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Ninhydrin Sweat Test: A Simple Method For Detecting Antibodies Neutralizing Botulinum Toxin Type A

B. Voller, E. Moraru, E. Auff, M. Benesch, W. Poewe, J. Wissel, J. Müller, T. Entner, H. Bigalke, P. Schnider
Published 2004 · Medicine, Psychology

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Approximately 5% of patients with cervical dystonia receiving repeated botulinum neurotoxin A (BoNT/A) injections develop secondary loss of treatment benefit. Currently available tests to directly detect neutralizing BoNT/A antibodies (BoNT/A‐AB) are either expensive or time consuming. To establish a simple, clinically useful test for antibody detection, we adapted the ninhydrin sweat test (NST). Eighteen dystonic patients with secondary nonresponse and clinically suspected BoNT/A‐AB formation were tested for BoNT/A‐AB in the mouse diaphragm test (MDT). In addition, the size of the anhidrotic area was determined by the NST 21 days after an intradermal dose of 10 U Dysport into the hypothenar region of the left palm. In nine patients, positive BoNT‐AB titers were found in the MDT. There was a significant correlation between the BoNT/A‐AB titers and the anhidrotic area (Spearman's rho = −0.9, P < 0.0001). Both tests provided comparably good results with respect to qualitative antibody detection. In the clinical situation of secondary nonresponse to BoNT/A therapy, the economical NST may be a helpful tool to detect neutralizing BoNT/A‐AB. © 2004 Movement Disorder Society
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