Alexis Ruet1, Marie Christine Durand2, Pierre Denys3, Frederic Lofaso2, François Genet3, Alexis Schnitzler3. 1. 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. 2. Department of Physiology, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin (EA 4497), Garches, France. 3. Physical Medicine and Rehabilitation Department, Raymond Poincaré Hospital, Paris' Public Assistance Hospitals, University of Versailles Saint Quentin, Garches, France.
Abstract
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.
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.
Authors: Hava Özlem Dede; Nermin Görkem Şırın; Elif Kocasoy-Orhan; Halil Atilla Idrısoğlu; Mehmet Barış Baslo Journal: Noro Psikiyatr Ars Date: 2019-08-16 Impact factor: 1.339