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4 - Botulinum toxin: primary and secondary resistance

Published online by Cambridge University Press:  02 December 2009

By
Benjamin Anyanwu ,
Philip A. Hanna  and
Joseph Jankovic
Edited by
Anthony B. Ward  and
Michael P. Barnes
Benjamin Anyanwu
Affiliation:
New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA
Philip A. Hanna
Affiliation:
New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA
Joseph Jankovic
Affiliation:
Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
Anthony B. Ward
Affiliation:
University Hospital of North Staffordshire
Michael P. Barnes
Affiliation:
Hunters Moor Regional Neurological Rehabilitation Centre
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Summary

Introduction

Botulinum toxin (BoNT), the most potent biologic toxin, is a highly effective therapeutic tool in a variety of neurologic and other disorders. In minute doses it has the ability to block Ach release and, therefore, has been exploited to relieve disease symptoms associated with muscle hyperactivity. Intramuscular injection of BoNT produces a chemodenervertion at the neuromuscular junction that results in reversible partial paralysis. While used primarily for conditions characterized by abnormal, excessive, or inappropriate muscle contractions, BoNT is also increasingly used in the management of a variety of ophthalmologic, urologic, gastrointestinal, orthopedic, cosmetic and dermatologic disorders.

As the use of BoNT continues to increase, the antigenicity of BoNT and development of immunoresistance secondary to blocking antibodies has continued to be a pressing concern. A certain percentage of patients receiving repeated injections develop blocking antibodies (immunoresistance) against BoNT (BoNT-Abs) causing them to be completely resistant to the effects of subsequent BoNT injections. This is termed secondary resistance. Primary resistance refers to lack of response to initial BoNT treatment, which is extremely rare, and may be due to pre-existing BoNT-Abs, possibly as a result of prior immunization against botulism. The frequency of neutralizing or blocking antibodies (immunoresistance) against BoNT is not known. This lack of information is partly due to a paucity of well-designed epidemiological studies utilizing appropriate assays to determine the frequency of blocking antibodies in a prospectively followed population of BoNT-treated patients.

Type
Chapter
Information
Clinical Uses of Botulinum Toxins , pp. 45 - 57
Publisher: Cambridge University Press
Print publication year: 2007

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  • Botulinum toxin: primary and secondary resistance
    • By Benjamin Anyanwu, New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA, Philip A. Hanna, New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA, Joseph Jankovic, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
  • Edited by Anthony B. Ward, Michael P. Barnes
  • Book: Clinical Uses of Botulinum Toxins
  • Online publication: 02 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544842.004
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  • Botulinum toxin: primary and secondary resistance
    • By Benjamin Anyanwu, New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA, Philip A. Hanna, New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA, Joseph Jankovic, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
  • Edited by Anthony B. Ward, Michael P. Barnes
  • Book: Clinical Uses of Botulinum Toxins
  • Online publication: 02 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544842.004
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Botulinum toxin: primary and secondary resistance
    • By Benjamin Anyanwu, New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA, Philip A. Hanna, New Jersey Neuroscience Institute, JFK Medical Center, Edison, NJ, USA; Seton Hall University School of Graduate Medical Education, South Orange, NJ, USA, Joseph Jankovic, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, Houston, Texas, USA
  • Edited by Anthony B. Ward, Michael P. Barnes
  • Book: Clinical Uses of Botulinum Toxins
  • Online publication: 02 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544842.004
Available formats
×