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

Alexandre Camões- Barbosa; Inês Mendes Ribeiro; Luisa Medeiros

doi:10.20344/amp.11503

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

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 Dec. 23];33(11):761-4. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/11503

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Issue

Vol. 33 No. 11 (2020): November

Section

Case Report

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