title: Human response to unintended intrathecal injection of botulinum toxin.
abstract: OBJECTIVE
  Describe the first reported human intrathecal (IT) botulinum toxin injection.
  
  
  METHODS
  Case report.
  
  
  METHODS
  We report here the sequelae to an unintended IT injection of botulinum toxin type B (BTB) in a 60-year-old woman with chronic back pain.
  
  
  RESULTS
  Following the IT administration of BTB, the patient experienced the onset of symmetric ascending stocking distribution painful dysesthesias, which persisted for approximately 6 months before receding. Objective neurologic deficits were not appreciated, and analgesic effects were prominently absent.
  
  
  CONCLUSIONS
  Analgesic actions of botulinum toxins in animals and in humans have led to speculation that IT botulinum toxin might exert significant analgesic effects. The unusual and unexpected subsequent clinical course, neurologic sequelae, dysesthesias, and absence of analgesia suggest that botulinum toxin will not be a therapeutic modality to treat pain as proposed by those studying botulinum toxin in animal models.
authors.affiliation: Division of Pain Management, Department of Anesthesiology, Stanford University, Palo Alto, CA 94040, USA. irc39@pain.stanford.edu
authors.forename: Ian
authors.initials: I
authors.lastname: Carroll
authors.forename: Nancy
authors.initials: N
authors.lastname: Fischbein
authors.forename: Meredith
authors.initials: M
authors.lastname: Barad
authors.forename: Sean
authors.initials: S
authors.lastname: Mackey
mesh_terms: D000818:Animals; D001416:Back Pain / Q000188:drug therapy*; D001905:Botulinum Toxins / Q000009:adverse effects* / Q000627:therapeutic use*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D001905:Botulinum Toxins