Development of Antibodies to Botulinum Toxin Type A in Patients with Torticollis Treated with Injections of Botulinum Toxin Type A

  • Paul Greene
  • Stanley Fahn


Botulinum toxin (botox) injections are now recognized as a major means of treating focal dystonia, e.g. blepharospasm,1,2 torticollis,3–9 and spastic dysphonia.10 Botox has also been used with success in treating patients with dystonia of jaw and other lower facial muscles,11 brachial dystonia,12,13 and a variety of other hyperkinetic movement disorders. Although local side effects, such as ptosis after blepharospasm injections and dysphagia after neck or tongue injections, may complicate treatment in a minority of patients, systemic side effects after therapeutic botox injections are uncommon. In most centers, early experience with the use of botox for blepharospasm, in doses of 25–100 units every three months, indicated that loss of benefit did not occur (a unit of botox is the mouse LD50 by intraperitoneal injection). Treatment of torticollis requires higher doses of botox, about 150u-300u every 3 months. At these doses, patients have been recognized with antibodies to botox in sufficient titers to block all clinical effect.14,15,16,17 In addition, some patients may have loss of response to botox, and failure to develop muscle atrophy after botox injections, without the presence of detectable serum antibodies. The prevalence of these problems inpatients receiving botox therapy for torticollis is not known. Nonetheless, they are a major therapeutic problem for some patients. We have reviewed our experience in treating torticollis with botox to determine the prevalence of antibody mediated resistance to botox, and to identify possible risk factors for the development of loss of response to botox.


Botulinum Toxin Botulinum Toxin Injection Botulinum Toxin Type Focal Dystonia Injection Series 
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Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Paul Greene
    • 1
  • Stanley Fahn
    • 1
  1. 1.Columbia-Presbyterian Medical CenterNew YorkUSA

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