Safe administration of botulinum neurotoxin type A for facial nerve palsy sequelae in a patient with myasthenia gravis.
Keishi Fujiwara, Shinya Morita, Kimiko Hoshino et al.
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Case in brief
A woman in her 40s with a 10-year history of generalized, seronegative myasthenia gravis presented with facial tightness and mild synkinesis due to facial nerve palsy sequelae. Despite the contraindication of botulinum neurotoxin type A (BoNT-A) in MG patients, off-label use was approved with a reduced dose of 3 units. The patient showed no adverse effects and experienced significant improvement in facial function and psychological well-being at 2 months post-injection.
What made this case unusual
The case highlights the successful off-label use of BoNT-A in a myasthenia gravis patient, which is typically contraindicated due to the risk of exacerbating neuromuscular blockade.
Diagnostic / clinical pearl
Clinicians should consider the potential for safe, low-dose botulinum neurotoxin type A administration in myasthenia gravis patients under strict risk management protocols.
Why it matters
This case provides insights into managing facial nerve palsy sequelae in patients with myasthenia gravis, emphasizing the importance of individualized treatment strategies.