Botulinum Toxin Resistance – Medical News Bulletin

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What is botulinum toxin?

Botulinum toxin is often known as the culprit behind food poisoning. Fortunately, this is a different form of poison. Botulinum toxin is produced by bacteria Clostridium botulinum.1 One effect of exposure to this toxin is reversible muscle paralysis.2 People often define food poisoning as food poisoning, but toxins have other functions.

Aside from the negatives, venom has some beneficial medicinal and non-medical uses. The toxin is commonly known as Botox and Dysport. The benefits are reduced facial wrinkles, pain relief, movement disorders and muscle stiffness.2,3

These treatment products contain botulinum toxin and proteins that together trigger an immune response. Another familiar product, Xeomin®, contains Clostridium botulinum But without immunostimulating proteins.4,5,6

types of responses

In some cases, people never feel any benefits from treatments with Botox or Dysport. Botox resistance is rare and is defined as an initial unresponsiveness.7 This type of resistance is due to inadequate dosing, improper storage of the product, or injection of the product into the wrong area.5,7

Another type of resistance is when people who initially benefit from treatment do not respond the same way or at all. Since the effects of the poison are temporary, multiple treatments are required to maintain the desired result. This type of resistance is known as secondary unresponsiveness.7

Why the resistance?

The immune system recognizes botulinum toxin as a foreign substance, so it works hard to remove it. The body develops antibodies specific to the venom proteins when the immune system kicks in. It is the antibodies that block the effects of the treatment and create resistance.5, 7, 8 Secondary non-responders present more antibodies, supporting the idea of ​​resistance being created by the immune system.9

Secondary non-responders often require a higher frequency of treatments.10 As the frequency increases, there is a greater risk of resistance. The greater risk of resistance is due to the increased production of antibodies specific to the toxin.11

Another reason for Botox resistance is that the proteins have been shown to enhance the immune response to the bacteria.12 If the immune response is enhanced, the toxin will not be able to do its job.

Compared to Botox and Dysport, patients with cervical dystonia with secondary unresponsiveness later showed benefits when switching to Xeomin, which does not contain immune-stimulating proteins.6

Fight Botox resistance

While other factors can lead to treatment resistance, it is essential to ask questions about the form of treatment medication and the frequency of dosing that is right for you. It is also important to do some research to know the right questions to ask about the diagnosis and the protocol prescribed. Arming yourself with knowledge can reduce your chances of developing resistance to a crucial treatment option.


  1. Davis Lee. botulinum toxin. From poison to medicine. West J Med. January 1993; 158 (1): 25-9.
  2. Park J, Park HJ. Botulinum toxin for the treatment of neuropathic pain. Poisons (Basel). August 24, 2017; 9(9) doi: 10.3390/toxin 9090260
  3. Botulinum toxin injections for facial wrinkles. I am a fam doctor. August 1, 2014; 90 (3): 168-75.
  4. Dressler D, Ban L, Adib Sabry F, Bigalke H. Do complex proteins provide mechanical protection for botulinum neurotoxins? J Neuro Transm (Vienna). August 2019; 126 (8): 1047-1050. doi: 10.1007/s00702-019-02023-x
  5. Benecke R. The clinical significance of botulinum toxin immunogenicity. Vital medicines. April 1, 2012; 26 (2): e1-9. doi: 10.2165/11599840-000000000-00000
  6. Hefter H, Hartmann CJ, Kahlen U, Samadzadeh S, Rosenthal D, Moll M. Clinical improvement after treatment with incobotulinumtoxinA (XEOMIN®) in patients with cervical dystonia resistant to botulinum toxin preparations containing complex proteins. Front Neurol. 2021; 12: 636590. doi: 10.3389/fneur.2021.636590
  7. Bellows S, Jankovic J. Immunogenesis associated with botulinum toxin treatment. Poisons (Basel). August 26, 2019; 11(9) doi: 10.3390/toxin 11090491
  8. Numan M, Bo LM, Ackermann AH, Gallagher CJ. Immunogenesis of botulinum toxin. J Neuro Transm (Vienna). February 2013 ; 120 (2): 275-90. doi: 10.1007/s00702-012-0893-9
  9. Fabry M, Liodori G, Fernandez RM, et al. Neutralizing antibody and botulinum toxin treatment: a systematic review and meta-analysis. Res neurotoxins. January 2016; 29 (1): 105-17. doi: 10.1007/s12640-015-9565-5
  10. Greene P, Fahn S, Diamond B. Development of resistance to type A botulinum toxin in patients with torticollis. Move Discord. March 1994; 9 (2): 213-7. doi: 10.1002/mds.870090216
  11. Jankovic J, Schwartz K. Immune response and resistance to botulinum toxin injection. Neurology. September 1995; 45 (9): 1743-6. doi: 10.1212/wnl.45.9.1743
  12. Lee JC, Yokota K, Arimitsu H, et al. Neurotoxin antibody production is enhanced by two subcomponents, HA1 and HA3b, of the Clostridium botulinum type B 16S toxin-haemagglutinin. Microbiology (Reading), Nov 2005, 151 (Pt11): 3739-3747. doi: 10.1099/mic.0.28421-0


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