What Causes Immunity to Botox in a Child with Cerebral Palsy?

My son has CP. He had his first dose of Botox in July 2012 and had absolutely no response. His doctor tells me he believes my son has antibodies which attack the botox and make it inaffectual Can anyone give me any further information regarding this. My son's doctor tells me this is extremely rare and has only ever had one other patient with immunity to Botox and never expected to meet another!

Doctor Answers 3

Botox and cerebral palsy

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I don't understand the mechanism for a child or adult to have an immunity to botox if they've not been exposed to the product in the past unless they had suffered a minor case of botulism from which they recovered.  The immune system would have to develop immunoglobulins to the bacterial protein toxin and this doesn't develop at the first exposure. There might be other reasons for the spastic muscles not to become relaxed with the botox that a neurologist might understand better than I.

Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Immunity to Botox

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In general, immunity to Botox (whether for cosmetic or therapeutic reasons) is built over time (years and years and years) as the body builds anitbodies that don't allow the Botox to work as well. I have never seen anyone with these antibodies present before they'd ever received the injections, which would then lead them to be totally ineffective. There are tests that can show the level of these antibodies and your son could undergo a test to show his levels and compare them. You could also see another physician for his or her assessment, or try Dysport. Since Dysport and Botox are ever so slightly different, for some people, one can be more effective than the other, especially if it's true he has antibodies in his system.

This would be pretty rare.

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Individuals exposed to therapeutic botulinum toxin can rarely develop neutralizing antibodies that render botulinum clinically ineffective.  The likelihood that your son would have such antibodies such that the very first therapeutic encounter with BOTOX would be ineffective is even less likely.  However, there are tests for neutralizing antibodies to BOTOX.  Under the circumstances, it would be reasonable to have your son tested.  A second opinion might also be reasonable.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

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