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Subject: BTX for Dystonias (AAN 2004) Date: 5/27/2004 E-MOVE reports from the American Academy of Neurology, San Francisco April 25-30, 2004. Page (A), session (S) and poster (P) numbers are from Neurology 2004;62(7), Suppl 51. Interim results of an observational study of neutralizing antibody formation with the current preparation of botulinum toxin type A treatment for cervical dystonia CL Comella, J Jankovic, S Daggett, J Mordaunt, MF Brin P06.141, A511 The rate of formation of neutralizing antibodies is extremely low with the current formulation of Botox, according to this study. Three hundred twenty-six BTX-naïve cervical dystonia patients commenced Botox injections and received follow-up injections as needed. Serum samples were taken at baseline and follow-up visits. Patients received up to 9 treatments, and 1036 serum samples were tested with the mouse protection assay. Of these, 1031 tested negative for neutralizing antibodies, 1 was positive, and 4 were inconclusive. The 1 positive sample was from the first follow-up visit of a patient who was antibody-negative at baseline and at the second follow-up visit, and who remained clinical responsive to treatment. The authors conclude, “These interim results suggest that neutralizing antibody formation is extremely rare with the current BTX-A preparation.” Supported by Allergan 2. A double-blind, randomized, parallel group design comparison of botulinum toxin type A (Botox) and botulinum toxin type B (Myobloc) on autonomic symptoms and physiology in patients with cervical dystonia R Tintner, UF Winzer, KA Smalky, J Jankovic S65.003, A538 Botox causes less dry mouth and constipation than Myobloc in cervical dystonia patients, according to this study. Twenty patients with CD who were responsive to Botox were randomized to receive Botox at their usual dose or Myobloc at a dose conversion of 50:1. Patients in the Myobloc group were on average 8 years older than patients in the Botox group. Assessment at 2 weeks indicated a significantly greater decrease in saliva production from Myobloc (p<0.01), and a greater number of complaints of dry mouth. Dysphagia occurred in 5 of 9 Myobloc patients and 2 of 11 Botox patients. Increased constipation severity occurred in 3 Myobloc patients, but no Botox patients. No differences were seen in frequency of orthostatic hypotension or blood pressure regulation. Supported by Allergan 3. Long-term botulinum toxin treatment for focal hand dystonia Z Mari, M Bruno, B Lee, BI Karp, M Hallett P06.143, A512 Outcome data was reviewed from 1100 injection sessions in 120 patients with focal hand dystonia, treated for a mean of 3.6 years (10 months to 14 years). Injections were deemed ineffective in 24% of sessions, minimal to moderate in 32%, marked in 30%, and maximal in 14%. Weakness did not occur in 26% of sessions, was minimal in 20 %, was moderate or marked in 47%, and was severe in 7%. Based on patient interviews, the authors note that “Dissatisfaction with the weakness/benefit ratio is a frequent cause of discontinuation.” [end] 4. Botulinum toxin injections in the treatment of musicians’ dystonia SU Schuele, HC Jabusch, RJ Lederman, EO Altenmueller P06.142, A511-512 Eighty-four of 88 consecutively treated musicians responded to a survey regarding treatment with BTX-A. Thirty-six percent indicated mild benefit or less, while 64% had marked benefit sufficient to improve their ability to perform. Eleven discontinued treatment after initial improvement: 5 due to insufficient response, 5 due to overall improvement, and 1 retired. Forearm flexors were the most commonly injected muscles, with no differences for woodwind, guitar, keyboard, string, and brass players. [end] E-MOVE Editor: Richard Robinson, NASW, WE MOVE
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