Botulinum Toxin Type A

FAQ

• Can oral or intrathecal antispastic medication be used in combination with BTX-A? (Yes)
  • Oral medications and intrathecal baclofen provide a more global tone reduction.
  • BTX-A injections can provide graded focal relief in selected muscles.
  • BTX-A and antispastic agents do not have drug-drug interactions.
  • The appropriateness of any spasticity therapy relies on its efficacy in meeting the goals of patients and caregivers.
  • The treatment plan should reflect the patient's current clinical status on antispastic medication and the therapeutic goals for BTX-A therapy, including target muscles and dosing levels.
• Can BTX-A and phenol or alcohol neurolysis therapies be combined? (Yes)
  • The primary reason for combining BTX-A with phenol or alcohol neurolysis therapies is to avoid resistance by remaining under the maximum dose per visit.
  • The decision to combine therapies usually depends on the location and number of target muscles involved. If both lower and upper extremities are to be injected, the combination of BTX-A and phenol may be warranted.
  • Although there are certain difficulties in using phenol or alcohol neurolysis, they provide inexpensive, long-term chemodenervation options for some patients.
• Is BTX-A useful in treating pain?
  • Some patients with painful spasms or contracture report a reduction in pain after injection with BTX-A.
• What are the chances of accidental overdose from BTX-A injections? (Unlikely)
  • Accidental overdose during spasticity therapy is highly improbable, since dozens more vials of BTX-A than are used therapeutically would need to be injected. In the event of an overdose, the medical information line maintained by Allergan can be contacted at (800) 433-8871 or (714) 246-5954.
• Can the risk of antibody formation be reduced? (Yes)
  • Repeated, high dose injections are far more likely to result in antibody formation than are less frequently repeated, low dose injections.
  • Physicians should, therefore, use the smallest amount of BTX-A necessary to achieve therapeutic benefit and extend the interval between treatment sessions as long as possible.
    • Antibody assays can be obtained through Northview Pacific Laboratories, 2800 7th Street, Berkeley, CA. 94710, (510) 548-8440.
• Can BTX-A booster injections be given without causing resistance? (Possibly)
  
  • When the amount injected totals the maximum of 400 units, due to the risk of producing resistance, further injections should not be given before three months after the last BTX-A treatment.
  • The interval between treatments to improve clinical objectives should be extended as long as possible.
  • The smallest amount of BTX-A necessary to achieve the desired effect is suggested.
  • Frequent injections do increase the chances of antibody formation.

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