Department of Physical Medicine and Rehabilitation, University of Foggia, Foggia, Italy.
J Rehabil Med. 2012 Sep;44(9):795-7. doi: 10.2340/16501977-1009.
Some patients receiving botulinum toxin type A therapy develop immunological resistance due to the production of neutralizing antibodies against the neurotoxin, thus partially or completely reducing the therapeutic effect.
We report here neurophysiological and clinical findings for a 58-year-old man treated with botulinum toxin type A for spasticity after ischaemic stroke, who became a secondary non-responder patient. Subsequent treatment with a different preparation of botulinum toxin type A had a great therapeutic effect on his spasticity. The muscles injected and the dosages were the same for each treatment, but evaluation with the Modified Ashworth Scale after treatment with the second preparation showed a reduction of approximately 2 points compared with the first examination. The clinical results were also supported by extensor digitorum brevis testing of the right muscle, which showed a reduction in compound muscle action potential, whereas it was unchanged in the non-injected muscle. No side-effects were reported, and after 1 year of treatment with this formulation clinical benefits were still evident.
The neurophysiological and clinical results obtained in this patient suggest that switching therapy from a complexing protein-containing product to a product potentially free of complexing proteins, which has low immunogenicity, may be a viable therapeutic option in secondary non-responder patients.
由于产生针对神经毒素的中和抗体，一些接受 A 型肉毒毒素治疗的患者出现免疫抵抗，从而部分或完全降低治疗效果。
我们在此报告 1 例 58 岁男性缺血性脑卒中后痉挛接受 A 型肉毒毒素治疗，发生继发无应答患者的神经生理学和临床发现。随后使用不同制备的 A 型肉毒毒素治疗对其痉挛有很大的疗效。每次治疗的注射肌肉和剂量相同，但第二次治疗后使用改良 Ashworth 量表评估显示，与第一次检查相比，痉挛程度降低了约 2 分。临床结果也得到右肌伸趾短肌检测的支持，复合肌肉动作电位降低，而未注射肌肉无变化。未报告任何副作用，且该制剂治疗 1 年后仍存在临床获益。
该患者的神经生理学和临床结果表明，从含有络合蛋白的产品转换为潜在不含络合蛋白、免疫原性低的产品可能是继发无应答患者的可行治疗选择。
