Breaking News
August 19, 2018 - Bifidobacteria supplement colonizes gut of breastfed infants
August 19, 2018 - Why patients with Alzheimer’s markers never develop the condition
August 19, 2018 - ACA’s Medicaid expansion associated with increase in prescriptions for opioid use disorder treatment
August 19, 2018 - Important factor may be missing in models used to predict spread of epidemics from climate change
August 19, 2018 - Indian-Americans have fewer sudden infant deaths, study finds
August 19, 2018 - Experts advise against universal genomic screening of newborns
August 19, 2018 - New trial to investigate whether weight loss before conception can make mom and baby healthier
August 19, 2018 - Sun Pharma Announces FDA Approval of Cequa (cyclosporine) Ophthalmic Solution to Treat Dry Eye Disease
August 19, 2018 - Researchers examining Parkinson’s resilience
August 19, 2018 - Researchers find mechanism that prepares brain to replicate repeated actions
August 19, 2018 - Those who are emotionally stable when young may remain the most stable as they age
August 19, 2018 - URI professor develops simpler and quicker method for detecting impurity in heparin
August 19, 2018 - Mayo Medical Laboratories and NDSC collaborate to develop new patient blood-management solution
August 19, 2018 - Insight into endocrine cancers and treatment options
August 19, 2018 - HPV Legislation Doesn’t Impact Teen Sexual Behaviors
August 19, 2018 - Exenatide treatment alleviated symptoms of depression in patients
August 19, 2018 - Tufts researchers win grant to study integration of genomic sequencing into neonatal care
August 19, 2018 - Novel finger-prick test can help prevent toxoplasmosis
August 19, 2018 - Cosmetic Procedures Boost Well-Being, Poll Shows
August 19, 2018 - Responsive parenting intervention results in lower BMIs through age three
August 19, 2018 - Anticancer drugs can help plants to battle infection
August 19, 2018 - Sunscreen from bathers releases significant quantities of polluting titanium dioxide into the sea
August 19, 2018 - Case Western Reserve gets three-year grant to enhance food systems in Cleveland neighborhoods
August 19, 2018 - Teenagers can thank their parents’ positive attitude for avoiding obesity
August 19, 2018 - Body mass index positively linked with blood pressure
August 19, 2018 - New tool fills gap in Small Molecules market
August 19, 2018 - Study compares survival outcomes in rural and urban cancer patients enrolled in clinical trials
August 19, 2018 - Researchers develop molecular matrix that delivers healing stem cells to injured elderly muscles
August 19, 2018 - Teva and Regeneron Announce Positive Topline Phase 3 Fasinumab Results in Patients with Chronic Pain from Osteoarthritis of the Knee or Hip
August 19, 2018 - New study pinpoints ways to improve quality of food and nutrition research
August 19, 2018 - Ology Bioservices wins $8.4 million worth agreement to manufacture anti-Ebola monoclonal antibody
August 19, 2018 - New CRISPR technology may help eliminate mutated gene sequence
August 19, 2018 - “Zombie gene” protects elephants from cancer finds study
August 19, 2018 - Study explores how many American cities protect the rights of employed breastfeeding mothers
August 19, 2018 - FDA Approves Lenvima (lenvatinib) for First-line Treatment of Unresectable Hepatocellular Carcinoma (HCC)
August 19, 2018 - Pain: Considering Complementary Approaches (eBook)
August 19, 2018 - Autoimmune response drives vision loss in glaucoma
August 19, 2018 - Tandem Diabetes Care introduces t:slim X2 Insulin Pump with Basal-IQ Technology in the US
August 19, 2018 - Innovative platform developed to destroy cancer cells
August 19, 2018 - Lowering pH inside tumor cells can slow down spread of cancer
August 19, 2018 - Biomarker predicts kidney cancer risk years before diagnosis
August 19, 2018 - Consequences of healthcare-associated infections go beyond patients’ physical health
August 19, 2018 - New drug- free, nanotechnology-based method detects and treats oral plaque
August 19, 2018 - Integration of Opioid, Infectious Disease Treatment Needed
August 19, 2018 - How eye disorders may have influenced the work of famous painters
August 18, 2018 - Blood biomarker could help predict kidney cancer up to five years prior to diagnosis
August 18, 2018 - Dartmouth scientists create more sustainable feed for aquaculture
August 18, 2018 - Immigrants Not a Burden on U.S. Health Care: Study
August 18, 2018 - Women who eat fast food take longer to become pregnant
August 18, 2018 - Most YouTube videos on plastic surgery are misleading marketing campaigns
August 18, 2018 - The essential guide to make your laboratory more sustainable
August 18, 2018 - Loyola Medicine offers scalp cooling treatment to reduce risk of chemotherapy hair loss
August 18, 2018 - Researchers describe promising strategy to remove melanoma’s most powerful defenses
August 18, 2018 - Women with polycystic ovary syndrome dissatisfied with medical care
August 18, 2018 - Research discoveries reveal insights behind neurological degeneration
August 18, 2018 - Researchers win multi-million Euro award to conduct research into liver disease
August 18, 2018 - Survey highlights variations in practice of airway management in pediatric intensive care units
August 18, 2018 - UK students win sponsorship from Promega Corporation
August 18, 2018 - Janssen Reports Positive Topline Results for ATLAS Phase III Study of a Novel, Long Acting Injectable Two-Drug Regimen for the treatment of HIV-1
August 18, 2018 - PSD as a molecular platform for understanding synapse formation and plasticity
August 18, 2018 - Improved visual communication could help patients to make informed health-care decisions
August 18, 2018 - New algorithm helps identify and manage diabetic patients at increased fracture risk
August 18, 2018 - Microscopic insect odour detecting mechanisms discovered
August 18, 2018 - Researchers develop new approach to study how tuberculosis infects people
August 18, 2018 - FDA Approves Kalydeco (ivacaftor) for Cystic Fibrosis in Children Ages 12 to
August 18, 2018 - An ion channel differentiates newborn and mature neurons in the adult brain
August 18, 2018 - Conditions of first sexual encounter can be indicators of future HIV risk and gender-based violence
August 18, 2018 - Socio-economic position associated with pregnant women’s exposure to environmental hazards
August 18, 2018 - Study evaluates how students change their breakfast consumption when given extra time
August 18, 2018 - Chronic perinatal hypoxia linked to locomotor miscoordination, long-term cerebellar learning deficits
August 18, 2018 - Voters to settle dispute over ambulance employee break times
August 18, 2018 - AGA urges policymakers and stakeholders to improve affordability of drugs
August 18, 2018 - Increasing dietary protein may lower risk of diabetes in people with NAFLD
August 18, 2018 - New HIV therapy suppresses viral replication and increases immune cells in drug-resistant patients
August 18, 2018 - Broad Genetic Testing for NSCLC May Not Improve Survival
August 18, 2018 - Discovery opens door for synthetic opioids with less addictive qualities
August 18, 2018 - Transgenic rice plant extracts could help stop the spread of HIV
August 18, 2018 - Hologic’s Cynosure division partners with Porter Instrument to distribute nitrous oxide and oxygen system
August 18, 2018 - Two thyroid medications recalled by FDA
August 18, 2018 - Forecast Sees Abnormal Heat Worldwide Through 2022
Physicians use pyridostigmine to reverse pediatric complications from botulinum toxin therapy

Physicians use pyridostigmine to reverse pediatric complications from botulinum toxin therapy

image_pdfDownload PDFimage_print

Physicians at the Medical University of South Carolina (MUSC) report the first pediatric use of a treatment to reverse complications from botulinum toxin therapy. Complications from botox treatment of muscle disorders were reversed when caught early, according to the findings of a study published online ahead of print by The Journal of Pediatrics on December 22, 2017.

In the study, physicians used a drug called pyridostigmine to treat one pediatric patient experiencing immediate complications from botulinum toxin therapy and another with delayed complications in distant muscles. In both cases, physicians recognized complications early and treated patients with the maximum dose of pyridostigmine appropriate for their weight.

Botolinum toxin is not just a cosmetic treatment for wrinkles. It blocks the nerves that control muscle tone, causing muscles to relax, making it a useful tool for neurologists and otolaryngologists who treat a group of nerve disorders called dystonias — problems with muscle tone — that affect the head and neck. For example, it can reduce hypersalivation, spasms in the larynx and the muscle spasms of cerebral palsy.

Yet rare but serious complications to botulinum toxin treatment can occur. When botulinum toxin is injected into a muscle, it can sometimes travel backward up nerves and cause unintended paralysis of nearby or distant muscles. In those cases, a drug called pyridostigmine can reverse the paralysis by encouraging muscles to contract.

The official antidote to botulinum toxin is difficult to procure quickly and takes several days to work, while pyridostigmine begins to relieve symptoms within hours. Early treatment is critical for patients who experience complications from botulinum toxin therapy, because symptoms can progress to difficulty swallowing or breathing, according to Lucinda A. Halstead, M.D., an associate professor in the MUSC Department of Otolaryngology and senior author on the study.

“We see a profound effect in people who can’t swallow. We give pyridostigmine and the effect is within hours,” said Halstead. “Patients are eating again within days.”

In the first case, physicians treated a one-year-old female patient having difficulty swallowing. The patient had a history of aspiration pneumonia, wherein food or saliva is inhaled into the lungs rather than passing into the esophagus, and she was dependent on a gastrostomy tube implanted in her abdomen for nutrition. During swallowing, one set of muscles called the pharyngeal constrictors must contract to push food toward the esophagus while another muscle called the cricopharyngeus must simultaneously relax for food to pass into the esophagus. Physicians observed a poorly relaxing cricopharyngeus and injected the muscle with botulinum toxin to force it to relax so the patient could keep food down.

The next day, however, the patient was admitted to the hospital with choking, vomiting and difficulty breathing. A swallow study revealed that her cricopharyngeus had indeed relaxed, as intended, but that the pharyngeal constrictors that must contract to push food toward the esophagus had also relaxed. As a result, she was nearly unable to swallow.

The patient was given pyridostigmine through her gastrostomy tube to oppose the effects of botulinum toxin, with the idea that the toxin had spread unintentionally to her neighboring pharyngeal constrictors, causing them to relax. Two days later, the patient was breathing normally, and she was released on day thirteen after admission. One month later, she had no signs of aspiration and continued to improve. Her gastrostomy tube was removed six months later.

In the second case, an eight year-old female patient was given an injection of botulinum toxin into her salivary glands to treat excessive salivation. She had displayed an excellent response to the same treatment six months earlier. Seven days after the injection, however, she returned to the hospital, unable to eat or drink without choking. A swallow study showed that her pharynx was not completely clearing itself of food during swallowing. The patient was given oral pyridostigmine and began to rapidly improve. Within a week, she was eating normally again.

This is the first report of physicians treating complications from botulinum toxin therapy with pyridostigmine in pediatric patients. Pyridostigmine is a widely available medication for myasthenia gravis, a disorder that causes muscle weakness. It is safe, but it can cause slowing heart rate in patients with a history of heart problems. It is not an antidote to botulinum toxin, but it does oppose its effects by preventing the breakdown of acetylcholine, which is needed for muscle contraction. In both patients, the drug was given in doses similar to those used to treat myasthenia gravis.

This study emphasizes the need for physicians to be alert to complications from botulinum toxin therapy in children and adults, recognizing that such problems might not arise immediately and can appear in muscles distant from the injection site. This recognition is critical in patients who have difficulty swallowing or breathing.

“When a patient has had too much botulinum toxin, there is a point when symptom management strategies are no longer beneficial to the patient,” said Halstead. “Pyridostigmine is an active intervention to modulate the effects of botulinum toxin therapy.”

Tagged with:

About author

Related Articles