Single-fiber electromyography analysis of botulinum toxin diffusion in patients with fatigue and pseudobotulism

Arch Phys Med Rehabil. 2015 Jun;96(6):1103-9. doi: 10.1016/j.apmr.2015.01.010. Epub 2015 Jan 22.


Objective: To characterize electromyographic abnormalities according to symptoms (asymptomatic, fatigue, pseudobotulism) reported 1 month after botulinum toxin injection.

Design: Retrospective, single-center study comparing single-fiber electromyography (SFEMG) in the extensor digitorum communis (EDC) or orbicularis oculi (OO) muscles.

Setting: Hospital.

Participants: 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).

Interventions: Not applicable.

Main outcome measures: 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.

Keywords: Asthenia; Botulinum toxins, type A; Botulism; Electromyography; Rehabilitation.

MeSH terms

  • Adult
  • Botulinum Toxins, Type A / administration & dosage
  • Botulinum Toxins, Type A / pharmacokinetics*
  • Botulism / epidemiology
  • Electromyography
  • Fatigue / chemically induced*
  • Female
  • Humans
  • Injections, Intramuscular
  • Male
  • Middle Aged
  • Muscle Fibers, Skeletal / physiology*
  • Muscle Hypertonia / drug therapy
  • Muscle Spasticity / drug therapy
  • Muscle Weakness / chemically induced*
  • Neuromuscular Agents / administration & dosage
  • Neuromuscular Agents / pharmacokinetics*
  • Retrospective Studies
  • Urinary Bladder, Neurogenic / drug therapy
  • Vision Disorders / chemically induced*


  • Neuromuscular Agents
  • Botulinum Toxins, Type A