Flu-Like and Systemic Symptoms Following Treatment with Botulinum Toxins (P01.230)

Abstract

Objective: We aimed to assess the frequency of systemic and flu-like symptoms (FLS) in consecutive patients undergoing botulinum toxin (BoNT) treatment. Background FLS have been reported to occur in 2-55% of patients after injections with different preparations of BoNT (Baizabal-Carvallo et al. Toxicon 2011;58:1-7). Design/Methods: Retrospective study using a detailed questionnaire and structured interview. Results: A total of 218 patients, 72.5% women, mean age 61.2 ± 13.3 years, with cervical dystonia (n=82, 37.3%), blepharospasm (n=32, 14.5%), craniocervical dystonia (n=32, 14.5%), and hemifacial spasm (n=21, 9.5%), were enrolled in the study. Most patients were receiving BoNT type A: n=212 (97.2%): onabotulinumtoxinA: n=184 (83.6%); abobotulinumtoxinA: n=11, (5%); incobotulinumtoxinA: n=17 (7.7%); and BoNT type B (rimabotulinumtoxinB) n=6 (2.8 %). The most frequently reported systemic adverse effects were: generalized fatigue: n=38 (17.4%); headache: n=34 (15.6%); muscle aches: n=29 (13.3%); and generalized weakness: n=27 (12.4%); FLS were reported by 20 (9.2%) patients, and at least one symptom was reported by 82 patients (37.6%). Some symptoms were more frequently reported by women, including headache (P=0.008), fatigue (P=0.029), nausea (P= 0.010), and FLS (P=0.066). Twenty six patients (11.9%) took over the counter medications to control the symptoms; 7.8% reported interference with activities of daily living; and 3.7% consulted a physician because of the symptoms. No differences in age, type or dosage of BoNT were observed among patients with or without systemic symptoms. Conclusions: FLS were reported by 9.2% patients receiving BoNT and more than a third had at least one systemic complaint following BoNT treatment. Women seem to have a higher risk for the development of these systemic side effects than men. We are collecting additional data and serological inflammatory markers in order to better understand the potential risk factors and mechanisms of these systemic BoNT-related side effects. Disclosure: Dr. Baizabal Carvallo has nothing to disclose. Dr. Jankovic has received personal compensation for activities with Allergan, Inc., Chelsea Therapeutics, Serono Inc., Merz Pharma, Lundbeck Research USA, Inc, Teva Neuroscience as a consultant. Dr. Jankovic has received personal compensation in an editorial capacity for Medlink: Neurology in Clinical Practice. Dr. Jankovic has received research support from Allergan, Inc, Allon Therapeutics, Ceregene, Inc., Chelsea Therapeutics; Diana Helis Henry Medical Research Foundation, Serono Inc., Huntington9s Disease Society of America, Huntington Study Group, Impax Pharmaceuticals, Ipsen Limited, Lundbeck Research USA, Inc.