Generalised muscular weakness after botulinum toxin injections for dystonia: a report of three cases

Abstract

Three patients are reported on who developed transient generalised weakness after receiving therapeutic doses of botulinum toxin for cervical dystonia (one case) and symptomatic hemidystonia (two cases) respectively. Clinical and electrophysiological findings were in keeping with mild botulism. All patients had received previous botulinum toxin injections without side eVects and one patient continued injections without recurrence of generalised weakness. The cause is most likely presynaptic inhibition due to systemic spread of the toxin. Patients with symptomatic dystonia may be more likely to have this side eVect and botulinum toxin injections in these patients should be carried out cautiously. (J Neurol Neurosurg Psychiatry 1999;67:90-93)

Safety profile and efficacy of botulinum toxin A (Dysporta) in children with muscle spasticity

“…The patients made complete recovery within a few weeks. A similar observation was made recently in another three patients (Bhatia et al 1999). This suggests that despite the rare occurrence of adverse events due to BTX-A, a careful follow-up of patients receiving this treatment is necessary.…”

Serious and Long-Term Adverse Events Associated with the Therapeutic and Cosmetic Use of Botulinum Toxin

“…The serious adverse events identified in case reports varied from idiosyncratic adverse reactions like anaphylactic shock to dose-dependent adverse reactions like cervical kyphosis and botulism [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. They were attributed to various types and preparations of botulinum toxin.…”

“…In addition, botulism-like generalized weakness has been reported in a patient treated for axillary and palmar hyperhidrosis [12]. Serious adverse events related to the therapeutic use of botulinum toxin include severe velopharyngeal insufficiency, brachial plexopathy, remote muscle weakness, botulism-like generalized muscle weakness, necrotizing fasciitis, crisis of myasthenia, generalized paralysis, marked bilateral blepharoptosis, impairment of speech and chewing, Guillain-Barré syndrome, severe dysphagia, iatrogenic botulism, generalized skin rash, aspiration pneumonia, unilateral facial madarosis and alopecia, and palatal palsy [13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38]. It is interesting that one of the patients presented with generalized weakness 5 years after continued use of botulinum toxin [19].…”

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.…”

“…gave no more adverse events. 13 Del Popolo 6 reduced the injected dose to half of the initial and saw no more side effects after injection of the detrusor muscle. Kuo spread a total of 200 U.I.…”