Botulinum Toxin Toxicity: Overview

00:01 So let's learn a little bit about, infectious causes of neuromuscular junction disorders and botulism toxin, toxicity specifically.

00:09 Botulism is a toxin, it is a type of infection.

00:14 Patients who ingest this toxin, present with proximal weakness.

00:18 This begins in the eye muscles typically, involves autonomic fibers and then progresses to include generalized weakness.

00:27 That bulbar initiation is very important, because that's different from other neuromuscular junction conditions.

00:35 In addition, we see that botulism involves the extraocular movements and autonomics and myasthenia gravis really does not.

00:42 So these are important differentiating details on both the history and the physical exam that will guide us in the direction of the appropriate diagnosis.

00:52 There are two types of patients that may present with botox toxicity or botulism toxicity.

00:58 The first is iatrogenic as in this case and this has become more common, though it's a rare complication of this treatment but more common with the widespread use of botulism toxin to treat patients who have certain disorders.

01:12 This patient had increased tone and a limb and was undergoing limb treatment for limb spasticity or limb rigidity.

01:19 The patient received multiple injections of botulism toxin into the muscle to result to decrease the tone in that muscle and improve movement, and this is not an uncommon dose or way to treat these patients.

01:33 In rare cases, patients will develop systemic botulism toxicity as a result of that localized treatment.

01:40 Just as was the case for our patient.

01:43 The other presentation is the floppy baby syndrome, and this is commonly tested not as commonly encountered but it is something that you should know about.

01:53 This is typically a young child that presents with hypotonia decreased muscle tone, and you can see the baby in this picture and here has reduced tone is unable to keep their normal body structure and tone with the examination.

02:07 The patient appears floppy, this is a floppy baby syndrome and this results from ingesting the botox toxin, which is commonly contained in certain foods and substances and in test questions, we often hear that there is an ingestion of honey.

02:22 And the botox toxin is contained within the honey and with ingestion, a young child or infant can present with hypotonia.