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Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:

Year 2009, Volume: 26 Issue: 1, 47 - 51, 06.12.2010

Abstract

We report three patients who developed transient constipation after receiving therapeutic doses of Botulinum Toxin-A (BTX-A) for spasticity of the lower limbs (two cases) and the upper limb (one case). Constipation was observed within the first week after treatment. In all three cases, this symptom resolved completely almost simultaneously with disappearance of the therapeutic effects of BTX-A on mobility. None of the patients had previously received BTX-A injections. Two patients received a second treatment and both presented the same autonomic cholinergic remote symptoms. The third patient refused a second treatment due to the complication noted earlier. Familiarity with this autonomic systemic side effect of BTX-A is essential for those who treat patients already at risk for gastro-intestinal dysfunction. Because the adverse effects were treatable and transitory, we believe that constipation per se is not an absolute contra-indication, if from a therapeutic point of view view, BTX-A is indicated.

References

  • Autti-Ramo I, Larsen A, Taimo A, von Wendt L.2001Management of the upper limb with botulinum toxin type A in children with spastic type cerebral palsy and acquired brain injury: clinical implications. Eur J Neurol.;8 Suppl 5:136-44.
  • Bakheit AM, Severa S, Cosgrove A et al. 2001.Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity. Dev Med Child Neurol.;43:234-8.
  • Bergfeldt U, Borg K, Kullander K, Julin P. 2006.Focal spasticity therapy with botulinum toxin: effects on function, activities of daily living and pain in 100 adult patients. J Rehabil Med.;38:166-71.
  • Cote TR, Mohan AK, Polder JA, Walton MK, Braun MM. 2005.Botulinum toxin type A injections: adverse events reported to the US
  • Food and Drug Administration in therapeutic and cosmetic cases. J Am Acad Dermatol.53:407-15.
  • De Louw AJ, de Vente J, Steinbusch HP et al. 2002. Apoptosis in the rat spinal cord during postnatal development; the effect of
  • perinatal asphyxia on programmed cell death. Neuroscience.;2:751-8
  • Dressler D, Benecke R. Autonomic side effects of botulinum toxin type B treatment of cervical dystonia and hyperhidrosis. Eur Neurol. 2003;49:34-8.
  • Dursun N, Dursun E, Alican D.2002.The role of botulinum toxin a in the management of lower limb spasticity in patients with cerebral palsy. Int J Clin Pract.;56:564-7.
  • Garner CG, Straube A, Witt TN, Gasser T, Oertel WH. 1993.Time course of distant effects of local injections of botulinum toxin. Mov Disord.;8:33-7.
  • Lange DJ, Brin MF, Fahn S, Lovelace RE. 1988.Distant effects of locally injected botulinum toxin: incidence and course. Adv Neurol.;50:609-13.
  • Mall V, Heinen F, Siebel A et al.2006.Treatment of adductor spasticity with BTX-A in children with CP: a randomized, double-blind, placebo- controlled study. Dev Med Child Neurol.;48:10-3.
  • Menkes JH, Ament ME. 1988. Neurologic disorders of gastroesophageal function. Adv Neurol.;49:409-16.
  • Olney RK, Aminoff MJ, Gelb DJ, Lowenstein DH. 1988.Neuromuscular effects distant from the site of botulinum neurotoxin injection. Neurology.;38:1780-3.
  • Patti F, Pappalardo A, Lo Fermo S, Cimino V, Castiglione A, Zappia M. 2008.Life-threatening constipation induced by intrathecal baclofen therapy. Eur Neurol.;60:95-6.
  • Polak F, Morton R, Ward C, Wallace WA, Doderlein L, Siebel A.2002. Double-blind comparison study of two doses of botulinum toxin A injected into calf muscles in children with hemiplegic cerebral palsy. Dev Med Child Neurol;44:551-5.
  • Robertshaw K, Watson L, Parkin T, Morton RE. 2005.Botulinum toxin A dosage: autonomic function as a measure of side effects. Dev Med Child Neurol.;47:792.
  • Rossi RP, Strax TE, Di Rocco A. Severe Dysphagia after botulinum toxin B injection to the lower limbs and lumbar paraspinal muscles. Am J Phys Med Rehabil. 2006;85:1011-3.
  • Satila H, Kotamaki A, Koivikko M, Autti-Ramo I. 2006. Low- and high-dose botulinum toxin A treatment: a retrospective analysis. Pediatr Neurol.;34:285-90.
  • Tintner R, Gross R, Winzer UF, Smalky KA, Jankovic J. 2005.Autonomic function after botulinum toxin type A or B: a double-blind, randomized trial. Neurology.;65:765-7.
  • Van Rhijn J, Molenaers G, Ceulemans B.2005.Botulinum toxin type A in the treatment of children and adolescents with an acquired brain injury. Brain Inj.;19:331-5.
Year 2009, Volume: 26 Issue: 1, 47 - 51, 06.12.2010

Abstract

References

  • Autti-Ramo I, Larsen A, Taimo A, von Wendt L.2001Management of the upper limb with botulinum toxin type A in children with spastic type cerebral palsy and acquired brain injury: clinical implications. Eur J Neurol.;8 Suppl 5:136-44.
  • Bakheit AM, Severa S, Cosgrove A et al. 2001.Safety profile and efficacy of botulinum toxin A (Dysport) in children with muscle spasticity. Dev Med Child Neurol.;43:234-8.
  • Bergfeldt U, Borg K, Kullander K, Julin P. 2006.Focal spasticity therapy with botulinum toxin: effects on function, activities of daily living and pain in 100 adult patients. J Rehabil Med.;38:166-71.
  • Cote TR, Mohan AK, Polder JA, Walton MK, Braun MM. 2005.Botulinum toxin type A injections: adverse events reported to the US
  • Food and Drug Administration in therapeutic and cosmetic cases. J Am Acad Dermatol.53:407-15.
  • De Louw AJ, de Vente J, Steinbusch HP et al. 2002. Apoptosis in the rat spinal cord during postnatal development; the effect of
  • perinatal asphyxia on programmed cell death. Neuroscience.;2:751-8
  • Dressler D, Benecke R. Autonomic side effects of botulinum toxin type B treatment of cervical dystonia and hyperhidrosis. Eur Neurol. 2003;49:34-8.
  • Dursun N, Dursun E, Alican D.2002.The role of botulinum toxin a in the management of lower limb spasticity in patients with cerebral palsy. Int J Clin Pract.;56:564-7.
  • Garner CG, Straube A, Witt TN, Gasser T, Oertel WH. 1993.Time course of distant effects of local injections of botulinum toxin. Mov Disord.;8:33-7.
  • Lange DJ, Brin MF, Fahn S, Lovelace RE. 1988.Distant effects of locally injected botulinum toxin: incidence and course. Adv Neurol.;50:609-13.
  • Mall V, Heinen F, Siebel A et al.2006.Treatment of adductor spasticity with BTX-A in children with CP: a randomized, double-blind, placebo- controlled study. Dev Med Child Neurol.;48:10-3.
  • Menkes JH, Ament ME. 1988. Neurologic disorders of gastroesophageal function. Adv Neurol.;49:409-16.
  • Olney RK, Aminoff MJ, Gelb DJ, Lowenstein DH. 1988.Neuromuscular effects distant from the site of botulinum neurotoxin injection. Neurology.;38:1780-3.
  • Patti F, Pappalardo A, Lo Fermo S, Cimino V, Castiglione A, Zappia M. 2008.Life-threatening constipation induced by intrathecal baclofen therapy. Eur Neurol.;60:95-6.
  • Polak F, Morton R, Ward C, Wallace WA, Doderlein L, Siebel A.2002. Double-blind comparison study of two doses of botulinum toxin A injected into calf muscles in children with hemiplegic cerebral palsy. Dev Med Child Neurol;44:551-5.
  • Robertshaw K, Watson L, Parkin T, Morton RE. 2005.Botulinum toxin A dosage: autonomic function as a measure of side effects. Dev Med Child Neurol.;47:792.
  • Rossi RP, Strax TE, Di Rocco A. Severe Dysphagia after botulinum toxin B injection to the lower limbs and lumbar paraspinal muscles. Am J Phys Med Rehabil. 2006;85:1011-3.
  • Satila H, Kotamaki A, Koivikko M, Autti-Ramo I. 2006. Low- and high-dose botulinum toxin A treatment: a retrospective analysis. Pediatr Neurol.;34:285-90.
  • Tintner R, Gross R, Winzer UF, Smalky KA, Jankovic J. 2005.Autonomic function after botulinum toxin type A or B: a double-blind, randomized trial. Neurology.;65:765-7.
  • Van Rhijn J, Molenaers G, Ceulemans B.2005.Botulinum toxin type A in the treatment of children and adolescents with an acquired brain injury. Brain Inj.;19:331-5.
There are 21 citations in total.

Details

Primary Language English
Journal Section Basic Medical Sciences
Authors

Georges F Vles This is me

Johan S Vles This is me

Catherine G Faber This is me

Mieke C Hermans This is me

Juan D Martina This is me

Anton de Louw This is me

Publication Date December 6, 2010
Submission Date November 23, 2009
Published in Issue Year 2009 Volume: 26 Issue: 1

Cite

APA Vles, G. F., Vles, J. S., Faber, C. G., Hermans, M. C., et al. (2010). Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:. Journal of Experimental and Clinical Medicine, 26(1), 47-51. https://doi.org/10.5835/jecm.v26i1.425
AMA Vles GF, Vles JS, Faber CG, Hermans MC, Martina JD, Louw Ad. Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:. J. Exp. Clin. Med. December 2010;26(1):47-51. doi:10.5835/jecm.v26i1.425
Chicago Vles, Georges F, Johan S Vles, Catherine G Faber, Mieke C Hermans, Juan D Martina, and Anton de Louw. “Constipation After Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:”. Journal of Experimental and Clinical Medicine 26, no. 1 (December 2010): 47-51. https://doi.org/10.5835/jecm.v26i1.425.
EndNote Vles GF, Vles JS, Faber CG, Hermans MC, Martina JD, Louw Ad (December 1, 2010) Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:. Journal of Experimental and Clinical Medicine 26 1 47–51.
IEEE G. F. Vles, J. S. Vles, C. G. Faber, M. C. Hermans, J. D. Martina, and A. d. Louw, “Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:”, J. Exp. Clin. Med., vol. 26, no. 1, pp. 47–51, 2010, doi: 10.5835/jecm.v26i1.425.
ISNAD Vles, Georges F et al. “Constipation After Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:”. Journal of Experimental and Clinical Medicine 26/1 (December 2010), 47-51. https://doi.org/10.5835/jecm.v26i1.425.
JAMA Vles GF, Vles JS, Faber CG, Hermans MC, Martina JD, Louw Ad. Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:. J. Exp. Clin. Med. 2010;26:47–51.
MLA Vles, Georges F et al. “Constipation After Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:”. Journal of Experimental and Clinical Medicine, vol. 26, no. 1, 2010, pp. 47-51, doi:10.5835/jecm.v26i1.425.
Vancouver Vles GF, Vles JS, Faber CG, Hermans MC, Martina JD, Louw Ad. Constipation after Botulinum Toxin- an Injection in Lower and Upper Limb Muscles:. J. Exp. Clin. Med. 2010;26(1):47-51.