Table Summary of clinical and electrophysiological features of reported patients with generalised weakness after BT injections

Age/ sexInjections for (primary diagnosis)Prior years of injectionsMuscles injected /total doseDistribution of weaknessOnset /durationElectrophysiologyFU
Our patients:
45/FCervical dystonia5scm, splenii,Generalised UL>LL dysphagia1 weekFibrillations, small and short MUPRecovered, no further injections
/650 U/Dys/6 monthsabnormal jitter, and blockings
Mild decrement
57/FArm dystonia (symptomatic hemidystonia)2.5L arm
/900 U/Dys
Generalised UL>LL2 weeks
/3 months
Abnormal jitter and blocking
Mild decrement
Recovered, no problems with further injections
32/FLeg dystonia (symptomatic hemidystonia)2.5L foot
Generalised UL>LL dysphagia1 week
/3 months
EMG normal
SFEMG normal
Similar episode on repeat injections. None since
Reported cases (Bakheit et al 8)
67/FSpasticity (MS)nilL legGeneralised LL>UL dysphagia ptosis4 daysEMG “denervation”Recovered
1×injection/250 U/Dys/4 weeksAbnormal jitter and blocking
34/FTorticollis (MSA)5scm, spleniusGeneralised proximal dysphagia3 weeksEMG “denervation”Recovered
/250 U/Dys/4 monthsAbnormal jitter and blocking
  • Scm=sternocleidomastoid muscle; LL=lower limb; UL=upper limbs; Dys=Dysport, RNS=repetitive nerve stimulation; SFEMG=single fibre EMG; MUP=motor unit potentials; MSA=muscle system atrophy; MS=multiple sclerosis.