eprintid: 10160996 rev_number: 8 eprint_status: archive userid: 699 dir: disk0/10/16/09/96 datestamp: 2022-12-01 16:30:08 lastmod: 2022-12-01 16:30:08 status_changed: 2022-12-01 16:30:08 type: article metadata_visibility: show sword_depositor: 699 creators_name: Dressler, Dirk creators_name: Rothwell, John C creators_name: Bhatia, Kailash creators_name: Kopp, Bruno creators_name: Bigalke, Hans creators_name: Adib Saberi, Fereshte title: Botulinum toxin antibody titres: measurement, interpretation, and practical recommendations ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D07 divisions: F84 keywords: Antibodies, Botulinum toxin, Mouse diaphragm assay, Mouse lethality assay, Sternocleidomastoid test, Therapy, Therapy failure, Titres note: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. abstract: Botulinum toxin (BT) therapy may be blocked by antibodies (BT-AB) resulting in BT-AB induced therapy failure (ABF). BT-AB may be detected by the mouse lethality assay (MLA), the mouse diaphragm assay (MDA) and the sternocleidomastoid test (SCMT). For the first time, we wanted to compare all three BT-AB tests and correlate them to subjective complaint of complete or partial secondary therapy failure in 37 patients with cervical dystonia (25 females, 12 males, age 51.2 ± 11.4 years, disease duration 12.4 ± 6.3 years). Complaint of therapy failure was not correlated with any of the BT-AB tests. MDA and MLA are closely correlated, indicating that the MDA might replace the MLA as the current gold standard for BT-AB measurement. The SCMT is closely correlated with MDA and MLA confirming that BT-AB titres and BT's paretic effect are in a functional balance: low BT-AB titres are reducing BT's paretic effect only marginally, whereas high BT-AB titres may completely block it. When therapy failure is classified as secondary and permanent, BT-AB evaluation is recommended and any BT-AB test may be applied. For MDA > 10 mU/ml, MLA > 3 and SCMT < 25%, ABF is highly likely. MDA < 0.6 mU/ml are therapeutically irrelevant. They are neither correlated with pathologic MLA nor with pathologic SCMT. They should not be the basis for treatment decisions, such as switching dystonia therapy to deep brain stimulation. All other results are intermediate results. Their interactions with therapy efficacy is unpredictable. In these cases, BT-AB tests should be repeated or one or two additional test methods should be applied. date: 2022-11-24 date_type: published publisher: Springer Science and Business Media LLC official_url: https://doi.org/10.1007/s00415-022-11424-0 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1992239 doi: 10.1007/s00415-022-11424-0 medium: Print-Electronic pii: 10.1007/s00415-022-11424-0 lyricists_name: Bhatia, Kailash lyricists_name: Rothwell, John lyricists_id: KPBHA96 lyricists_id: JCROT52 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: Journal of Neurology event_location: Germany citation: Dressler, Dirk; Rothwell, John C; Bhatia, Kailash; Kopp, Bruno; Bigalke, Hans; Adib Saberi, Fereshte; (2022) Botulinum toxin antibody titres: measurement, interpretation, and practical recommendations. Journal of Neurology 10.1007/s00415-022-11424-0 <https://doi.org/10.1007/s00415-022-11424-0>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10160996/1/s00415-022-11424-0.pdf