Abstract
OBJECTIVE—A previous study of botulinum toxin type F (BTX-F) treatment for torticollis had shown a dose of 520 MU to be effective, but for a much shorter duration than is usual with botulinum toxin type A (BTX-A). The objective was to assess the effect of a higher dose of BTX-F. METHODS—Four of the previously treated patients, plus an additional patient, were treated with a higher dose of 780 MU BTX-F. All were secondary non-responders to BTX-A due to neutralising antibodies. A test injection of 40 MU BTX-F was also given into the extensor digitorum brevis muscle (EDB), to examine the time course of the biological effect of the toxin electrophysiologically. Patients were followed up at two, four, eight, and 12weeks. RESULTS—All patients reported subjective improvement lasting from seven to 11 (mean 8.6) weeks accompanied by a significant reduction in mean clinical severity scores at two weeks. Four patients had pain which was substantially reduced. The electrophysiological studies confirmed biological sensitivity to the toxin in all patients, showing a significant change beginning at two weeks and returning to baseline at 12 weeks. The time course of this effect paralleled roughly that of the clinical response. The four patients who had previously received 520 MU BTX-F reported that the response was better and longer in duration with 780 MU. Dysphagia was more common than reported with the lower dose. CONCLUSION—Better results are possible with higher doses of BTX-F but the duration of benefit is still shorter than with BTX-A, seemingly due to a shorter duration of neuromuscular junction blockade.
Full Text
The Full Text of this article is available as a PDF (93.6 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Greene P. E., Fahn S. Use of botulinum toxin type F injections to treat torticollis in patients with immunity to botulinum toxin type A. Mov Disord. 1993 Oct;8(4):479–483. doi: 10.1002/mds.870080411. [DOI] [PubMed] [Google Scholar]
- Hamjian J. A., Walker F. O. Serial neurophysiological studies of intramuscular botulinum-A toxin in humans. Muscle Nerve. 1994 Dec;17(12):1385–1392. doi: 10.1002/mus.880171207. [DOI] [PubMed] [Google Scholar]
- Kauffman J. A., Way J. F., Jr, Siegel L. S., Sellin L. C. Comparison of the action of types A and F botulinum toxin at the rat neuromuscular junction. Toxicol Appl Pharmacol. 1985 Jun 30;79(2):211–217. doi: 10.1016/0041-008x(85)90342-4. [DOI] [PubMed] [Google Scholar]
- Kessler K. R., Benecke R. The EBD test--a clinical test for the detection of antibodies to botulinum toxin type A. Mov Disord. 1997 Jan;12(1):95–99. doi: 10.1002/mds.870120116. [DOI] [PubMed] [Google Scholar]
- Ludlow C. L., Hallett M., Rhew K., Cole R., Shimizu T., Sakaguchi G., Bagley J. A., Schulz G. M., Yin S. G., Koda J. Therapeutic use of type F botulinum toxin. N Engl J Med. 1992 Jan 30;326(5):349–350. doi: 10.1056/NEJM199201303260516. [DOI] [PubMed] [Google Scholar]
- Mezaki T., Kaji R., Kohara N., Fujii H., Katayama M., Shimizu T., Kimura J., Brin M. F. Comparison of therapeutic efficacies of type A and F botulinum toxins for blepharospasm: a double-blind, controlled study. Neurology. 1995 Mar;45(3 Pt 1):506–508. doi: 10.1212/wnl.45.3.506. [DOI] [PubMed] [Google Scholar]
- Sheean G. L., Lees A. J. Botulinum toxin F in the treatment of torticollis clinically resistant to botulinum toxin A. J Neurol Neurosurg Psychiatry. 1995 Dec;59(6):601–607. doi: 10.1136/jnnp.59.6.601. [DOI] [PMC free article] [PubMed] [Google Scholar]