Botulinum toxin type B de novo therapy of cervical dystonia: frequency of antibody induced therapy failure

J Neurol. 2005 Aug;252(8):904-7. doi: 10.1007/s00415-005-0774-3. Epub 2005 Mar 11.


Botulinum toxin induced therapy failure type B antibody (BT-B, BT-B-AB) has so far only been reported after previous formation of antibodies against botulinum toxin type A (BT-A, BTA- AB). We wanted to explore the risk of BT-B-AB-induced therapy failure in patients who were exposed to botulinum toxin for the first time. For this purpose we followed nine patients with cervical dystonia receiving BT-B (NeuroBloc/Myo- Bloc, Elan Pharmaceuticals) in a dose of 11435 +/- 2977MU during 4.9 +/- 3.0 injection series. All patients showed a satisfactory initial therapeutic response as documented by a Toronto Western Spasmodic Torticollis Rating Scale score reduction from 17.7 +/- 9.4 to 5.3 +/- 4.8 and an overall subjective improvement of 56.1 +/- 28.3%. Seven patients experienced systemic anticholinergic side effects. Five patients had stable therapeutic responses over subsequent injection series. Four patients experienced complete therapy failure with BT-B-AB titres in excess of 10 mU/ml on the mouse diaphragm assay. Doubling the last effective BT-B dose produced neither therapeutic effects nor side effects. Subsequent applications of botulinum toxin type A produced a continued therapeutic response in one patient and complete therapy failure in the other.Despite the small sample size a frequency of 44 % indicates a high risk for BT-B-AB-induced complete therapy failure. The high amount of neurotoxin administered when NeuroBloc/MyoBloc is used might be a contributory factor. Further prospective comparative studies are necessary to monitor the frequency and time course of BT-B-AB formation.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Botulinum Toxins / immunology
  • Botulinum Toxins / therapeutic use*
  • Botulinum Toxins, Type A
  • Disability Evaluation
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neuromuscular Agents / immunology
  • Neuromuscular Agents / therapeutic use*
  • Severity of Illness Index
  • Torticollis / drug therapy*
  • Torticollis / immunology*
  • Treatment Failure


  • Neuromuscular Agents
  • rimabotulinumtoxinB
  • Botulinum Toxins
  • Botulinum Toxins, Type A