The use of flexible botulinum toxin type A inter-injection intervals after removal of deep brain stimulation due to infection in patient with DYT-THAP1 (DYT6)
- Authors: Krasakov I.V.1, Litvinenko I.V.1, Dyskin D.E.1
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Affiliations:
- Military Medical Academy
- Issue: Vol 42, No 4 (2023)
- Pages: 421-426
- Section: Case report
- URL: https://journals.rcsi.science/RMMArep/article/view/264753
- DOI: https://doi.org/10.17816/rmmar595878
- ID: 264753
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Abstract
Deep brain stimulation of globus pallidus internus is a safe and effective method of treatment of isolated generalized dystonia. Abrupt discontinuation of stimulation can lead to a sharp increase in the severity of the condition with a significant increase in the risk of dystonic status. Correction of the condition by selecting conservative therapy is often insufficient. Based on the description of a clinical observation, we demonstrated the possibility of effective use of flexible botulinum toxin type A inter-injection intervals after removal of deep brain stimulation due to infection in patient with DYT-THAP1 (DYT6). Due to the high risk of formation of antibodies to botulinum toxin type A when using short intervals, as well as when using high doses, preference was given to a drug with proven low immunogenicity — incobotulotoxin A. Incobotulotoxin A was administered once a month in a total dose of 400 units to various muscle groups (head, neck, trunk, limbs). At the time of publication, the duration of follow-up was six months, six procedures were performed, a total of 2,400 units of incobotulotoxin A. No significant side effects were noted. Evaluation of the effectiveness of the therapy was carried out by calculating the points of the Burke–Fahn–Marsden Dystonia Rating Scale. There was a decrease from 34 points (the indicator at the time of termination of neurostimulation) to 13.5 points (after six months of therapy). The therapy allowed the patient to maintain motor activity during the waiting period for repeated deep brain stimulation.
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##article.viewOnOriginalSite##About the authors
Igor' V. Krasakov
Military Medical Academy
Author for correspondence.
Email: ikrasakov@gmail.com
ORCID iD: 0000-0001-6092-0659
SPIN-code: 9891-8300
Scopus Author ID: 26642102200
ResearcherId: I-8865-2016
M.D., Ph.D. (Medicine)
Russian Federation, Saint PetersburgIgor' V. Litvinenko
Military Medical Academy
Email: litvinenkoiv@rambler.ru
ORCID iD: 0000-0001-8988-3011
SPIN-code: 6112-2792
Scopus Author ID: 35734354000
ResearcherId: F-9120-2013
M.D., D.Sc. (Medicine), Professor
Russian Federation, Saint PetersburgDmitriy E. Dyskin
Military Medical Academy
Email: drabovsk@mail.ru
ORCID iD: 0000-0002-2855-2953
SPIN-code: 6662-9481
Scopus Author ID: 6602481680
ResearcherId: J-3336-2016
M.D., D.Sc. (Medicine), Associate Professor
Russian Federation, Saint PetersburgReferences
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