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Abstract
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.
Glossary
- 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.
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