title: The use of botulinum toxin type-B in the treatment of patients who have become unresponsive to botulinum toxin type-A -- initial experiences.
abstract: The increasing use of botulinum toxin type-A, especially for focal dystonia and spasticity has highlighted the issue of secondary non-responsiveness. Within the last few years botulinum toxin type-B (Myobloc/Neurobloc) has become commercially available as an alternative to type-A. This paper discusses our initial experience of botulinum toxin type-B in a total of 63 individuals who attended our botulinum clinic. Thirty-six patients had cervical dystonia and a secondary non-response to type-A toxin. Thirteen of these patients (36%) had a reasonable clinical response to Neurobloc and continue to have injections. The other 23 patients either had no response, or a poor response, or had unacceptable side effects and ceased treatment. A small number of people with blepharospasm, hemifacial spasm and foot dystonia also had a disappointing response to injection. Twenty patients with spasticity were also type-A resistant. Seven of these show some continuing response to type-B, without unacceptable side effects. These findings demonstrate that botulinum toxin type-B has a place in the management of patients who have become non-responsive to type-A, but overall the responses to type-B toxin were disappointing.
authors.affiliation: Specialist Neurological Rehabilitation Services Division, Northgate & Prudhoe NHS Trust, Hunters Road, Newcastle-upon-Tyne, UK. m.p.barnes@btinternet.com
authors.forename: M P
authors.initials: MP
authors.lastname: Barnes
authors.forename: D
authors.initials: D
authors.lastname: Best
authors.forename: L
authors.initials: L
authors.lastname: Kidd
authors.forename: B
authors.initials: B
authors.lastname: Roberts
authors.forename: S
authors.initials: S
authors.lastname: Stark
authors.forename: P
authors.initials: P
authors.lastname: Weeks
authors.forename: J
authors.initials: J
authors.lastname: Whitaker
mesh_terms: D000906:Antibodies / Q000097:blood; D001905:Botulinum Toxins / Q000276:immunology / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A / Q000276:immunology / Q000627:therapeutic use*; D004361:Drug Tolerance / Q000276:immunology*; D004421:Dystonia / Q000188:drug therapy*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy*; D009465:Neuromuscular Agents / Q000276:immunology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000906:Antibodies; D009465:Neuromuscular Agents; C096323:rimabotulinumtoxinB; D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A