Use of Botulinum Neurotoxin Injections to Treat Recurrent Shoulder Dislocations in a Patient with Severe Epilepsy

Abstract

The treatment of a shoulder dislocation sustained during an epileptic seizure can be a challenge to the orthopaedic surgeon. Severe drug-resistant epilepsy with multiple seizures may cause repeated dislocations of the shoulder, resulting in damage to the joint capsule and the glenoid. Any attempt at reconstructive surgery of the shoulder requires complete control of the seizures and prevention of dislocations for at least three months following the surgical procedure. We report our experience with one patient who had recurrent dislocations of the right shoulder due to uncontrollable seizures; we treated this patient with botulinum neurotoxin type A to prevent the dislocations. The patient was informed that data concerning her case would be submitted for publication, and she provided consent. The case report was approved by our institutional review board. A twenty-three-year-old woman had been diagnosed with acute intermittent porphyria and severe epilepsy at the age of fourteen. She had had repeated tonic-clonic seizures, which were unresponsive to therapy with multiple drugs (sodium valproate, carbamazepine, vigabatrin, sulthiame, clonazepam, levetiracetam, and topiramate). She had undergone implantation of a vagus nerve stimulator, which did not control the seizures but did shorten the postictal period. At the age of sixteen, the patient had sustained anterior glenohumeral dislocations of both shoulders during a seizure. By the time she was referred to our care at the age of nineteen, she had a chronic dislocation of the left shoulder and recurrent dislocations of the right shoulder. A computerized tomography (CT) examination of the right shoulder …