Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity

• Published in: Revista de neurologiá Vol. 37; no. 5; p. 444
• Main Authors: Beseler-Soto, B, Sánchez-Palomares, M, Santos-Serrano, L, Landa-Rivera, L, Sanantonio-Valdearcos, F, Paricio-Talayero, J M
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.09.2003
• Subjects: Agenesis of Corpus Callosum; Botulinum Toxins - adverse effects; Botulinum Toxins - therapeutic use; Botulism - chemically induced; Cerebral Palsy - drug therapy; Child; Fatal Outcome; Female; Humans; Iatrogenic Disease; Neuromuscular Agents - adverse effects; Neuromuscular Agents - therapeutic use
• ISSN: 0210-0010

During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare.