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Generalised muscular weakness after botulinum toxin injections for dystonia: a report of three cases
  1. K P Bhatiaa,
  2. A Münchaua,
  3. P D Thompsona,
  4. M Housera,
  5. V S Chauhana,
  6. M Hutchinsonb,
  7. A H V Shapiraa,c,
  8. C D Marsden*,a
  1. aDepartment of Clinical Neurology, Institute of Neurology, University College, London, Queen Square, London, UK, bSt Vincents Hospital, Elm Park, Dublin, Ireland, cUniversity Department of Clinical Neurosciences, Royal Free and UCH Medical Sciences, University College London, London
  1. Dr KP Bhatia, Institute of Neurology, Queen Square, London WC1N 3BG, UK. Telephone 0044 171 837 3611; fax 0044 171 278 5616.


Three patients are reported on who developed transient generalised weakness after receiving therapeutic doses of botulinum toxin for cervical dystonia (one case) and symptomatic hemidystonia (two cases) respectively. Clinical and electrophysiological findings were in keeping with mild botulism. All patients had received previous botulinum toxin injections without side effects and one patient continued injections without recurrence of generalised weakness. The cause is most likely presynaptic inhibition due to systemic spread of the toxin. Patients with symptomatic dystonia may be more likely to have this side effect and botulinum toxin injections in these patients should be carried out cautiously.

  • botulism
  • botulinum toxin injections
  • dystonia

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  • * Deceased 29 September 1998