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

Authors

  • Alexandre Camões- Barbosa Neurotoxin Clinic. Neurophysiology Unit. Centro Hospitalar Universitário de Lisboa Central. Lisboa.
  • Inês Mendes Ribeiro Physical Medicine and Rehabilitation Department. Hospital Prof. Doutor Fernando Fonseca. Amadora.
  • Luisa Medeiros Neurophysiology Unit. Centro Hospitalar de Lisboa Central. Lisboa.

DOI:

https://doi.org/10.20344/amp.11503

Keywords:

Botulinum Toxins, Type A/adverse effects, Muscle Weakness/etiology, Upper Extremity

Abstract

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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Published

2020-11-02

How to Cite

1.
Camões- Barbosa A, Ribeiro IM, Medeiros L. Contralateral Upper Limb Weakness Following Botulinum Toxin A Injection for Poststroke Spasticity. Acta Med Port [Internet]. 2020 Nov. 2 [cited 2024 Mar. 29];33(11):761-4. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/11503

Issue

Section

Case Report