ABSTRACT
To determine the long-term efficacy of botulinum toxin (BTX) treatments, we analyzed longitudinal follow-up data on 45 patients (32 women; mean age, 68.8 years) currently followed in the Baylor College of Medicine Movement Disorders Clinic, who have received BTX treatments continuously for at least 12 years (mean 15.8 +/- 1.5 years). Their mean response rating after the last injection, based one a previously described scale 0-to-4 scale (0 = no effect; 4 = marked improvement) was 3.7 +/- 0.6 and the mean total duration of response was 15.4 +/- 3.4 weeks. Although the latency and total duration of the response to treatment have not changed over time, the peak duration of response (P < 0.005) and dose per visit (P < 0.0001) have increased since the initial visit. Furthermore, global rating (P < 0.02) and peak effect (P < 0.05) have improved. In total, 20 adverse events occurred in 16 of 45 (35.6%) patients after their initial visit and 11 adverse events in 10 of 45 (22.2%) patients at their most recent injection visit. Antibody (Ab) testing was carried out in 22 patients due to nonresponsiveness; blocking Abs were confirmed by the mouse protection assay in 4 of 22 (18%) patients. Of the Ab-negative patients, 16 resumed responsiveness after dose adjustments and 2 persisted as nonrespondents. Except for 1 patient, the 4 Ab-positive and the 2 clinical nonresponders are being treated with BTX-B. This longest reported follow-up of BTX injections confirms the long-term efficacy and safety of this treatment.
Subject(s)
Antibodies/immunology , Botulinum Toxins, Type A/therapeutic use , Dystonia/drug therapy , Dystonia/immunology , Neuromuscular Agents/therapeutic use , Aged , Blepharoptosis/drug therapy , Blepharoptosis/immunology , Blepharoptosis/physiopathology , Botulinum Toxins, Type A/administration & dosage , Botulinum Toxins, Type A/adverse effects , Deglutition Disorders/drug therapy , Deglutition Disorders/immunology , Deglutition Disorders/physiopathology , Drug Administration Schedule , Dystonia/physiopathology , Female , Hemifacial Spasm/drug therapy , Hemifacial Spasm/immunology , Hemifacial Spasm/physiopathology , Humans , Injections , Male , Middle Aged , Muscle Weakness/drug therapy , Muscle Weakness/immunology , Muscle Weakness/physiopathology , Neck Muscles/physiopathology , Neuromuscular Agents/administration & dosage , Neuromuscular Agents/adverse effects , Time FactorsABSTRACT
The purpose of the study is to elucidate the effects of a craniotomy on patients regarding the cytokines and immunological function. TNF-alpha, IL-6, the CD4/8 ratio, cortisol, and WBC were all measured perioperatively in 29 patients. No serum TNF-alpha was detectable in any patients. The IL-6 level, cortisol and neutrophils all showed an increase with a peak at three hours after the end of operation. On the other hand, the lymphocytes and the CD4/8 ratio demonstrated a opposite pattern with a negative peak at the same time, however, these levels all gradually recovered to their preoperative states on the 7th operative day. The overall effect of a craniotomy was therefore found to correlate with the length of the operation.
