Internationale Zeitschrift für Physikalische Medizin und Rehabilitation
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Exercise Induced Spread of Neurotoxin Following Chemodenervation of Neck Muscles: Report of Four Cases

Ib R. Odderson*, James J. Ying

This is the first study to report that exercise is a risk factor for spread of neurotoxin after cervical chemodenervation. While exercise after limb muscle injection is known to enhance the effects; the effects of exercise following cervical chemodenervation are unknown. We report a case series where exercise following cervical chemodenervation was associated with adverse events or no benefits. The dose ranged from 70-175 units of onabotulinumtoxin A and all injections were performed under EMG guidance. Exercise after chemodenervation was in the form of manual labor such as printing of logos, painting, lifting and cleaning. The events ranged from dysphagia, dysarthria, blurred vision, muscle weakness, heavy head, and numbness, to no benefits. In conclusion, chemodenervation of neck muscles followed by exercise can exacerbate the spread of neurotoxin, limit the therapeutic effect, and cause adverse events.