Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity

Botulinum toxin type A has been approved for spasticity management in poststroke patients. The adverse effects are generally of two types: those related to local injection; and those related to the systemic effects from spread of the toxin. Contralateral weakness after botulinum toxin A treatment i...

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Main Authors: Alexandre Camões- Barbosa, Inês Mendes Ribeiro, Luisa Medeiros
Format: Article
Language:English
Published: Ordem dos Médicos 2020-11-01
Series:Acta Médica Portuguesa
Subjects:
Online Access:https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11503
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author Alexandre Camões- Barbosa
Inês Mendes Ribeiro
Luisa Medeiros
author_facet Alexandre Camões- Barbosa
Inês Mendes Ribeiro
Luisa Medeiros
author_sort Alexandre Camões- Barbosa
collection DOAJ
description Botulinum toxin type A has been approved for spasticity management in poststroke patients. The adverse effects are generally of two types: those related to local injection; and those related to the systemic effects from spread of the toxin. Contralateral weakness after botulinum toxin A treatment is a rarely reported adverse effect. We report the case of a 33-year-old female who had been receiving regular injections of incobotulinum toxin A due to spasticity of the right limbs after a hemorrhagic stroke. A switch was made to abobotulinum toxin A with an overall conversion ratio of 1:3.83. The patient presented contralateral upper limb paresis, especially of the deltoid muscle, in the second week post-injection. The electroneuromyography showed neuromuscular block due to botulinum toxin A. She recovered completely after eight months. A switch between different formulations of botulinum toxin type A should prompt caution when carrying out unit conversions. Distant side effects may appear, including paresis in the contralateral limbs.
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spelling doaj.art-8d90ec46efa94826b45905dc7f1a5dea2022-12-22T04:07:40ZengOrdem dos MédicosActa Médica Portuguesa0870-399X1646-07582020-11-01331110.20344/amp.115034963Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke SpasticityAlexandre Camões- Barbosa0Inês Mendes Ribeiro1Luisa Medeiros2Neurotoxin Clinic. Neurophysiology Unit. Centro Hospitalar Universitário de Lisboa Central. Lisboa.Physical Medicine and Rehabilitation Department. Hospital Prof. Doutor Fernando Fonseca. Amadora.Neurophysiology Unit. Centro Hospitalar de Lisboa Central. Lisboa. Botulinum toxin type A has been approved for spasticity management in poststroke patients. The adverse effects are generally of two types: those related to local injection; and those related to the systemic effects from spread of the toxin. Contralateral weakness after botulinum toxin A treatment is a rarely reported adverse effect. We report the case of a 33-year-old female who had been receiving regular injections of incobotulinum toxin A due to spasticity of the right limbs after a hemorrhagic stroke. A switch was made to abobotulinum toxin A with an overall conversion ratio of 1:3.83. The patient presented contralateral upper limb paresis, especially of the deltoid muscle, in the second week post-injection. The electroneuromyography showed neuromuscular block due to botulinum toxin A. She recovered completely after eight months. A switch between different formulations of botulinum toxin type A should prompt caution when carrying out unit conversions. Distant side effects may appear, including paresis in the contralateral limbs. https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11503Botulinum ToxinsType A/adverse effectsMuscle Weakness/etiologyUpper Extremity
spellingShingle Alexandre Camões- Barbosa
Inês Mendes Ribeiro
Luisa Medeiros
Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity
Acta Médica Portuguesa
Botulinum Toxins
Type A/adverse effects
Muscle Weakness/etiology
Upper Extremity
title Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity
title_full Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity
title_fullStr Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity
title_full_unstemmed Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity
title_short Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity
title_sort contralateral upper limb weakness following botulinum toxin a injection for poststroke spasticity
topic Botulinum Toxins
Type A/adverse effects
Muscle Weakness/etiology
Upper Extremity
url https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11503
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