Botox Resistance and Treatment Strategies

Introduction to Botox Resistance

Distinguish true immunologic resistance from inadequate dosing, incorrect injection technique or muscle targeting, disease progression, with inadequate dosing and incorrect injection technique being key considerations 1, 2

For cervical dystonia, abobotulinumtoxinA and rimabotulinumtoxinB are similarly effective and should be offered, as per the American Academy of Family Physicians 3
For blepharospasm, onabotulinumtoxinA and incobotulinumtoxinA are equally effective and should be considered, as per the American Academy of Family Physicians 3
For spasticity, abobotulinumtoxinA, incobotulinumtoxinA, and onabotulinumtoxinA are all safe and effective for upper extremity spasticity, as per the American Academy of Family Physicians 3, 4
For neurogenic lower urinary tract dysfunction, onabotulinumtoxinA (200-300 U) strongly improves bladder storage parameters, with no difference in efficacy between 200 U and 300 U doses, as reported in The Journal of Urology 1

Adjusting dose, distribution, and timing of injections can minimize adverse events, as per Praxis Medical Insights 2