Electrophysiological abnormalities of the neuromuscular transmission in two patients with botulism-like syndrome following Botulinum-A muscle injections

• Published in: Neurophysiologie clinique Vol. 54; no. 4; p. 102984
• Main Authors: Theuriet, Julian, Huchon, Laure, Luaute, Jacques, Vallet, Anne-Evelyne, Bouhour, Françoise, Pegat, Antoine
• Format: Journal Article
• Language: English
• Published: France Elsevier Masson SAS 01.07.2024
• Subjects: Adult; Botulinum Toxins, Type A - administration & dosage; Botulinum Toxins, Type A - adverse effects; Botulism; Botulism - diagnosis; Decrement; Electroneuromyography; Female; Humans; Injections, Intramuscular - adverse effects; Male; Middle Aged; Muscle Weakness - etiology; Neuromuscular Agents - administration & dosage; Neuromuscular Agents - adverse effects; Neuromuscular Junction - drug effects; Neuromuscular Junction - physiopathology; RNS; Synaptic Transmission - drug effects; Synaptic Transmission - physiology; Electroneuromyography; Botulism; Decrement; RNS
• ISSN: 0987-7053; 1769-7131; 1769-7131
• DOI: 10.1016/j.neucli.2024.102984

Botulinum neurotoxin serotype A (BoNT-A) has several therapeutic indications such as spasticity and dystonia. Although its use is generally considered safe, a systemic diffusion can lead to systemic complications, and a botulism-like syndrome can occur after intramuscular injections. Herein, two adult cases who developed general muscle weakness after a BoNT-A intramuscular injection are reported. Both presented with a progressive decrement on low-frequency (LF) repetitive nerve stimulation (RNS). It is suggested that a progressive decrement on LF-RNS in muscles distant from the injection site strongly supports the diagnosis of iatrogenic botulism.