Related Experiment Video
Updated: Jan 17, 2026

Ultrasound-guided Botulinum Toxin-A Injections: A Method of Treating Sialorrhea
Published on: November 9, 2016
Botulinum Toxicity Managed With Pyridostigmine Following Botulinum Toxin Injections for Bilateral Neurogenic Thoracic
Brian Lee1, Jovan George1, Briana Novello1
1Albany Medical Center, Albany, NY.
Background:
Botulinum toxin injections have been increasingly used in the treatment of different painful conditions, including thoracic outlet syndrome (TOS). Guidelines to manage adverse effects or toxicity from botulinum toxin injections in these cases are not well established.
Case Report:
A female patient in her forties with bilateral arm pain secondary to bilateral neurogenic TOS (NTOS) presented to the pain clinic for botulinum toxin injections to the scalene muscles. Several hours after receiving the injections, the patient experienced dysphagia, hoarseness, and facial paresthesia suspicious for botulinum toxicity. She was administered pyridostigmine for symptom management and for approximately one month until symptom resolution.
Conclusions:
To our knowledge, this is the first case report to discuss the presentation of botulinum toxicity and its management following botulinum toxin injections for pain relief in bilateral NTOS. Botulinum toxicity may be managed with pyridostigmine with some benefit, but further research is needed to establish guidelines.
Related Concept Videos
Directly Acting Muscle Relaxants: Dantrolene and Botulinum Toxin
The binding of dantrolene to the RYR1...
Anticholinesterase Agents: Poisoning and Treatment
Irreversible agents form a strong bond with the cholinesterase enzyme, making it inactive. The breakdown of the phosphorylated enzyme is...
Skeletal Muscle Relaxants: Therapeutic Uses
Myasthenia Gravis: Overview and Treatment
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
Depolarizing Blockers: Pharmocokinetics
Prevention of Further Absorption of Poison

