Badarny Samih, Susel Zvi, Honigman Silvia
Movement Disorders Clinic, Neurology Department, Lady Davis Carmel Medical Center, Haifa, Israel.
Isr Med Assoc J. 2008 Jul;10(7):520-2.
Long-term therapy with botulinum toxin is sometimes associated with therapy failure following repeated injections of the neurotoxin, presumably due to specific antibody production. Primary therapy failure with botulinum toxin is less common and poorly understood.
To examine the effectiveness of the botulinum neurotoxin Dysport in patients with blepharospasm and hemifacial spasm after primary or secondary failure with Botox treatments.
In this case series study, eight patients with blepharospasm and hemifacial spasm who experienced primary or secondary therapy failure with Botox were treated with Dysport. In order to render an equivalent Dysport dose, a conversion ratio of 1:3 to 1:4 Botox/Dysport was used.
Two patients, one with blepharospasm and the other with hemifacial spasm, who showed primary therapeutic failure with Botox showed good response to Dysport treatments. One patient with tardive blepharospasm did not respond to either drug. Two patients with blepharospasm and three patients with hemifacial spasm who experienced Botox secondary therapy failure responded well to Dysport treatments.
Botox and Dysport are both serotype A botulinum toxins but carry different characteristics of biological activity. These differences possibly account for the favorable therapeutic response to Dysport in patients with hemifacial spasm or blepharospasm following failure with Botox treatments.
肉毒杆菌毒素的长期治疗有时会在反复注射神经毒素后出现治疗失败的情况，推测是由于产生了特异性抗体。肉毒杆菌毒素的原发性治疗失败较少见且了解不足。
研究在肉毒杆菌毒素（保妥适）原发性或继发性治疗失败后，注射用A型肉毒毒素（丽舒妥）治疗眼睑痉挛和半面痉挛患者的有效性。
在这个病例系列研究中，8例眼睑痉挛和半面痉挛患者在接受保妥适治疗原发性或继发性失败后接受了丽舒妥治疗。为了获得等效的丽舒妥剂量，使用了保妥适与丽舒妥1:3至1:4的换算比例。
2例患者，1例眼睑痉挛和1例半面痉挛，在保妥适原发性治疗失败后对丽舒妥治疗表现出良好反应。1例迟发性眼睑痉挛患者对两种药物均无反应。2例眼睑痉挛患者和3例半面痉挛患者在保妥适继发性治疗失败后对丽舒妥治疗反应良好。
保妥适和丽舒妥均为A型肉毒杆菌毒素，但具有不同的生物活性特征。这些差异可能解释了在保妥适治疗失败后，半面痉挛或眼睑痉挛患者对丽舒妥有良好治疗反应的原因。
