Pain and calf hypertrophy associated with spontaneous repetitive discharges treated with botulinum toxin.
OBJECTIVE
To report a case of neurogenic calf hypertrophy associated with root lesion responsive to botulinum toxin (BTX). In addition, we systematically review the literature for cases of muscle hypertrophy associated with radiculopathy.


METHODS
A 56-year-old man with a previous history of S1 root lesion presented with marked calf hypertrophy, muscle pain, cramps, fasciculations, and increased CK level. Magnetic resonance imaging and muscle biopsy confirmed true muscle hypertrophy. Electromyography (EMG) showed signs of chronic denervation-reinnervation in the right S1 myotome, with greatly increased spontaneous activity (SA) (fasciculations and complex repetitive discharges). Botox(R) was injected in 3 occasions on 4 sites on the right gastrocnemius (20U per site). Symptoms, CK level and SA on EMG (quantified) were evaluated.


RESULTS
The patient improved clinically, CK level and SA steadily decreased.


CONCLUSIONS
The literature review failed to identify a unique causative factor for muscle hypertrophy related to neurogenic lesions. BTX treatment was effective in our patient with muscle hypertrophy associated with SA.


CONCLUSIONS
We provide further evidence that spontaneous activity secondary to nerve lesion may cause focal muscle hypertrophy. Treatment with BTX should be considered in these conditions.
Costa
João
J
Department of Neurology, Santa Maria Hospital. Institute of Molecular Medicine-Faculty of Medicine. Lisbon. Portugal.
Graça
Pedro
P
Evangelista
Teresinha
T
de Carvalho
Mamede
M
D018726:Anti-Dyskinesia Agents / Q000627:therapeutic use*; D001706:Biopsy; D001905:Botulinum Toxins / Q000627:therapeutic use*; D004576:Electromyography; D006801:Humans; D006984:Hypertrophy; D007866:Leg; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000294:innervation / Q000473:pathology / Q000503:physiopathology; D009468:Neuromuscular Diseases / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology*; D010146:Pain / Q000188:drug therapy / Q000503:physiopathology; D011843:Radiculopathy / Q000188:drug therapy* / Q000503:physiopathology*
D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins