Le 02/12/2022 de 08:00 à 09:30
Le "pseudobotulisme" se scinderait-il en deux syndromes distincts ? Première description des syndromes après injection de toxine botulinique chez des patients avec pathologie neurologique centrale.
Celine Karabulut (Garches, France), Simona FICARRA (Garches, France), Marie-Christine DURAND (Garches, France), Thibaud LANSAMAN (Garches, France), Caroline HUGERON (Garches, France), Pierre DENYS (Garches, France), Djamel BENSMAÏL (Garches, France), Jonathan LEVY (Garches, France), Charles JOUSSAIN (Garches, France)
Objective : Botulism-like symptoms can occur after intra-muscular botulinum toxin A injections (BTI), to treat spasticity or neurogenic detrusor overactivity (NDO). The aim of this study was to characterize clinical syndromes that encompass these symptoms and define pseudobotulism (PB).
Material / Patients and Methods : This monocentric retrospective study collected data from medical records of neurological patients treated for spasticity and/or NDO with BTI and with evocative symptoms of PB who underwent an ENMG between 2005 and 2020. Symptoms, reported in at least 10% of cases, were included in a principal component analysis (PCA) to define syndromes. Spearman coefficients were calculated to assess correlations between syndrome(s) and qualitative variables. Odds ratios (OR) were calculated, with Miettinen method considering only variables with moderate correlation.
Results : Fifty-eight patients were included. The PCA highlighted two types of PB: type 1, “severe form” characterized by ear-nose-throat symptoms, ocular symptoms, sane limb weakness, and respiratory failure; type 2, “functional form” characterized by falls, degradation of transfers and distant limb weakness. Type 1 was correlated with simultaneous multiple muscles injections (r=0,56; p<0,01), high doses (r=0,54; p<0,01), pathological ENMG (r=0,31; p=0.02) and hospitalizations (r=0,30; p=0.02). Type 2 was inversely correlated to the number of BTI sessions, total dose, and correlated to detrusor injection (r=0,46; p<0,01). The risk of developing a severe form with high doses (>300U OnabotulinumtoxinA equivalent) was OR=11 (IC 95% [2,68-45.11]) and 23.29 (IC 95% [4.47-121.37]) with simultaneous multiple muscles injections.
Discussion - Conclusion : Pseudobotulism could be considered as two defined syndromes based on severity, appearing dose dependant and related to multiple muscles injections, and functional impact.
Keywords : Pseudobotulism, pseudobolism syndromes, botulinum toxin injection, central nervous system disorders