Physicians at the Medical University of South Carolina ( MUSC ) report the first pediatric use of a treatment for complications from botulinum toxin therapy . According to the findings of a study published in The Journal of Pediatrics , disorders from botox treatment of muscle disorders were reversed when caught early.

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 affects the head and neck. 

The official antidote to botulinum toxin is difficult to procure quickly and takes several days to work, while pyridostigmine begins to highlight symptoms within hours. Early treatment is critical for patients who suffer from the disease, according to Lucinda A. Halstead senior author on the study.

In the first case, physicians treated to one-year-old female patient having difficulty swallowing. The patient had a history of aspiration pneumonia, which was inhaled into the lungs rather than passing into the esophagus, and she was dependent on a gastrostomy tube implanted in her abdomen for nutrition.

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 towards the esophagus had also relaxed. As a result, it was nearly unable to swallow.

The patient was given pyridostigmine through her gastrostomy 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. 

In the second case, an eight year old patient was given an injection of botulinum toxin into her salivary glands to treat excessive salivation. She had shown 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. 

This is the first report of physicians treating complications from botulinum toxin therapy with pyridostigmine in pediatric patients. Pyridostigmine 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. 

This study emphasizes the need for physicians to be alert to complications from botulinum toxin therapy in children and adults, Recognizing That Might Such problems can not Arise and Immediately Appear in muscles distant from the injection site. This recognition is critical in patients who have difficulty swallowing or breathing .