title: Single-fiber electromyography analysis of botulinum toxin diffusion in patients with fatigue and pseudobotulism.
abstract: OBJECTIVE
  To characterize electromyographic abnormalities according to symptoms (asymptomatic, fatigue, pseudobotulism) reported 1 month after botulinum toxin injection.
  
  
  METHODS
  Retrospective, single-center study comparing single-fiber electromyography (SFEMG) in the extensor digitorum communis (EDC) or orbicularis oculi (OO) muscles.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  Four groups of adults treated for spasticity or neurologic bladder hyperactivity (N=55): control group (asymptomatic patients: n=17), fatigue group (unusual fatigue with no weakness: n=15), pseudobotulism group (muscle weakness and/or visual disturbance: n=20), and botulism group (from intensive care unit of the same hospital: n=3).
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Mean jitter, percentage of pathologic fibers, and percentage of blocked fibers were compared between groups.
  
  
  RESULTS
  SFEMG was abnormal for 17.6% of control patients and 75% of patients in the pseudobotulism group. There were no differences between the control and fatigue groups. Mean jitter, percentage of pathologic fibers, and percentage of blocked fibers of the EDC muscle were significantly higher in the pseudobotulism group than in the fatigue and control groups. There were no differences between groups for the OO muscle. The SFEMG results in the botulism group were qualitatively similar to those of the pseudobotulism group.
  
  
  CONCLUSIONS
  SFEMG of the EDC muscle confirmed diffusion of the toxin into muscles distant from the injection site in the pseudobotulism group. SFEMG in the OO muscle is not useful for the diagnosis of diffusion. No major signs of diffusion of botulinum toxin type A were found away from the injection site in patients with fatigue but no motor weakness. Such fatigue may be related to other mechanisms.
authors.affiliation: Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France. Electronic address: alexis.ruet@rpc.aphp.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Ruet
authors.affiliation: Department of Physiology, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin (EA 4497), Garches, France.
authors.forename: Marie Christine
authors.initials: MC
authors.lastname: Durand
authors.affiliation: Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Denys
authors.affiliation: Department of Physiology, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin (EA 4497), Garches, France.
authors.forename: Frederic
authors.initials: F
authors.lastname: Lofaso
authors.affiliation: Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France.
authors.forename: François
authors.initials: F
authors.lastname: Genet
authors.affiliation: Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France.
authors.forename: Alexis
authors.initials: A
authors.lastname: Schnitzler
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000493:pharmacokinetics*; D001906:Botulism / Q000453:epidemiology; D004576:Electromyography; D005221:Fatigue / Q000139:chemically induced*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D018485:Muscle Fibers, Skeletal / Q000502:physiology*; D009122:Muscle Hypertonia / Q000188:drug therapy; D009128:Muscle Spasticity / Q000188:drug therapy; D018908:Muscle Weakness / Q000139:chemically induced*; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D012189:Retrospective Studies; D001750:Urinary Bladder, Neurogenic / Q000188:drug therapy; D014786:Vision Disorders / Q000139:chemically induced*
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Asthenia; Botulinum toxins, type A; Botulism; Electromyography; Rehabilitation