Fatal heart block following treatment with botulinum toxin for achalasia

Malnick, Stephen; Metchnik, Laura; Somin, Marina; Bergman, Nina; Attali, Malka

doi:10.1111/j.1572-0241.2000.03331.x

Cited by 32 publications

(5 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…see reference [60]), to date only one publication attributed a patient's death to the therapeutic administration of BtxA [61]. see reference [60]), to date only one publication attributed a patient's death to the therapeutic administration of BtxA [61].…”

Section: Fatality Associated With Treatment With Botulinum Toxinmentioning

confidence: 99%

The Possible Adverse Effects of Intramuscular Botulinum Toxin Injections and their Management

Bakheit

2006

CDS

View full text Add to dashboard Cite

In the last two decades or so the intramuscular administration of botulinum toxin type A, and more recently type B, has become an established first line treatment of many neurological and other medical disorders. So far, the toxin has been used mainly by experienced researchers and clinicians with extensive knowledge of its mode of action and potential adverse effects. However, in the foreseeable future it is likely that this treatment will be provided by more medical practitioners and in different clinical settings, especially as the range of its clinical indications increases. Botulinum toxin, in therapeutic doses, is a remarkably safe drug with relatively few adverse effects. The commonest adverse effects are muscle weakness, fatigue, flu-like symptoms, a dry mouth, dizziness and a skin rash. Nonetheless, serious adverse events may occur, albeit rarely, and it is imperative that prescribers of this treatment are thoroughly familiar with its potential risks. The purpose of this article is to review the possible adverse effects of botulinum toxin intramuscular injections, to describe the factors that might predispose to them and to summarise the strategies for their prevention and treatment.

show abstract

Section: Fatality Associated With Treatment With Botulinum Toxinmentioning

confidence: 99%

The Possible Adverse Effects of Intramuscular Botulinum Toxin Injections and their Management

Bakheit

2006

CDS

View full text Add to dashboard Cite

show abstract

“…Whereas retrospective studies have shown that myotomy and pneumatic dilatation are equally effective, randomised prospective studies have found that pneumatic dilatation is superior to botulinum toxin injection, since patients treated with botulinum toxin need regular repeat treatments during the further course. From the point of view of cost-effectiveness, pneumatic dilatation is superior to both myotomy [34] and botulinum toxin injection [30] The overall complication rate with pneumatic balloon dilatation (3%) is higher than that with botulinum toxin injection, for which – with the exception of one case report of a fatal heart block in a patient with previously known cardiac arrhythmia [35] – no serious complications have so far been reported.…”

Section: Discussionmentioning

confidence: 99%

Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment

et al. 2002

View full text Add to dashboard Cite

BackgroundIt has been suggested that intrasphincteric injection of botulinum toxin (BTX) may represent an alternative therapy to balloon dilatation in achalasia. The aim of the present study was to test the effectiveness of botulinum toxin injections in achalasia patients, as assessed using lower oesophageal sphincter pressure (LOSP) and symptom scores, and to compare the response in patients with different types of pretreatment (no previous treatment, balloon dilatation, myotomy, BTX injection).MethodsForty patients who presented with symptomatic achalasia were treated with BTX injection (48 injections in 40 patients). Some of the patients had received prior treatment (seven with myotomy, seven with dilatation and eight with BTX). The symptoms were assessed using a global symptom score (0–10), which was evaluated before treatment, 1 week afterwards, and 1 month afterwards. Manometry was also carried out before and after treatment. Three different selections of patients were studied: all patients; untreated patients; and patients with prior BTX, dilatation, or myotomy.ResultsAfter BTX injection, there was a significant reduction in LOSP (before, 38.2 ± 11.3 mmHg; 1 week after, 20.5 ± 6.9 mmHg; 1 month after, 17.8 ± 6.8 mmHg; P < 0.001). The global symptom score and symptom subscores (dysphagia, regurgitation, chest pain) were significantly decreased after 1 week and 1 month. When the beneficial effects following BTX injection were compared (untreated vs. pretreated), neither changes in LOSP nor beneficial effects on the symptom scores significantly differed. After 6 months, 67.7% of all treated patients were still in symptomatic remission (subgroups: previously untreated patients, 61.5%, n = 26; prior dilatation, 71.4%, n = 7; prior myotomy, 71.4%, n = 7; prior BTX, 73.9%, n = 8).ConclusionsBTX injection offers an alternative treatment for achalasia which is safe and can be performed in an outpatient setting. The initial response to BTX, in terms of symptom scores and LOSP, appears to be independent of any prior treatment. A number of patients do not adequately respond to balloon dilatation or myotomy, which are the first-line treatment modalities in achalasia patients. BTX injection can be performed in these patients, and symptomatic benefit can be expected in the same percentages as with BTX injection in untreated patients.

show abstract

“…Spread to nearby muscles is possible, particularly when high volumes are injected, but weakness of distant muscles or generalized weakness is very rare. Diffusion of BTX-A is thought to be responsible for the detection of abnormalities of cardiovascular reflexes and for the occurrence of a heart block following treatment for achalasia, in a case report of a patient with pre-existing cardiac conduction disease [114].…”

Section: Results Of Btx-a Treatmentmentioning

confidence: 99%

Gastrointestinal Smooth Muscles and Sphincters Spasms: Treatment with Botulinum Neurotoxin

Brisinda

Albanese

et al. 2003

CMC

View full text Add to dashboard Cite

More than fifty years following the discovery that botulinum neurotoxins inhibit neuromuscular transmission, these powerful poisons have become drugs with many indications. First used to treat strabismus, local injections of botulinum neurotoxin are now considered a safe and efficacious treatment for neurological and non-neurological conditions. One of the most recent achievements in the field is the observation that botulinum neurotoxin is a treatment for diseases of the gastrointestinal tract. Botulinum neurotoxin is not only potent in blocking skeletal neuromuscular transmission, but also block cholinergic nerve endings in the autonomic nervous system. The capability to inhibit contraction of smooth muscles of the gastrointestinal tract was first suggested based on in vitro observations and later demonstrated in vivo; it has also been shown that botulinum neurotoxin does not block non adrenergic non cholinergic responses mediated by nitric oxide. This has further promoted the interest to use botulinum neurotoxin as a treatment for overactive smooth muscles and sphincters, such as the lower esophageal sphincter to treat esophageal achalasia, or the internal anal sphincter to treat anal fissure. Information on the anatomical and functional organization of innervation of the gastrointestinal tract is a prerequisite to understand many features of botulinum neurotoxin action on the gut and the effects of injections placed into specific sphincters. This review presents current data on the use of botulinum neurotoxin to treat diseases of the gastrointestinal tract and summarizes recent knowledge on the pathogenesis of disorders of the gut due to a dysfunction of the enteric nervous system.

show abstract

Fatal heart block following treatment with botulinum toxin for achalasia

Cited by 32 publications

References 8 publications

The Possible Adverse Effects of Intramuscular Botulinum Toxin Injections and their Management

The Possible Adverse Effects of Intramuscular Botulinum Toxin Injections and their Management

Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment

Gastrointestinal Smooth Muscles and Sphincters Spasms: Treatment with Botulinum Neurotoxin

Contact Info

Product

Resources

About