Botulinum toxin is usually injected into one or more muscles for its local effect. However, if the toxin is absorbed systemically there may be effects elsewhere, termed distant spread.

Patient selection: local intramuscular injection of botulinum toxin


Onset: anytime after the injection, including weeks later


Risk factors:

(1) child

(2) large doses of the botulinum toxin

(3) incorrect injection technique

(4) comorbid conditions predisposing to the symptoms


Symptoms may include:

(1) asthenia

(2) generalized muscle weakness

(3) diplopia

(4) ptosis

(5) dysphagia

(6) dysphonia

(7) dysarthria

(8) urinary incontinence

(9) difficulty breathing

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