Schönweiler R, Zwirner P
Abteilung für Phoniatrie und Pädaudiologie, HNO-Klinik, Universitätsklinikum Schleswig-Holstein-Campus Lübeck.
HNO. 2005 Feb;53(2):166-73. doi: 10.1007/s00106-004-1072-6.
Today, most patients with severe adductor type spasmodic dysphonia are treated with repeated injections of botulinum toxin type A (BTA). It is known that patients who have been treated for many years and have received a high cumulative dosage may develop antibodies against BTA, making them "resistant" to further injections. For these patients, botulinum toxin type B (BTB, NeuroBloc) is considered to be a new chance to continue the treatment. When changing to BTB, one has to find an "equivalent dosage" which is estimated for cervical dystonia to be 25-33-fold of the previous Botox dosage and the 10-13-fold for the previous Dysport dosage. We report on a 62 year old female patient with antibodies against BTA. For maximum care, the first injection of BTB was performed with the sixfold of the previous Dysport dosage, which was almost the half of the needed dosage predicted from experience with cervical dystonia. The relief only lasted 3 weeks and was therefore disappointing. For the subsequent injections, we consulted Sataloff who also had one patient with antibodies treated with BTB. Based on his personnel advice, we chose the 30-fold dosage, which was effective for 3 months, resulting in improvements to voice quality (both psychoacoustic rating and acoustic measures), voice "quantity" (voice range profiles), aerodynamics (maximum phonation time, phonation quotient), and voice handicap. As with Sataloff et al. (2002), we found that the dosage of BTB probably has to be much higher than in cervical dystonia.
如今，大多数重度内收型痉挛性发音障碍患者接受反复注射A型肉毒杆菌毒素（BTA）治疗。众所周知，接受多年治疗且累积剂量较高的患者可能会产生抗BTA抗体，从而对进一步注射产生“抵抗”。对于这些患者，B型肉毒杆菌毒素（BTB，商品名NeuroBloc）被视为继续治疗的新希望。改用BTB时，必须找到“等效剂量”，据估计，对于颈部肌张力障碍，该剂量是先前保妥适剂量的25 - 33倍，是先前得宝松剂量的10 - 13倍。我们报告了一名62岁的女性患者，她体内存在抗BTA抗体。为了给予最大程度的治疗，首次注射BTB时采用了先前得宝松剂量的6倍，这几乎是根据颈部肌张力障碍经验预测所需剂量的一半。缓解仅持续了3周，因此令人失望。对于后续注射，我们咨询了萨塔洛夫，他也有一名抗体阳性患者接受BTB治疗。根据他的个人建议，我们选择了30倍剂量，该剂量起效3个月，使声音质量（心理声学评分和声学测量）、声音“数量”（嗓音音域图）、空气动力学指标（最长发声时间、发声商）以及嗓音障碍状况均得到改善。与萨塔洛夫等人（2002年）的情况一样，我们发现BTB的剂量可能必须比颈部肌张力障碍时高得多。
