Botulinum neurotoxin type A for Hyperkinetic Therapy of Facial Lines:
Efficiency, molecular aspects and possible causes of secondary irresponsiveness
Keywords:
neurotoxina botulínica tipo A, irresponsividade secundária, imunogenicidadeAbstract
Abstract: Facial hyperkinetic lines, or dynamic wrinkles, are marks caused by muscle movement for facial mimicry and can be corrected with botulinum neurotoxin type A, which causes paresis by cleaving SNAP-25 and preventing the release of acetylcholine. A good response to treatment depends on the dose, technique, in-depth anatomical knowledge and personalized planning. Due to its effectiveness, other off-label applications have been adopted, increasing the dose per session. In Brazil, there are seven formulations of botulinum toxin A available, which, despite having the same mechanism of action, have different potency, protein load, excipients and immunogenic risks. High doses, cumulative doses, short intervals between sessions - including booster doses - and products with accessory proteins are related to immunogenicity, which can lead to secondary irresponsiveness. Other causes of secondary irresponsiveness may include insufficient dose, incorrect target muscle selection, proper storage, inadequate reconstitution, low potency of the product, underlying diseases, and senescence of the immune system.
Key-words: botulinum neurotoxin type A, secondary irresponsiveness, immunogenicity.
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