Relapsing–remitting severe generalized muscular weakness after botulinum toxin treatment for hyperhidrosis

Chiarello, Daniela; Piombo, Marianna; Corbetto, Marzia; Pino, Giovanni Di; Assenza, Giovanni; Capone, Fioravante; Lazzaro, Vincenzo Di

doi:10.1002/mus.24304

Cited by 6 publications

(3 citation statements)

References 9 publications

(9 reference statements)

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“…The gastrointestinal disorders in this study included those of only the upper tract (achalasia, gastroparesis, chronic dysmotility, delayed gastric emptying, dysphagia, and impaired esophagogastric junction relaxation). Kent et al [34] and Chiarello et al [35] hypothesized that treatment with botulinum toxin A may unmask latent motor neuron disease. Alhajri et al [36] noted that, when botulinum toxin A was used to treat symptoms of delayed gastric emptying, the patient was subsequently treated successfully with neostigmine, a drug used to treat myasthenia gravis, thus suggesting that the botulinum toxin A unmasked a new diagnosis of myasthenia gravis by mimicking symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews were included in this study if they referenced articles with specific cases [22][23][24][25][26][27]. The inclusion criteria for all articles were as follows: (1) English language publications, (2) human studies, (3) publications from 1997 to 2020, (4) studies that used botulinum toxin A (any formulation), and (5) studies that reported systemic muscle weakness as an adverse event.…”

Section: Study Selectionmentioning

confidence: 99%

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Systemic muscular weakness after botulinum toxin A administration: a review of the literature

Locke

Nabavian

Neu

et al. 2021

Drugs Ther Perspect

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Objectives In this study we perform a review of the literature on systemic muscle weakness after administration of botulinum toxin A, to describe the factors that predispose patients to this adverse event and to suggest strategies for prevention. Methods Our search criteria included the terms "Botulinum toxin, Abobotulinum toxin, Dysport ® , Onabotulinum toxin, Botox ® , Incobotulinum toxin and Xeomin ® , muscle weakness, generalized muscle weakness and respiratory distress." Statistical analysis was completed using IBM ® SPSS software. Results We identified 2029 articles and narrowed this to 38 articles referencing 63 specific cases (including two studies form our institution) and 11 case series. Our analysis of 11 case series suggested that systemic muscle weakness is a rare event with botulinum toxin A. Of the 63 cases identified, the most common indications for use were spasticity (49.2%) and neurogenic detrusor overactivity (22.2%). The median age was low at 34 years, and the majority were female (76.2%). Furthermore, 47.6% of the cases were associated with the abobotulinum toxin A formulation. On average, the doses administered were 3.2 times the recommended dose (standard deviation 1.9) suggested for the particular botulinum toxin A formulation and indication. If systemic muscle weakness did occur, indication for botulinum toxin A being upper tract gastrointestinal disorder was associated with more severe impairment (W 2 = 10.2, p = 0.001). Conclusion Based on data from the identified cases of systemic muscle weakness with botulinum toxin A, this adverse event was more common in female, younger, patients with spasticity or neurogenic detrusor overactivity indication or those receiving abobotulinum toxin A formulation and/or higher botulinum toxin A doses. A prevention strategy may include reducing the dose of botulinum toxin A to those recommended by the US FDA.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Systemic muscular weakness after botulinum toxin A administration: a review of the literature

Locke

Nabavian

Neu

et al. 2021

Drugs Ther Perspect

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“…Some rare cases of transient botulism-like symptoms with generalized weakness and dysphagia after palmar, plantar, and axillary BoNT-A and BoNT-B injections are on record. [23][24][25][26] Hematogenic distribution and application of high doses may explain this effect. Therefore, special attention has to be paid to the intradermal injection technique, correct dosage, and exclusion of underlying neuromuscular junction disorders like myasthenia gravis.…”

Section: Side Effects and Contraindicationsmentioning

confidence: 99%

Botulinum Toxin Treatment of Autonomic Disorders: Focal Hyperhidrosis and Sialorrhea

2016

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Primary focal hyperhidrosis is a common autonomic disorder that significantly impacts quality of life. It is characterized by excessive sweating confined to circumscribed areas, such as the axillae, palms, soles, and face. Less frequent types of focal hyperhidrosis secondary to underlying causes include gustatory sweating in Frey's syndrome and compensatory sweating in Ross' syndrome and after sympathectomy. Approval of onabotulinumtoxinA for severe primary axillary hyperhidrosis in 2004 has revolutionized the treatment of this indication. Meanwhile further type A botulinum neurotoxins like abobotulinumtoxinA and incobotulinumtoxinA, as well as the type B botulinum neurotoxin rimabotulinumtoxinB are successfully used off-label for axillary and various other types of focal hyperhidrosis. For unexplained reasons, the duration of effect differs considerably at different sites. Beside hyperhidrosis, botulinum neurotoxin is also highly valued for the treatment of sialorrhea affecting patients with Parkinson's disease, cerebral palsy, amyotrophic lateral sclerosis, motor neuron disease, and other neurologic conditions. With correct dosing and application, side effects are manageable and transient.

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Botulinum toxin A

2014

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Relapsing–remitting severe generalized muscular weakness after botulinum toxin treatment for hyperhidrosis

Cited by 6 publications

References 9 publications

Systemic muscular weakness after botulinum toxin A administration: a review of the literature

Systemic muscular weakness after botulinum toxin A administration: a review of the literature

Botulinum Toxin Treatment of Autonomic Disorders: Focal Hyperhidrosis and Sialorrhea

Botulinum toxin A

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