Ptosis as a remote effect of therapeutic botulinum toxin B injection.
The authors report a patient with cervical dystonia, previously treated with botulinum toxin A (BTX-A), who developed bilateral ptosis and difficulty with accommodation only after botulinum toxin B (BTX-B). High-frequency repetitive nerve stimulation of the abductor digiti minimi demonstrated a 34% increment in compound muscle action potential. No increment in 20 people injected with BTX-A and no cases of ptosis in a chart review of 1,606 BTX-A injections for cervical dystonia were found. The authors conclude that systemic spread of BTX-B can cause symptomatic involvement of autonomic neurons.
Racette
B A
BA
Department of Neurology and Neurological Surgery, Washington University Sxhool of Medicine, St. Louis, MO 63110, USA. racetteb@neuro.wustl.edu
Lopate
G
G
Good
L
L
Sagitto
S
S
Perlmutter
J S
JS
D000328:Adult; D018726:Anti-Dyskinesia Agents / Q000009:adverse effects*; D001763:Blepharoptosis / Q000139:chemically induced* / Q000175:diagnosis; D001905:Botulinum Toxins / Q000009:adverse effects*; D019274:Botulinum Toxins, Type A / Q000009:adverse effects; D004576:Electromyography; D005260:Female; D006801:Humans; D009465:Neuromuscular Agents / Q000009:adverse effects; D012189:Retrospective Studies; D014103:Torticollis / Q000188:drug therapy*
D018726:Anti-Dyskinesia Agents; D009465:Neuromuscular Agents; C096323:rimabotulinumtoxinB; D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A