The use of botulinum toxin type-B in the treatment of patients who have become unresponsive to botulinum toxin type-A -- initial experiences

Eur J Neurol. 2005 Dec;12(12):947-55. doi: 10.1111/j.1468-1331.2005.01095.x.

Abstract

The increasing use of botulinum toxin type-A, especially for focal dystonia and spasticity has highlighted the issue of secondary non-responsiveness. Within the last few years botulinum toxin type-B (Myobloc/Neurobloc) has become commercially available as an alternative to type-A. This paper discusses our initial experience of botulinum toxin type-B in a total of 63 individuals who attended our botulinum clinic. Thirty-six patients had cervical dystonia and a secondary non-response to type-A toxin. Thirteen of these patients (36%) had a reasonable clinical response to Neurobloc and continue to have injections. The other 23 patients either had no response, or a poor response, or had unacceptable side effects and ceased treatment. A small number of people with blepharospasm, hemifacial spasm and foot dystonia also had a disappointing response to injection. Twenty patients with spasticity were also type-A resistant. Seven of these show some continuing response to type-B, without unacceptable side effects. These findings demonstrate that botulinum toxin type-B has a place in the management of patients who have become non-responsive to type-A, but overall the responses to type-B toxin were disappointing.

MeSH terms

  • Antibodies / blood
  • Botulinum Toxins / immunology
  • Botulinum Toxins / therapeutic use*
  • Botulinum Toxins, Type A / immunology
  • Botulinum Toxins, Type A / therapeutic use*
  • Drug Tolerance / immunology*
  • Dystonia / drug therapy*
  • Enzyme-Linked Immunosorbent Assay
  • Female
  • Humans
  • Male
  • Middle Aged
  • Muscle Spasticity / drug therapy*
  • Neuromuscular Agents / immunology
  • Neuromuscular Agents / therapeutic use*
  • Treatment Outcome

Substances

  • Antibodies
  • Neuromuscular Agents
  • rimabotulinumtoxinB
  • Botulinum Toxins
  • Botulinum Toxins, Type A