Electrophysiological abnormalities of the neuromuscular transmission in two patients with botulism-like syndrome following Botulinum-A muscle injections

Julian Theuriet; Laure Huchon; Jacques Luaute; Anne-Evelyne Vallet; Françoise Bouhour; Antoine Pegat

doi:10.1016/j.neucli.2024.102984

Electrophysiological abnormalities of the neuromuscular transmission in two patients with botulism-like syndrome following Botulinum-A muscle injections

Neurophysiol Clin. 2024 May 16;54(4):102984. doi: 10.1016/j.neucli.2024.102984. Online ahead of print.

Authors

Julian Theuriet¹, Laure Huchon², Jacques Luaute², Anne-Evelyne Vallet³, Françoise Bouhour¹, Antoine Pegat⁴

Affiliations

¹ Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France; Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, Université Lyon 1, Faculté de Médecine Lyon Est, 69008, Lyon, France.
² Service de Médecine Physique et Réadaptation, Hôpital Henry Gabrielle, Hospices Civils de Lyon, Groupement Sud, Saint-Genis-Laval, 69230, France.
³ Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France.
⁴ Service d'ENMG et de Pathologies Neuromusculaires, Centre de Référence des Maladies Neuromusculaires PACA-Réunion-Rhône-Alpes, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Groupement Est, 69500, Bron, France; Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, Université Lyon 1, Faculté de Médecine Lyon Est, 69008, Lyon, France. Electronic address: antoine.pegat@chu-lyon.fr.

PMID: 38759365
DOI: 10.1016/j.neucli.2024.102984

Abstract

Botulinum neurotoxin serotype A (BoNT-A) has several therapeutic indications such as spasticity and dystonia. Although its use is generally considered safe, a systemic diffusion can lead to systemic complications, and a botulism-like syndrome can occur after intramuscular injections. Herein, two adult cases who developed general muscle weakness after a BoNT-A intramuscular injection are reported. Both presented with a progressive decrement on low-frequency (LF) repetitive nerve stimulation (RNS). It is suggested that a progressive decrement on LF-RNS in muscles distant from the injection site strongly supports the diagnosis of iatrogenic botulism.

Keywords: Botulism; Decrement; Electroneuromyography; RNS.