Clinical use of non-a botulinum toxins: botulinum toxin type B

Abstract

Botulinum neurotoxin type B (BT, BT-B) has been used as NeuroBloc/MyoBloc since 1999 for treatment of cervical dystonia, hyperhidrosis, spastic conditions, cerebral palsy, hemifacial spasm, bladder dysfunction, spasmodic dysphonia, sialorrhoea, anal fissures, piriformis syndrome, various pain conditions and cosmetic applications. Generally, its therapeutic effects are comparable to BT type A (BT-A). The adverse effect profiles of BT-B and BT-A, however, differ considerably. BT-B has been found to produce more regional as well as systemic anticholinergic adverse effects, such as dryness of mouth, accommodation difficulties, conjunctival irritation, reduced sweating, dysphagia, heartburn, constipation, bladder voiding difficulties and dryness of nasal mucosa. In BT-B the relationship between autonomic and motor effects known from BT-A is substantially shifted towards autonomic effects. BT-B, therefore, should be used carefully in patients with autonomic disorders and in patients with concomitant anticholinergic therapy. If NeuroBloc/MyoBloc is used to treat cervical dystonia patients with antibody-induced failure of BT-A therapy, 86% of those will develop complete secondary therapy failure after five applications. If NeuroBloc/MyoBloc used to treat cervical dystonia patients without prior exposure to BT, 44% of those will develop complete secondary therapy failure after nine applications. NeuroBloc/MyoBloc, therefore, is associated with substantial antigenicity problems originating from a particular low specific biological potency. Systemic anticholinergic adverse effects and high antigenicity limits the clinical use of NeuroBloc/MyoBloc considerably.

Botulinum toxin type-B improves sialorrhea and quality of life in bulbaronset amyotrophic lateral sclerosis

“…This may be of importance since the frequency of de novo BTX-B immuno-resistant cases is high (which may in part be due to the higher protein content), and associated with a poorer clinical response, at least in patients treated for cervical dystonia [28,29]. However, it should be considered that the mean doses used for treating sialorrhea are smaller than those used for cervical dystonia, the mean treatment duration is longer than for cervical dystonia, and that the survival of ALS patients with severe bulbar symptoms is short.…”

Botulinum neurotoxins for post‐stroke spasticity in adults: A systematic review

“…This is suggested not only by the study included in the present review, 28 but also by trials with BoNT/B for other indications. 45 Six studies reported inconsistent and conflicting results on pain reduction in the upper limb following BoNT treatment, 10,11,21,25,26,28 whereas one controlled study showed significant pain reduction in the lower limb. 27 These inconsistencies in secondary outcome measures are likely explained by the heterogeneity of patients included and by the lack of systematic evaluation of pain or disability as outcome measures.…”

Clinical Effectiveness of Botulinum Toxin Type B in the Treatment of Subacromial Bursitis or Shoulder Impingement Syndrome

“…7,16 BT type B has been used since 1999 for the treatment of cervical dystonia, hyperhidrosis, spastic conditions, cerebral palsy, hemifacial spasm, bladder dysfunction, and various pain conditions. 17 Compared with type A, type B is thought to have a greater affinity for the sympathetic nerve system and therefore is more likely to relieve pain than the type A toxin. 17 A dosage of 5000 U of type B injection in patients with piriformis syndrome significantly reduced buttock and lower limb pain and these pain relieving effects were maintained at 16 weeks after injection.…”