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a Parkinson's Disease
Center and Movement Disorders Clinic, Department of Neurology, Baylor
College of Medicine, Houston, Texas, USA, b Neurosciences Group, Department of
Clinical Neurology, Institute of Molecular Medicine, John Radcliffe
Hospital, Oxford UK
Correspondence to: Dr Joseph Jankovic, Department of Neurology, Director of Parkinson's Disease Center, and Movement Disorders Clinic, Baylor College of Medicine, 6550 Fannin St No 1801, Houston, Texas 77030, USA. Telephone 001 713 798 5998; fax 001 713 798 6808.
Received 27 August
1998 and in revised form 16 November 1998;
Accepted 26
November 1998
OBJECTIVE
To compare a
recently developed immunoprecipitation assay (IPA) to the mouse
protection bioassay (MPB), currently considered the "gold
standard", for detecting antibodies against botulinum toxin A (BTX-A)
and to correlate these assay results with clinical responses to BTX-A injections.
METHODSMPB and IPA
assays were performed on serum samples from 83 patients (38 non-responders, 45 responders) who received BTX-A injections. Six
non-responders had serum tested on two separate occasions. Some
patients also received a "test" injection into either the right
eyebrow (n=29) or right frontalis (n=19).
RESULTSAll patients
antibody positive (Ab+) by MPB were also Ab+ by IPA, whereas an
additional 19 patients (17 with reduced or no clinical response) who
were MPB Ab
were Ab+, with low titres, by IPA. Two of these 19 patients (non-responders) were initially MPB Ab but later became MPB
Ab+. Similar to previous studies, the sensitivity for the MPB was low;
50% for clinical, 38% for eyebrow, and 30% for frontalis responses
whereas the IPA sensitivity was much higher at 84% for clinical
(p<0.001), 77% for eyebrow (p=0.111, NS) and 90% for frontalis
responses (p<0.02). The IPA specificity was 89% for clinical, 81%
for eyebrow, and 89% for frontalis responses, whereas the MPB
specificity was 100% for all three response types, which were all
non-significant differences.
CONCLUSIONSBoth
assays had high specificity although the sensitivity of the IPA was
higher than the MPB. In addition, the IPA seems to display positivity
earlier than the MPB, and as such, it may prognosticate future
non-responsiveness. Eyebrow and frontalis "test" injections correlated well with clinical and immunological results and are useful
in the assessment of BTX non-responders.
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