Generalised botulism-like syndrome after intramuscular injections of botulinum toxin type A: a report of two cases.

High doses of incobotulinumtoxinA for the treatment of post-stroke spasticity: are they safe and effective?

“…There is the possibility to use higher doses of incobotulinumtoxinA, given that this neurotoxin is free of accessory complexing proteins and its employment could reduce the risk of Ab formation, even if this possibility is not yet demonstrated, and it does not exclude the possibility to have generalized adverse effects. However, as described in previous studies, generalized botulism-like syndrome for subjects treated can occur also for recommended doses of BoNT-A or increasing the frequency of the injections [9]. Therefore, the clinicians recommend careful consideration for reinjection period with doses greater than 600 U of BoNT-A: a reduction in systemic side effects may be obtained with a reinjection frequency greater than four months.…”

“…Localized effects comprised those directly associated with the injection as swelling, hematoma, bruising, and pain at injection site, lasting few days with resolution without any complications. The generalized adverse events were related to spread of toxin distant from the site of injection: botulism-like syndrome, exaggerated muscle weakness, dysphagia, breathing or speech difficulty, and severe allergic reaction can result in death in very rare cases, also at low doses [9].…”

Botulism

“…En un medio de cultivo o en la comida, la toxina se encuentra asociada en forma no covalente a proteínas no tóxicas, incluyendo subunidades de aglutinina y un componente único no tóxico no-hemaglutinina para formar complejos botulínicos de varios tamaños 21 . Existen 3 formas clínicas clásicas de adquisición de botulismo, que incluyen: a) la producida por ingestión de alimentos; b) la colonización intestinal infantil y adulta; y c) la que se produce por heridas infectadas 98,103 , aunque también se ha descripto una forma iatrogénica 6 y otra por inhalación 4,16 . El botulismo por ingestión de alimentos es causada habitualmente por ingestión de toxinas de C.botulinum y otras especies ; una pequeña cantidad de neurotoxina (aproximadamente 30 ng) puede llegar a ser fatal 74 .…”

“…Se produce por diseminación deliberada de toxina botulínica mediante aerosoles 4 . El botulismo iatrogénico es causado por inyección de toxina botulínica con propósitos cosméticos o terapéuticos a dosis mayores que las indicadas 6 . Cuando es ingerida, la neurotoxina se absorbe fundamentalmente en la parte más craneal del intestino delgado 10,94 , y alcanza los nervios colinérgicos a través de la circulación sanguínea y linfática 61 .…”

Adverse events after botulinum A toxin injection for neurogenic voiding disorders

“…13,17 This general muscle weakness is usually self-limiting and not life threatening. However, for some patients, it can be temporarily very disabling.…”