Serum Antibody Production to Botulinum A Toxin

Siatkowski, R. Michael; Tyutyunikov, Anna; Biglan, Albert W.; Scalise, Deborah; Genovese, Christine; Raikow, Radmila B.; Kennerdell, John S.; Feuer, William J.

doi:10.1016/s0161-6420(93)31384-9

Cited by 78 publications

(34 citation statements)

References 11 publications

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“…21 There is also an anxiety among patients that the treatment will become less effective with time, 22 although the duration of benefit from toxin treatment has been shown to be stable over time. 23 In this study, the interval between treatments decreased in only about 10% of patients and increased in about half of the patients.…”

Section: Discussionmentioning

confidence: 99%

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Ortisi

Henderson

Bunce

et al. 2006

Eye

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Purpose To evaluate a protocol for the treatment of facial dystonias. Method A retrospective noncomparative interventional case series of all patients who attended a specialised tertiary referral clinic between January 2000 and January 2003. At the start of treatment, patients were seen and treated at weekly intervals until their symptoms were controlled or they developed complications. The sum of the weekly doses was taken as the individual patient dose and then given at 3-4 monthly intervals as required for the individual patient. Refractory cases of spasm underwent orbicularis muscle reduction. Pretarsal spasm was treated with pretarsal botulinum toxin. If the spasm was relieved but the patient could not open their eyelids, a trial of ptosis props was undertaken and the toxin injections continued, before considering a brow suspension. If patients could not see because of a spastic Bell's phenomenon, they were given centrally acting systemic medication. Results Of 182 new patients, 63 (35%) required two or more sets of injections to titrate their optimum dose of toxin. Symptoms improved in 169 patients (93%). Of a total 332 new patients and follow-up patients, 47 (14%) underwent surgery during their management, 36 protractor myectomy, and 13 brow suspension. Protractor myectomy improved symptoms in 23 (64%). Brow suspension improved symptoms in 12 patients (92%). Conclusions The dose of botulinum toxin can be titrated to the individual patient, and the refractory cases managed satisfactorily if a logical protocol is followed. Eye (2006) 20, 916-922.

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Section: Discussionmentioning

confidence: 99%

Blepharospasm and hemifacial spasm: a protocol for titration of botulinum toxin dose to the individual patient and for the management of refractory cases

Ortisi

Henderson

Bunce

et al. 2006

Eye

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“…6 Botulinum neurotoxin A (BoNT-A) therapy for strabismus was introduced by Scott 11 in the early 1980s, and in 1989 the Food and Drug Administration approved BoNT-A for ophthalmologic and neurologic use in treating strabismus, blepharospasm, and hemifacial spasm (HFS). 12 Since then, BoNT-A has replaced eyelid surgery as the first-line therapy for BEB, [13][14][15][16][17] and has become the treatment of choice, as it is very successful in controlling eyelid spasms. [17][18][19][20][21][22][23][24][25][26][27][28][29] Although some authors have reported decreasing effectiveness with prolonged use, 23,30 others have not observed this in the majority of patients.…”

Section: Introductionmentioning

confidence: 99%

Long-term efficacy of botulinum toxin A for treatment of blepharospasm, hemifacial spasm, and spastic entropion: a multicentre study using two drug-dose escalation indexes

Cillino

Raimondi

Guépratte

et al. 2009

Eye

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Purpose To investigate the long-term effectiveness and safety of botulinum neurotoxin A (BoNT-A) treatment in patients with blepharospasm (BEB), hemifacial spasm (HFS), and entropion (EN) and to use for the first time two modified indexes, 'botulin toxin escalation index-U' (BEI-U) and 'botulin toxin escalation index percentage' (BEI-%), in the dose-escalation evaluation. Methods All patients in this multicentre study were followed for at least 10 years and main outcomes were clinical efficacy, duration of relief, BEI-U and BEI-%, and frequency of adverse events. Results BEB, HFS, and EN patients received a mean BoNT-A dose with a significant intergroup difference (Po0.0005, respectively). The mean ( ± SD) effect duration was statistically different (P ¼ 0.009) among three patient groups. Regarding the BoNT-A escalation indexes, the mean ( ± SD) values of BEI-U and BEI-% were statistically different (P ¼ 0.035 and 0.047, respectively) among the three groups. In BEB patients, the BEI-% was significantly increased in younger compared with older patients (P ¼ 0.008). The most frequent adverse events were upper lid ptosis, diplopia, ecchymosis, and localized bruising. Conclusions This long-term multicentre study supports a high efficacy and good safety profile of BoNT-A for treatment of BEB, HFS, and EN. The BEI indexes indicate a significantly greater BoNT-A-dose escalation for BEB patients compared with HFS or EN patients and a significantly greater BEI-% in younger vs older BEB patients. These results confirm a greater efficacy in the elderly and provide a framework for long-term studies with a more flexible and reliable evaluation of drug-dose escalation.

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“…1 The reason for this is unknown, but may be related to immune-mediated phenomena. 5,6 Myectomy has been reported to be successful in relieving symptoms in 88% of these cases, but more than one operation is sometimes necessary. 1,2 Hirayama et al 7 have reported the beneficial effects of goggles in patients with apraxia of the lids.…”

Section: Commentmentioning

confidence: 99%