Myasthenia gravis exacerbation with low dose ocular botulinum toxin for epiphoria

Jennifer Watts; Bruce Brew; Stephen Tisch

doi:10.1016/j.jocn.2015.05.032

Myasthenia gravis exacerbation with low dose ocular botulinum toxin for epiphoria

J Clin Neurosci. 2015 Dec;22(12):1979-81. doi: 10.1016/j.jocn.2015.05.032. Epub 2015 Jul 15.

Authors

Jennifer Watts¹, Bruce Brew², Stephen Tisch²

Affiliations

¹ St Vincents Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia. Electronic address: jwatts@globaldial.com.
² St Vincents Hospital, Victoria Street, Darlinghurst, NSW 2010, Australia; University of New South Wales, Kingsford, NSW, Australia.

PMID: 26188667
DOI: 10.1016/j.jocn.2015.05.032

Abstract

We present a man with clinically stable systemic myasthenia gravis (MG) which flared with a low dose of peripherally injected botulinum toxin type A (BTX-A). Botulinum toxin drugs generally have an excellent safety profile, however, they are contentious in patients with neuromuscular disorders. Despite this, there remain limited reports on the systemic effects of botulinum therapy in patients with MG. This man is one of less than 10 reported patients worldwide in whom MG was exacerbated by a peripheral BTX-A injection. This is an important reminder to Australian clinicians of the potential risks of this common place medication in patients with neuromuscular disorders, even those with stable disease.

Keywords: Botulinum toxin; Epiphora; Myasthenia gravis; Neuroimmunology; Neuromuscular junction.

Publication types

Case Reports

MeSH terms

Administration, Ophthalmic
Aged
Australia
Botulinum Toxins, Type A / administration & dosage
Botulinum Toxins, Type A / adverse effects*
Head
Humans
Lacrimal Apparatus Diseases / drug therapy*
Lacrimal Apparatus Diseases / etiology
Male
Myasthenia Gravis / drug therapy*
Neuromuscular Agents / administration & dosage
Neuromuscular Agents / adverse effects*

Substances

Neuromuscular Agents
Botulinum Toxins, Type A