Electrophysiological abnormalities in iatrogenic botulism: Two case reports and review of the literature. (February 2019)

• Record Type: Journal Article
• Authors: Leonardi, Luca; Haggiag, Shalom; Petrucci, Antonio; Lispi, Ludovico
• Is Part Of: Journal of clinical neuroscience. Volume 60(2019)
• Page Start: 138
• Page End: 141
• Publication Date: 2019-02
• Subjects: Botulinum neurotoxin type/A -- Iatrogenic botulism -- Electrophysiological abnormalities; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.10.059
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: BoNT/A has been reported as associated to systemic iatrogenic botulism (IB). Electrodiagnostic (EDX) data could support the diagnosis of IB. Few and heterogeneous data on EDX of IB are reported in literature. No abnormal response at low and high frequency RNS was detected in our patients. Acute denervation and alterations at SFEMG are the most suggestive abnormalities in IB. Abstract: Therapeutic use of botulinum neurotoxin type A (BoNT/A) is effective, and generally safe. Nevertheless, iatrogenic botulism (IB) is rarely reported as a result of systemic spread of the BoNT/A, causing general weakness, bulbar symptoms and dysautonomia. Suggestive clinical feature are decisive to raise the diagnostic suspicion, which however needs a confirmation in the electrodiagnostic (EDX) study, above all to exclude other treatable diseases. In this study, we report 2 patients who developed IB after receiving therapeutic doses of BoNT/A, assessing the EDX changes, and reviewing the literature on EDX in IB. Although there is not enough data to draw solid conclusions we propose that, in a subject with suggestive clinical features and recent exposure to BoNT/A, the absence of a decremental or incremental response to repetitive nerve stimulation in muscles showing acute denervation changes, is a suggestive finding for the diagnosis of IB.