title: Depletion of neutralising antibodies resensitises a secondary non-responder to botulinum A neurotoxin.
abstract: The objective was to evaluate whether removal of neutralising antibodies potentially resensitises a secondary non-responder to botulinum neurotoxin A (BoNT/A). Neutralising antibodies directed against BoNT/A are produced during long term treatment with BoNT/A-hemagglutinin complex in up to 10% of patients with cervical dystonia. These patients become secondary non-responders. Other serotypes of BoNT are not yet generally available and may also bear the risk of inducing antibody formation. Plasma exchange (PE) (one treatment cycle) and immunoadsorption on a protein A column (IA-PA; three treatment cycles) was employed over 15 months to remove neutralising antibodies from a severely disabled secondary non-responder with cervical dystonia. After plasma exchange or IA-PA, BoNT/A was reinjected. Antibodies were measured with a sensitive functional toxin neutralising test. Repeated use of plasma exchange and IA-PA depleted neutralising antibodies to below the detection limit and subsequently allowed successful BoNT/A injection into dystonic muscles. No serious side effects were found related to the depletion of IgG. In conclusion PE or IA-PA performed before BoNT/A readministration may provide an alternative strategy in treating selected secondary non-responders who are severely disabled.
authors.affiliation: Department of Neurology, Bayerische Julius-Maximilians-Universität, Würzburg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Naumann
authors.forename: K V
authors.initials: KV
authors.lastname: Toyka
authors.forename: B
authors.initials: B
authors.lastname: Mansouri Taleghani
authors.forename: J
authors.initials: J
authors.lastname: Ahmadpour
authors.forename: K
authors.initials: K
authors.lastname: Reiners
authors.forename: H
authors.initials: H
authors.lastname: Bigalke
mesh_terms: D000328:Adult; D001665:Binding Sites / Q000187:drug effects; D019274:Botulinum Toxins, Type A / Q000276:immunology* / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000187:drug effects* / Q000276:immunology*; D009498:Neurotoxins / Q000276:immunology* / Q000494:pharmacology*; D010951:Plasma Exchange / Q000379:methods; D014103:Torticollis / Q000175:diagnosis / Q000628:therapy
chemical_list: D007074:Immunoglobulin G; D009498:Neurotoxins; D019274:Botulinum Toxins, Type A