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Neurology 2002;59:1445-1447
© 2002 American Academy of Neurology
Brief Communications

Ptosis as a remote effect of therapeutic botulinum toxin B injection

B. A. Racette, MD, G. Lopate, MD, L. Good, BA, S. Sagitto, RN and J. S. Perlmutter, MD

From the Department of Neurology and Neurological Surgery (Neurology) (Drs. Racette, Lopate, and Perlmutter, L. Good and S. Sagitto), American Parkinson Disease Association Advanced Center for Parkinson Research (Drs. Racette and Perlmutter, L. Good and S. Sagitto), Huntington Disease Society of America Center of Excellence (Drs. Racette and Perlmutter, L. Good and S. Sagitto), Mallinckrodt Institute of Radiology (Dr. Perlmutter), and Department of Anatomy and Neurobiology (Dr. Perlmutter), Washington University, St. Louis, MO.

Address correspondence and reprint requests to Dr. Brad A. Racette, Washington University School of Medicine, 660 S. Euclid Ave., Box 8111, St. Louis, MO 63110; e-mail-racetteb{at}neuro.wustl.edu

The authors report a patient with cervical dystonia, previously treated with botulinum toxin A (BTX-A), who developed bilateral ptosis and difficulty with accommodation only after botulinum toxin B (BTX-B). High-frequency repetitive nerve stimulation of the abductor digiti minimi demonstrated a 34% increment in compound muscle action potential. No increment in 20 people injected with BTX-A and no cases of ptosis in a chart review of 1,606 BTX-A injections for cervical dystonia were found. The authors conclude that systemic spread of BTX-B can cause symptomatic involvement of autonomic neurons.




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