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Results of a BoNT/A Antibody Study in Children and Adolescents after Onabotulinumtoxin A (Botox®) Detrusor Injection

Schulte-Baukloh H.a · Herholz J.a · Bigalke H.b · Miller K.c · Knispel H.H.a
aDepartment of Urology, St. Hedwig Hospital, Medical School of Charité Universitätsmedizin Berlin, Berlin, bInstitute of Toxicology, Medical School of Hannover, Hannover, and cDepartment of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany Urol Int 2011;87:434–438 (DOI:10.1159/000331726)


Background: Onabotulinumtoxin A (OnaBoNT/A, Botox®) is effective in the treatment of neurogenic detrusor overactivity, however this therapy can fail. In a prospective study, we analyzed patient serum for BoNT/A antibodies (BoNT/A-AB) as a possible cause of therapy failure. Methods: 17 patients (average age 14.5 years) who had neurogenic detrusor overactivity were admitted for repeated OnaBoNT/A injection into the detrusor muscle. We analyzed their serum for BoNT/A-AB. The clinical findings were correlated with the incidence of BoNT/A-AB. Results: Positive BoNT/A-AB were clearly or marginally determined in 6 patients. Therapy had failed in all 6. In 4 of the 6, therapy might have failed because of a low-compliance bladder (3 patients) or tethered-cord syndrome (1), but BoNT/A-AB were found as the only possible cause in 2 patients. Thus, the incidence of BoNT/A-AB in the 17 patients was 35%, and the antibodies were clinically significant in 12%. All patients with BoNT/A-AB had a history of recurrent urinary tract infections. Conclusions: Patients who show a failure of therapy after OnaBoNT/A injections for which no other causes can be determined should have their serum checked for BoNT/A-AB. Recurrent urinary tract infection might be a predisposing factor for BoNT/A-AB.


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