title: Results of a BoNT/A antibody study in children and adolescents after onabotulinumtoxin A (Botox®) detrusor injection.
abstract: BACKGROUND
  Onabotulinumtoxin A (OnaBoNT/A, Botox®) is effective in the treatment of neurogenic detrusor overactivity, however this therapy can fail. In a prospective study, we analyzed patient serum for BoNT/A antibodies (BoNT/A-AB) as a possible cause of therapy failure.
  
  
  METHODS
  17 patients (average age 14.5 years) who had neurogenic detrusor overactivity were admitted for repeated OnaBoNT/A injection into the detrusor muscle. We analyzed their serum for BoNT/A-AB. The clinical findings were correlated with the incidence of BoNT/A-AB.
  
  
  RESULTS
  Positive BoNT/A-AB were clearly or marginally determined in 6 patients. Therapy had failed in all 6. In 4 of the 6, therapy might have failed because of a low-compliance bladder (3 patients) or tethered-cord syndrome (1), but BoNT/A-AB were found as the only possible cause in 2 patients. Thus, the incidence of BoNT/A-AB in the 17 patients was 35%, and the antibodies were clinically significant in 12%. All patients with BoNT/A-AB had a history of recurrent urinary tract infections.
  
  
  CONCLUSIONS
  Patients who show a failure of therapy after OnaBoNT/A injections for which no other causes can be determined should have their serum checked for BoNT/A-AB. Recurrent urinary tract infection might be a predisposing factor for BoNT/A-AB.
authors.affiliation: Department of Urology, St. Hedwig Hospital, Medical School of Charité Universitätsmedizin Berlin, Berlin, Germany. hschultebaukloh @ hotmail.com
authors.forename: H
authors.initials: H
authors.lastname: Schulte-Baukloh
authors.forename: J
authors.initials: J
authors.lastname: Herholz
authors.forename: H
authors.initials: H
authors.lastname: Bigalke
authors.forename: K
authors.initials: K
authors.lastname: Miller
authors.forename: H H
authors.initials: HH
authors.lastname: Knispel
mesh_terms: D000283:Administration, Intravesical; D000293:Adolescent; D000907:Antibodies, Bacterial / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000276:immunology*; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000276:immunology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D017211:Treatment Failure; D053201:Urinary Bladder, Overactive / Q000188:drug therapy* / Q000503:physiopathology; D014563:Urodynamics / Q000187:drug effects; D055815:Young Adult
chemical_list: D000907:Antibodies, Bacterial; D015415:Biomarkers; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A