Summary
A case of complete bilateral internal ophthalmoplegia as the sole clinical sign of botulism is reported. Diagnosis was immediately confirmed by single-fibre electromyography (SFEMG), which revealed abnormally high blocking (14.3%), contrasting with moderately increased jitter (mean consecutive difference in the extensor digitorum communis muscle, 43.9 μs). After giving equine botulinum antitoxin and simultaneous forced emptying of the bowels, ocular symptoms completely disappeared within 2 days. Six days, 5 weeks and 6 months after the first SFEMG study, the jitter was still abnormal, even becoming more so with time. Blocking, however, was only rarely observed in the follow-up studies. It is concluded that SFEMG may serve as a useful and sensitive method for the rapid diagnosis of botulinum intoxication, even in cases where no clinical signs of general muscular weakness are apparent.
References
Cruz Martinez A, Anciones B, Ferrer MT, Diez Tejedor E, Perer Conde MC, Bescansa E (1985) Electrophysiologic study in benign human botulism type B. Muscle Nerve 8:580–585
Duchen LW, Strich SJ (1968) The effects of botulinum toxin on the pattern of innervation of skeletal muscle in the mouse. Q J Exp Physiol 53:84–89
Girlanda P, Dattola R, Messina C (1983) Single fibre EMG in 6 cases of botulism. Acta Neurol Scand 67:118–123
Sanders DB, Massey EW, Buckley EG (1986) Botulism toxin for blepharospasm: single-fiber EMG studies. Neurology 36:545–547
Schiller HH, Stålberg E (1978) Human botulism studied with single-fiber electromyography. Arch Neurol 35:346–349
Stålberg E, Trontelj JV (1979) Single fibre electromyography. Miravalle Press, Old Working
Stålberg E, Chu J, Bril V, Nandekar S, Stålberg S, Ericsson M (1983) Automatic analysis of the EMG interference pattern. Electroencephalogr Clin Neurophysiol 56:672–681
Vita G, Girlanda P, Puglisi RM, Marabello L, Messina C (1987) Cardiovascular-reflex testing and single-fiber electromyography in botulism. Arch Neurol 44:202–206
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Ehrenreich, H., Garner, C.G. & Witt, T.N. Complete bilateral internal ophthalmoplegia as sole clinical sign of botulism: confirmation of diagnosis by single fibre electromyography. J Neurol 236, 243–245 (1989). https://doi.org/10.1007/BF00314507
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DOI: https://doi.org/10.1007/BF00314507