Summary: Botolinum toxin is antigenic. It provokes antibody formation, which destroys it and limits its usefulness the next time it is used. Hence it can only be used 2 to 3 times. A new low protein low antigenic variety of botulinum toxin, called Botox® Purified Neurotoxin Type A is now commercially available, that is claimed to cause negligible antibody formation, hence it should be possible to use it a number of times.
LOW ANTIGENIC BOTULINUM TOXIN TYPE A
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Botulinum toxin comprises 7 serotypes: A, B. C1, D, E, F and G. They exhibit individually characteristic structural and pharmacological properties like site of action, potency and duration of paralysis.
Botulinum Type A is both high in potency and long in duration of action. In addition, matters like formulation techniques and purification process to remove extraneous proteins, determine the therapeutic potency of a product. Hence, no two brands may be comparable.
The present commercially available batches of Botox® are called Purified Botulinum Neurotoxin Type A Complex. It is claimed that they have one-third the protein content of earlier batches, thus virtually eliminating drug induced antibody formation.
Cost in India, inclusive of all taxes, is about Rs.16,000/- (About $330 as on February 2002.)
At UDAAN, we evaluate the child thoroughly, and arrange to have the child administered the injection if needed by the specialists at New Delhi, and follow it up with guidance on necessary supporting devices (AFO, special chairs, and other aids as per individual need), guidance on necessary Occupational therapy and other therapies that may benefit the child. The parents have to pay for the cost of the injection, and a nominal charge to us for the evaluation, logistic support, guidance, and OT if required. If the child needs special appliances, we arrange to get them, payment for which can be paid directly to the manufacturer.
So far we have evaluated Botox immediately following HBOT, along with Standard Therapy, Acupuncture and Unani Drugs, to maximize its benefit on a long lasting basis. We now rarely give the nerve block as part of medical intervention in our Multimode Therapy, since the effects are temporary, and usually takes away the drive for intensive OT/PT, leading to relapse of spasticity and contractures in less than a year or so.
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