title: Problems with botulinum toxin treatment in mitochondrial cytopathy: case report and review of the literature.
abstract: Botulinum toxin type A (BTXA) is widely used in neurological therapeutics for a variety of indications such as dystonia, spasticity, hyperhidrosis, and hypersalivation. It is relatively contraindicated in disorders of neuromuscular transmission, in individuals with known hypersensitivity or bleeding disorders, and during pregnancy. Two patients are presented with initially undetermined multisystem neurological disorders and excessive sialorrhoea, later diagnosed as mitochondrial cytopathy, who had side effects after treatment with ultrasound guided BTXA injections. Published reports on the use of BTXA injections in hypersalivation of various causes are reviewed, along with the proposed mechanisms of hypersensitivity to BTXA in patients with mitochondrial cytopathies. Clinicians should be cautious when using BTXA injections in such patients because of the significant risk of side effects.
authors.affiliation: Department of Neurology, Aristotle's University of Thessaloniki, Greece. theogiol@hotmail.com
authors.forename: T
authors.initials: T
authors.lastname: Gioltzoglou
authors.forename: C
authors.initials: C
authors.lastname: Cordivari
authors.forename: P J
authors.initials: PJ
authors.lastname: Lee
authors.forename: M G
authors.initials: MG
authors.lastname: Hanna
authors.forename: A J
authors.initials: AJ
authors.lastname: Lees
mesh_terms: D000328:Adult; D001706:Biopsy; D019274:Botulinum Toxins, Type A / Q000009:adverse effects* / Q000627:therapeutic use; D001933:Brain Stem / Q000473:pathology; D002531:Cerebellum / Q000473:pathology; D003680:Deglutition Disorders / Q000139:chemically induced; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D017240:Mitochondrial Myopathies / Q000188:drug therapy*; D018482:Muscle, Skeletal / Q000473:pathology; D009465:Neuromuscular Agents / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A