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Effectiveness of Switching Therapy from Complexing Protein-containing Botulinum Toxin Type A to a Formulation with Low Immunogenicity in Spasticity after Stroke: A case report

doi: 10.2340/16501977-1009

Open access

Abstract:

OBJECTIVE: Some patients receiving botulinum toxin type A therapy develop immunological resistance due to the production of neutralizing antibodies against the neurotoxin, thus partially or completely reducing the therapeutic effect.
Case report: We report here neurophysiological and clinical findings for a 58-year-old man treated with botulinum toxin type A for spasticity after ischaemic stroke, who became a secondary non-responder patient. Subsequent treatment with a different preparation of botulinum toxin type A had a great therapeutic effect on his spasticity. The muscles injected and the dosages were the same for each treatment, but evaluation with the Modified Ashworth Scale after treatment with the second preparation showed a reduction of approximately 2 points compared with the first examination. The clinical results were also supported by extensor digitorum brevis testing of the right muscle, which showed a reduction in compound muscle action potential, whereas it was unchanged in the non-injected muscle. No side-effects were reported, and after 1 year of treatment with this formulation clinical benefits were still evident.
CONCLUSION: The neurophysiological and clinical results obtained in this patient suggest that switching therapy from a complexing protein-containing product to a product potentially free of complexing proteins, which has low immunogenicity, may be a viable therapeutic option in secondary non-responder patients.

Authors:

Andrea Santamato, Maurizio Ranieri, Francesco Panza, Vincenza Frisardi, Maria Francesca Micello, Serena Filoni , Pietro Fiore
Department of Physical Medicine and Rehabilitation, University of Foggia “OORR”, Viale Pinto, IT-71100 Foggia, Italy. E-mail: a.santamato@unifg.it

References

  1. Wissel J, Ward AB, Erztgaard P, Bensmail D, Hecht MJ, Lejeune TM, et al. European consensus table on the use of botulinum toxin type A in adult spasticity. J Rehabil Med 2009; 41: 13–25.
  2. Greene P, Fahn S, Diamond B. Development of resistance to botulinum toxin type A in patients with torticollis. Mov Disord 1994; 9: 213–217.
  3. Dressler D, Hallett M. Immunological aspects of Botox, Dysport and Myobloc/NeuroBloc. Eur J Neurol 2006; 13 Suppl 1: 11–15.
  4. Yablon SA, Brashear A, Gordon MF, Elovic EP, Turkel CC, Daggett S, et al. Formation of neutralizing antibodies in patients receiving botulinum toxin type A for treatment of post stroke spasticity: a pooled-data analysis of three clinical trials. Clin Ther 2007; 29: 683–690.
  5. Turkel C, Dru R, Liu J. Double-blind, randomized, dose-ranging study of BOTOX1 purified neurotoxin complex for treating focal spasticity post-stroke. Naunyn Shmiedebergs Arch Pharmacol 2002; 365 Suppl 2: R47.
  6. Dressler D, Benecke R, Bigalke H. Botulinum toxin type B (NeuroBloc) in patients with botulinum toxin type A antibody-induced therapy failure. J Neurol 2003; 250: 967–969.
  7. Frevert J. Xeomin® is free from complexing proteins. Toxicon 2009; 54: 697–701.
  8. Frevert J, Dressler D. Complexing proteins in botulinum toxin type A drugs: a help or a hindrance? Biologics 2010; 4: 325–332.
  9. Bohannon RW, Smith RB. Interrater reliability of a modified Ashworth scale of muscle spasticity. Phys Ther 1987; 67: 206–207.
  10. Kessler KR, Benecke R. The EBD test – a clinical test for the detection of antibodies to botulinum toxin type A. Mov Disord 1997; 12: 95–99.
  11. Kimura J. Electrodiagnosis in diseases of nerve and muscle: principles and practice. Philadelphia, PA: FA Davis Co.; 1989.
  12. Jost WH, Kohl A, Brinkmann S, Comes G. Efficacy and tolerability of a botulinum toxin type A free of complexing proteins (NT 201) compared with commercially available botulinum toxin type A (BOTOX) in healthy volunteers. J Neural Transm 2005; 112: 905–913.
  13. Eisele K, Taylor HV, Blümel J. Immunogenicity of NT201 (Xeomin®) in cynomolgus monkeys following high-dose injections. Mov Disord 2008; 23 Suppl 1: S15.
  14. Kanovský P, Slawek J, Denes Z, Platz T, Sassin I, Comes G, et al. Efficacy and safety of botulinum neurotoxin NT 201 in poststroke upper limb spasticity. Clin Neuropharmacol 2009; 32: 259–265.
  15. Sankhla C, Jankovic J, Duane D. Variability of the immunologic and clinical response in dystonic patients immunoresistant to botulinum toxin injections. Mov Disord 1998; 13: 150–154.


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Volume 44, Issue 9

DOI: 10.2340/16501977-1009

Pages: 795-797

View at PubMed