title: Contralateral weakness and fatigue after high-dose botulinum toxin injection for management of poststroke spasticity.
abstract: A 53-yr-old woman developed contralateral weakness and fatigue, without autonomic symptoms, 2 wks after receiving an injection with 800 units of botulinum toxin A for management of her poststroke spasticity. Although the patient reported resolution 4 wks later, clinical evaluations suggested an even longer time course. The patient then experienced the same contralateral symptoms again more than a year later, after a 500-unit injection, which took a similar length of time to resolve. We report the first known case of repeated contralateral weakness and fatigue after high-dose botulinum toxin A injection. Currently, dosage is largely titrated by the practitioner based on individual patient response. Before performing botulinum toxin A injections for therapeutic purposes, the expected risks and benefits for each patient must be carefully considered.
authors.affiliation: Department of Physical Medicine and Rehabilitation, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ 07101, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Varghese-Kroll
authors.forename: Elie P
authors.initials: EP
authors.lastname: Elovic
mesh_terms: D018726:Anti-Dyskinesia Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001905:Botulinum Toxins / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000209:etiology; D018908:Muscle Weakness / Q000139:chemically induced*; D020521:Stroke / Q000150:complications*
chemical_list: D018726:Anti-Dyskinesia Agents; D001905:Botulinum Toxins