Document Detail


Sudomotor testing predicts the presence of neutralizing botulinum A toxin antibodies.
MedLine Citation:
PMID:  12112049     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The increasing number of patients being treated with botulinum toxin A complex (BoNT/A) has led to a higher incidence of neutralizing anti-BoNT/A antibodies (ABAs). Because BoNT/A is known to inhibit sweating, here we report sudometry as a possibility for predicting the presence of ABA. Sixteen patients suffering from spasmodic torticollis were selected: in 2 patients, BoNT/A treatment continued to be effective, in 9 patients, the treatment effect was impaired, and in 5 patients, secondary treatment failure developed. BoNT/A (100 mouse units, Dysport; Ipsen Pharma, Berkshire, United Kingdom) was injected subcutaneously into the lateral calves. Sweating was visualized with iodine starch staining. In addition, quantitative sudomotor axon reflex testing was performed at the injection site. Individual ABA titers were determined with a mouse bioassay. Results of sudometry significantly correlated with the BoNT/A treatment success. The quantitative sudomotor axon reflex testing was 0.58 +/- 0.63 fraction of the normal mean in patients with treatment failure, 0.18 +/- 0.13 fraction of the normal mean in those who responded partially, and 0 in responders (p < 0.01). Accordingly, the areas of the anhidrotic skin after subcutaneous injections were 4.5 +/- 10.3 cm(2), 32.7 +/- 16.5 cm(2), and 62 cm(2) (p < 0.01). Discrimination analysis indicated that the presence of ABA (6 ABA-positive and 10 ABA-negative) could be predicted correctly in all patients from the results of sudometry. Therefore, sudometry is a useful tool for identifying patients with neutralizing ABAs and might be helpful for identifying reasons for BoNT/A treatment failure.
Authors:
Frank Birklein; Dirk Walther; Hans Bigalke; Martin Winterholler; Frank Erbguth
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Publication Detail:
Type:  Comparative Study; In Vitro; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of neurology     Volume:  52     ISSN:  0364-5134     ISO Abbreviation:  Ann. Neurol.     Publication Date:  2002 Jul 
Date Detail:
Created Date:  2002-07-11     Completed Date:  2002-07-31     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7707449     Medline TA:  Ann Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  68-73     Citation Subset:  IM    
Affiliation:
Neurologische Klinik, Johannes-Gutenberg Universität Mainz, Germany. birklein@neurologie.klinik.uni-mainz.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Animals
Antibodies, Bacterial / analysis*,  blood
Botulinum Toxin Type A / immunology*,  therapeutic use
Female
Humans
Hypohidrosis / chemically induced,  immunology
Male
Mice
Middle Aged
Predictive Value of Tests
Statistics, Nonparametric
Sweating / drug effects,  immunology*,  physiology
Torticollis / blood*,  drug therapy,  immunology
Chemical
Reg. No./Substance:
0/Antibodies, Bacterial; 0/Botulinum Toxin Type A

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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