Case ReportHead drop after botox: Electrodiagnostic evaluation of iatrogenic botulinum toxicity
Introduction
Systemic weakness following botulinum neurotoxin injection is rare. Life-threatening cases of iatrogenic botulism have been reported following lethal doses of unlicensed preparations. In adults, iatrogenic botulism has been reported in hereditary spastic paraparesis, limb dystonia, hemiparesis, stroke, hyperhidrosis, and even following detrusor injection for neurogenic bladder [4], [5]. In the majority of reported cases, clinical criteria have established the diagnosis ([1], [6], [7], [8]). Few reports, however, have included electrodiagnostic (EDX) confirmation.
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Report
A 72 year-old Caucasian female with Parkinson's disease (PD) and peripheral neuropathy presented for evaluation of right foot dystonia. She was initially managed with oral medications without improvement and subsequently underwent botulinum toxin type A (i.e. BOTOX® or onabotulinumtoxin A) injection twice at an outside facility (preparation and dose unknown). On presentation to our facility, examination revealed mild rigidity, bradykinesia, and severe gait disturbance with equinovalgus right
Discussion
Botulinum neurotoxin is an important therapy in many neurologic diseases, but local therapy can have distant effects. Underlying mechanisms of systemic neurotoxicity are unknown. Diffusion of botulinum toxin into adjacent muscles is well documented. Distant spread of neurotoxin may occur as a result of a shortened inter-dose interval, larger volume of fluid for injection, higher single injection doses, axonal transport, or other factors. Here we describe a case of iatrogenic botulism, and
Conclusion
Systemic botulinum neurotoxicity is a rare but recognized side effect of therapeutic botulinum toxin injections. Systemic botulinum neurotoxicity is a rare but recognized side effect of therapeutic botulinum toxin injections. EDX findings include decremental response on RNS and rare denervation potentials in addition to low amplitude and short duration motor unit morphology on EMG. Prompt clinical and electrodiagnostic evaluation is important. Findings suggest the pertinence of SFEMG to confirm
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Cited by (10)
Electrophysiological abnormalities in iatrogenic botulism: Two case reports and review of the literature
2019, Journal of Clinical NeuroscienceCitation Excerpt :MUAPs are usually reduced in duration and amplitude, with unstable and polyphasic morphology [5,6,9–11] (Table 1). Increased jitter and blocks revealed by SFEMG are reported in human botulism and less frequently in IB [5–7,10,11,13]. Interestingly, increased jitter was also documented in asymptomatic subjects, following therapeutic BoNT/A injections [17].
Botulism Presented with Clinical Head Drop, Approach to Botulinum Toxin A: A Case Report
2023, Turk Noroloji DergisiLessons from a recent multicountry iatrogenic botulism outbreak
2023, EurosurveillanceSystemic muscular weakness after botulinum toxin A administration: a review of the literature
2021, Drugs and Therapy Perspectives