Intragastric botulismus toxin-A (BoNT-A) is one of
the new approaches in the treatment of obesity. We aimed to contribute to the
literature by presenting the clinical features, laboratory findings and
treatment responses of iatrogenic botulism cases due to intragastric BoNT-A
administered in our clinic. All detailed medical information was obtained by
accessing the medical records of the patients who were hospitalized and
followed up and treated between September 2022 and December 2022, and the
diagnosis of A.05.1 Botulism was entered according to ICD-10, and whose
clinical findings were compatible with botulism disease and who underwent
intragastric BoNT-A application beforehand. These records were obtained by
examining this information. 10 patients who developed botulism after intragastric
BoNT-A application between 01/09/2022 and 28/02/2023 were followed up in our
clinic. All of the patients were women. The mean age was 35. The mean hospital
stay was 9 days. Only 1 of our cases required intensive care. Good response to
treatment was accepted as a complete or near-complete improvement in the
clinical findings of the patients and all of them had a good response to
treatment. Intragastric BoNT-A administration is a procedure that requires
careful indication with a profit/loss calculation considering the potential
side effects. In addition, attention should be paid to dilution rates and dose
amounts.
References
[1]
Torralvo, F.J.S., Pedreño, L.V., Marín, M.G., et al. (2021) Endoscopic Intragastric Injection of Botulinum Toxin a in Obese Patients on Bariatric Surgery Waiting Lists: A Randomised Double-Blind Study (IntraTox Study). Clinical Nutrition, 40, 1834-1842. https://doi.org/10.1016/j.clnu.2020.10.008
[2]
ASGE Bariatric Endoscopy Task Force and ASGE Technology Committee, Abu Dayyeh, B.K., Edmundowicz, S.A., Jonnalagadda, S., et al. (2015) Endoscopic Bariatric Therapies. Gastrointestinal Endoscopy, 81, 1073-1086.
https://doi.org/10.1016/j.gie.2015.02.023
[3]
Elder, K.A. and Wolfe, B.M. (2007) Bariatric Surgery: A Review of Procedures and Outcomes. Gastroenterology, 132, 2253-2271.
https://doi.org/10.1053/j.gastro.2007.03.057
[4]
Zargaran, D., Zoller, F., Zargaran, A., et al. (2022) Complications of Cosmetic Botulinum Toxin a Injections to the Upper Face: A Systematic Review and Meta-Analysis. Aesthetic Surgery Journal, 42, 327-336.
https://doi.org/10.1093/asj/sjac036
[5]
Boon Harold Tan, K. (2007) Aesthetic Medicine: A Health Regulator’s Perspective. Clinical Governance: An International Journal, 12, 13-25.
https://doi.org/10.1108/14777270710725364
[6]
Li, Y., Liu, T. and Luo, W. (2021) Botulinum Neurotoxin Therapy for Depression: Therapeutic Mechanisms and Future Perspective. Frontiers in Psychiatry, 12, Article 584416. https://doi.org/10.3389/fpsyt.2021.584416
[7]
Chiu, S.Y., Burns, M.R. and Malaty, I.A. (2021) An Update on Botulinum Toxin in Neurology. Neurologic Clinics, 39, 209-229.
https://doi.org/10.1016/j.ncl.2020.09.014
[8]
Dressler, D. (2021) Clinical Pharmacology of Botulinum Toxin Drugs. In: Whitcup, S.M. and Hallett, M., Eds., Botulinum Toxin Therapy, Springer, Cham, 93-106.
https://doi.org/10.1007/164_2019_273
[9]
Finucane, M.M., Stevens, G.A., Cowan, M.J., et al. (2011) National, Regional, and Global Trends in Body-Mass Index Since 1980: Systematic Analysis of Health Examination Surveys and Epidemiological Studies with 960 Country-Years and 9•1 Million Participants. The Lancet, 377, 557-567.
https://doi.org/10.1016/S0140-6736(10)62037-5
[10]
Rollnik, J.D., Meier, P.N., Manns, M.P. and Göke, M. (2003) Antral Injections of Botulinum a Toxin for the Treatment of Obesity. Annals of Internal Medicine, 138, 359-360. https://doi.org/10.7326/0003-4819-138-4-200302180-00026
[11]
Foschi, D., Lazzaroni, M., Sangaletti, O., Corsi, F., Trabucchi, E. and Bianchi Porro, G. (2008) Effects of Intramural Administration of Botulinum Toxin a on Gastric Emptying and Eating Capacity in Obese Patients. Digestive and Liver Disease, 40, 667-672. https://doi.org/10.1016/j.dld.2008.02.040
[12]
Topazian, M., Camilleri, M., Enders, F.T., et al. (2013) Gastric Antral Injections of Botulinum Toxin Delay Gastric Emptying But Do Not Reduce Body Weight. Clinical Gastroenterology and Hepatology, 11, 145-150.
https://doi.org/10.1016/j.cgh.2012.09.029
[13]
Bang, C.S., Baik, G.H., Shin, I.S., et al. (2015) Effect of Intragastric Injection of Botulinum Toxin a for the Treatment of Obesity: A Meta-Analysis and Meta-Regression. Gastrointestinal Endoscopy, 81, 1141-1149.
https://doi.org/10.1016/j.gie.2014.12.025
[14]
Bustamante, F., Brunaldi, V.O., Bernardo, W.M., et al. (2017) Obesity Treatment with Botulinum Toxin-A Is Not Effective: A Systematic Review and Meta-Analysis. Obesity Surgery, 27, 2716-2723. https://doi.org/10.1007/s11695-017-2857-5
[15]
De Moura, E.G.H., Ribeiro, I.B., Frazão, M.S.V., et al. (2019) EUS-Guided Intragastric Injection of Botulinum Toxin a in the Preoperative Treatment of Super-Obese Patients: A Randomized Clinical Trial. Obesity Surgery, 29, 32-39.
https://doi.org/10.1007/s11695-018-3470-y
[16]
Wolfe, B.M., Kvach, E. and Eckel, R.H. (2016) Treatment of Obesity: Weight Loss and Bariatric Surgery. Circulation Research, 118, 1844-1855.
https://doi.org/10.1161/CIRCRESAHA.116.307591
[17]
Simpson, S.A., Shaw, C. and McNamara, R. (2011) What Is the Most Effective Way to Maintain Weight Loss in Adults? BMJ, 343, d8042.
https://doi.org/10.1136/bmj.d8042
[18]
Michael Cherington, M. (2004) Botulism: Update and Review. Seminars in Neurology, 24, 155-163. https://doi.org/10.1055/s-2004-830901
[19]
Zong, C., Chen, Z.Y., Liu, W.H. and Li, G.S. (2021) Botulism Due to Cosmetic Injection of Botulinum Toxin: Five-Year Experience. Plastic and Reconstructive Surgery, 148, 335e-337e. https://doi.org/10.1097/PRS.0000000000008173
[20]
Ghasemi, M., Norouzi, R., Salari, M. and Asadi, B. (2012) Iatrogenic Botulism after the Therapeutic Use of Botulinum Toxin-A: A Case Report and Review of the Literature. Clinical Neuropharmacology, 35, 254-257.
https://doi.org/10.1097/WNF.0b013e31826248b8
[21]
Coban, A., Matur, Z., Hanagasi, H.A. and Parman, Y. (2010) Iatrogenic Botulism after Botulinum Toxin Type A Injections. Clinical Neuropharmacology, 33, 158-160.
https://doi.org/10.1097/WNF.0b013e3181d479e0
[22]
Crowner, B.E., Torres-Russotto, D., Carter, A.R. and Racette, B.A. (2010) Systemic Weakness after Therapeutic Injections of Botulinum Toxin A: A Case Series and Review of the Literature. Clinical Neuropharmacology, 33, 243-247.
https://doi.org/10.1097/WNF.0b013e3181f5329e
[23]
Varghese-Kroll, E. and Elovic, E.P. (2009) Contralateral Weakness and Fatigue after High-Dose Botulinum Toxin Injection for Management of Poststroke Spasticity. American Journal of Physical Medicine & Rehabilitation, 88, 495-499.
https://doi.org/10.1097/PHM.0b013e3181a5b056
[24]
Howell, K., Selber, P., Graham, H.K. and Reddihough, D. (2007) Botulinum Neurotoxin A: An Unusual Systemic Effect. Journal of Paediatrics and Child Health, 43, 499-501. https://doi.org/10.1111/j.1440-1754.2007.01122.x
[25]
Elder, K.A. and Wolfe, B.M. (2007) Bariatric Surgery: A Review of Procedures and Outcomes. Gastroenterology, 132, 2253-2271.
https://doi.org/10.1053/j.gastro.2007.03.057
[26]
Shapiro, R.L., Hatheway, C. and Swerdlow, D.L. (1998) Botulism in the United States: A Clinical and Epidemiologic Review. Annals of Internal Medicine, 129, 221-228. https://doi.org/10.7326/0003-4819-129-3-199808010-00011
[27]
García-Compean, D. and Maldonado Garza, H. (2008) Intragastric Injection of Botulinum Toxin for the Treatment of Obesity. Where Are We? World Journal of Gastroenterology, 14, 1805-1809. https://doi.org/10.3748/wjg.14.1805
[28]
Topazian, M., Camilleri, M., De La Mora-Levy, J., et al. (2008) Endoscopic Ultrasound-Guided Gastric Botulinum Toxin Injections in Obese Subjects: A Pilot Study. Obesity Surgery, 18, 401-407. https://doi.org/10.1007/s11695-008-9442-x
[29]
Bustamante, F., Ottoboni Brunaldi, V., Bernardo, W.M., et al. (2017) Obesity Treatment with Botulinum Toxin-A Is Not Effective: A Systematic Review and Meta-Analysis. Obesity Surgery, 27, 2716-2723.
https://doi.org/10.1007/s11695-017-2857-5
[30]
Gui, D., Migrone, G. and Valenza, V. (2006) Effect of Botulinum Toxin Antral Injection on Gastric Emptying and Weight Reduction in Obese Patients: A Pilot Study. Alimentary Pharmacology & Therapeutics, 23, 675-680.
https://doi.org/10.1111/j.1365-2036.2006.02773.x
[31]
Tacket, C.O., Shandera, W.X. and Mann, J.M. (1984) Equine Antitoxin Use and Other Factors That Predict Outcome in Type A Foodborne Botulism. The American Journal of Medicine, 76, 794-798. https://doi.org/10.1016/0002-9343(84)90988-4
[32]
Chang, G.Y. and Ganguly, G. (2003) Early Antitoxin Treatment in Wound Botulism Results in Better Outcome. European Neurology, 49, 151-153.
https://doi.org/10.1159/000069073
[33]
Sandrock, C.E. and Murin, S. (2001) Clinical Predictors of Respiratory Failure and Long-Term Outcome in Black Tar Heroin-Associated Wound Botulism. Chest, 120, 562-566. https://doi.org/10.1378/chest.120.2.562
[34]
Coban, A., Matur, Z., Hanagasi, H.A. and Parman, Y. (2010) Iatrogenic Botulism after Botulinum Toxin Type A Injections. Clinical Neuropharmacology, 33, 158-160.
https://doi.org/10.1097/WNF.0b013e3181d479e0
[35]
Garner, C.G., Straube, A., Witt, T.N., Gasser, T. and Oertel, W.H. (1993) Time Course of Distant Effects of Local Injections of Botulinum Toxin. Movement Disorders, 8, 33-37. https://doi.org/10.1002/mds.870080106
[36]
Coté, T.R., Mohan, A.K., Polder, J.A., Walton, M.K. and Braun, M.M. (2015) Botulinum Toxin Type A Injections: Adverse Events Reported to the US Food and Drug Administration in Therapeutic and Cosmetic Cases. Journal of the American Academy of Dermatology, 53, 407-415. https://doi.org/10.1016/j.jaad.2005.06.011
