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New formulation of Botox: complete antibody-induced treatment failure in cervical dystonia
  1. D Dressler1,
  2. F Adib Saberi2
  1. 1Department of Neurology, Rostock University, Rostock, Germany
  2. 2Department of Neurology, Klinikum NordHeidberg, Hamburg, Germany
  1. Correspondence to:
 D Dressler
 Department of Neurology, Rostock University, Gehlsheimer Street 20, D-18147 Rostock, Germany; dirk.dressler{at}

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Botulinum toxin is used with remarkable success to treat various muscle and exocrine gland hyperactivity syndromes. Rarely, treatment failure due to formation of botulinum toxin antibodies (ABF) occurs.1,2 To reduce the risk of ABF, a new formulation of Botox (in the following referred to as “current Botox”; Allergan, Irvine, California, USA) with increased specific biological potency was introduced. Although ABF could not be detected with current Botox in a large prospective study, it has been reported recently in a patient with special immunoreactive predisposition.3,4 We are now reporting ABF after current Botox in an immunologically unremarkable patient.

A 50-year-old woman had substantial idiopathic tonic–clonic cervical dystonia for the past 7 months. Her score on the Toronto Western Torticollis Rating Scale (TWSTRS) was 25 (Torticollis Severity Scale), 22 (Disability Scale) and 17.5 (Pain Scale).5 Treatment was initiated with current Botox (100 MU/1.0 ml, 0.9% NaCl/H2O) (table 1). Two weeks after injection series …

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  • Competing interests: DD and FAS have been consultants to Allergan, Elan, Ipsen and Merz.