was 27 months (range, 1543 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.</AbstractText>
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