Botulism after intragastric botulinum toxin injections for weight reduction.
botulinum toxins
botulism
medical tourism
obesity
Journal
European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311
Informations de publication
Date de publication:
12 2023
12 2023
Historique:
revised:
26
07
2023
received:
25
05
2023
accepted:
10
08
2023
medline:
10
11
2023
pubmed:
16
8
2023
entrez:
16
8
2023
Statut:
ppublish
Résumé
Although-considering the risk-benefit ratio-botulinum neurotoxin A (BoNT/A) is unequivocally recommended to treat severe neurological diseases such as dystonia, this has not yet been determined for its endoscopic intragastric injection aimed at weight reduction in obesity. However, severe adverse effects of intragastric BoNT/A had not yet been reported, prompting some European countries to endorse its (off-label) use and treat patients transnationally. We here present three cases of botulism after intragastric BoNT/A injections for obesity treatment in a Turkish hospital. Patients presented with cranial nerve affection, bulbar symptoms, and descending paresis, and benefited from treatment with BoNT antitoxin and pyridostigmine. We assume that iatrogenic botulism was induced by overdosing in combination with toxin spread via the highly vascularized gastric tissue. Of note, within a few weeks, more than 80 cases of iatrogenic botulism were reported across Europe after identical intragastric BoNT/A injections. These cases demonstrate the risks of BoNT/A injections if they are not applied within the limits of evidence-based medicine. There is a need for international guidelines to define the indication and a safe dosing scheme, especially in the context of medical tourism.
Substances chimiques
Botulinum Toxins, Type A
EC 3.4.24.69
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
3979-3981Informations de copyright
© 2023 European Academy of Neurology.
Références
Yen YA, Wang CC, Sung WW, et al. Intragastric injection of botulinum toxin a for weight loss: a systematic review and meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2022;37(6):983-992. doi:10.1111/jgh.15847
Anandan C, Jankovic J. Botulinum Toxin in Movement Disorders: An Update. Toxins. 2021;13(1):42. doi:10.3390/toxins13010042
Fung HT, Chan KM, Lam SKT. A review on iatrogenic botulism. Hong Kong J Emerg Med. 2020;27(6):356-367. doi:10.1177/1024907920934901
Pfausler B. DGN Guideline Botulism.
Dorner MB, Wilking H, Skiba M, et al. A large travel-associated outbreak of iatrogenic botulism in four European countries following intragastric botulinum neurotoxin injections for weight reduction, Türkiye, February to march 2023. Eurosurveillance. 2023;28(23):2300203. doi:10.2807/1560-7917.ES.2023.28.23.2300203