Treatment with botulinum toxin in a patient with myasthenia gravis and cervical dystonia
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The therapeutic use of botulinum toxin (BTX) is contraindicated in patients with disorders of neuromuscular transmission (such as myasthenia gravis [MG]). In addition to the desired effect on muscles injected with BTX, instrument investigations reveal a remote cholinergic denervation distant from the injection site, consisting of an increase in jitter, evaluated by EMG-single fiber, and mild abnormalities of autonomic fibers evaluated by cardiovascular reflexes.1,2
We report the results of repeated treatments with BTX type A (BTX-A) in a patient with an association of MG and cervical dystonia (CD).
Case report.
A 23-year-old woman presented in May 2002. Her medical history was unremarkable (except for right esotropia present at birth) until 1998, when she had fluctuating ptosis and diplopia, later associated with generalized weakness involving limbs and neck extensor muscles. A good response to an anti-cholinesterase injection, CMAP decrement on low-rate RNS, and increased serum anti-acetylcholine receptor antibodies led to the diagnosis of MG. The patient was treated chronically …
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