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Longitudinal neurophysiological assessment of intramuscular type-A botulin toxin in healthy humans

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The aim of this study is to assess the neurophysiological abnormalities of type A botulin toxin-infiltrated human muscle, and their evolution over time. Seried cMAP measurements, 3 and 20 Hz repetitive nerve stimulation, EMG, SFEMG over 3 months from toxin injection. Our findings consist in lack of decrement with 3 Hz repetitive nerve stimulation and facilitation with 20 Hz repetitive nerve stimulation; progressive increasing of jitter; early appearance of fibrillations; small and short motor unit action potential in the first 3 weeks, followed by increasing of MUAP amplitude and duration, with polyphasic morphology. Although claimed as highly specific and sensible, neuromuscular junction facilitation is an inconstant finding in human botulism. Therefore, lack of neuromuscular junction facilitation cannot exclude a diagnosis of botulism. Our findings are compatible with a process of acute denervation followed by distal reinnervation, favored by terminal nerve sprouting.

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Correspondence to L. Leonardi.

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This study was performed in accordance with the Helsinki Declaration. Written informed consent was obtained from all participating subjects. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

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The authors declare that they have no conflict of interest.

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Lispi, L., Leonardi, L. & Petrucci, A. Longitudinal neurophysiological assessment of intramuscular type-A botulin toxin in healthy humans. Neurol Sci 39, 329–332 (2018).

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