Document Detail

Secondary non-response due to antibody formation in a child after three injections of botulinum toxin B into the salivary glands.
MedLine Citation:
PMID:  17209979     Owner:  NLM     Status:  MEDLINE    
Botulinum toxin (BTX) offers a new treatment option to reduce drooling in adults and children. Antibody formation against BTX is known to be one reason for clinical secondary non-response to this treatment. This is a case report on the development of secondary non-response to BTX type B (BTX-B) in a 15-year-old male, with bilateral dyskinetic cerebral palsy (Gross Motor Function Classification System Level IV) with additional learning disability* and microcephaly, treated for the indication of drooling. After three successful treatment sessions, the fourth and fifth injections showed no clinical response. This was associated with the presence of antibodies against BTX-B as determined using the mouse diaphragm assay. Thus, formation of neutralizing antibodies against BTX-B appears to be an important issue, not only in patients treated for cervical dystonia but also in children treated for drooling. Subsequent injections with an adequate dose of BTX type A (BTX-A) did not show any clinical response either, although no antibodies to BTX-A were detected. Besides the unanswered questions of dosing and distribution, a second possible explanation could be that BTX-B gave rise to non-neutralizing antibodies that cross-react with BTX-A. The resulting immune complexes could be taken up by phagocytes and, thereby, impede clinical response.
Steffen Berweck; A Sebastian Schroeder; Seung-Hee Lee; Hans Bigalke; Florian Heinen
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Developmental medicine and child neurology     Volume:  49     ISSN:  0012-1622     ISO Abbreviation:  Dev Med Child Neurol     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-09     Completed Date:  2007-02-15     Revised Date:  2009-11-11    
Medline Journal Info:
Nlm Unique ID:  0006761     Medline TA:  Dev Med Child Neurol     Country:  England    
Other Details:
Languages:  eng     Pagination:  62-4     Citation Subset:  IM    
Dr von Hauner's Children's Hospital, University of Munich, Munich, Germany.
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MeSH Terms
Antibody Formation / drug effects*
Botulinum Toxin Type A / administration & dosage,  adverse effects*,  immunology*
Cerebral Palsy / complications,  physiopathology
Drug Administration Schedule
Follow-Up Studies
Learning Disorders / complications
Movement Disorders / complications,  physiopathology
Neuromuscular Agents / administration & dosage,  adverse effects*,  immunology*
Salivary Glands / drug effects*,  physiopathology
Severity of Illness Index
Sialorrhea / complications,  drug therapy*,  physiopathology
Reg. No./Substance:
0/Botulinum Toxin Type A; 0/Neuromuscular Agents

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