Editöre Mektup / Letter to the Editor DOI:10.4274/tnd.2022.00525 Botulism Presented with Clinical Head Drop, Approach to Botulinium Toxin A, A Case Report Klinik Olarak Kafa Düşmesi ile Prezente Olan Botulism Vakası, Botulinium Toxin A’ya Yaklaşım, Vaka Raporu Short title: Botulism Presented with Clinical Head Drop Kemal İzzettin Barkut, Hülya Olgun, Seda Koşan Taksim Education and Research Hospital, Clinic of Neurology, Istanbul Turkey Corresponding Author Information Kemal İzzettin Barkut kbarkut@gmail.com +90 212 909 500 https://orcid.org/0000-0002-4243-6422 15.06.2022 14.10.2022 18.10.2022 Keywords: Botulinium toxin, BoNT, Adverse event, Electrodiagnosis, Head drop Anahtar Kelimeler: Botulinium toksini, BoNT, Advers olay, Elektrodiagnoz, Baş düşmesi Dear editor, Botulinum toxin (BoNT) is a proteinaceous exotoxin. Of all biotoxins, BoNT has the greatest neurotoxic potential. BoNTis a strong, fatal, and irreversible neurotoxic; if administered incorrectly, it can cause in botulism. BoNT-A has stability since it is the most powerful neurotoxin that is frequently used in medicine because it is simple to prepare and has the longest function duration at low temperatures. [1] The effects of BoNT on the cholinergic motor nerve terminals, flaccid paralysis of the muscles, and transient denervation have been seen. BoNT has the potential to kill an organism's neurological system, which might result in symptoms including lightheadedness, breathing difficulties, muscular weakness, and others. It is used therapeutically to treat abnormalities of muscular movement, including facial spasms. BoNT has been used to treat conditions like hyperhidrosis, strabismus, facial tics, refractory headaches, and persistent migraines. [2] The cosmetic injection of BoNT rocked the world since many people's passion with looking young has grown widespread. [3] Typically, a clinical history and laboratory confirmation are used to make the diagnosis of botulism. Botulism is occasionally misdiagnosed as a stroke, Guillain-Barré syndrome, or Myasthenia Gravis. High dosages of BoNT can result in botulism when used to treat conditions such hereditary spastic paraparesis, extremities dystonia, hemiparesis, paralysis, hyperhidrosis, and neurogenic bladder. The diagnosis was made in the vast majority of reported instances using clinical criteria. However, electrodiagnostic confirmation is not included in many publications. [1] Our patient was a 50-year-old woman. After receiving 100 u of Dysport (abobotulinumtoxinA) for her masseters on 2022.03.30, the patient complained of weakness and difficulties swallowing and was later sent to the critical care unit on 2022.04.05. BoNT was administered to the patient's masseters for cosmetic reasons. It was the first time BoNT was used on the masseter muscles. The patient was fatigued from 2022.03.30 till she was taken to the hospital critical care unit on the fifth day of his sickness, due to widespread weakness and inability to support his neck backwards. (Fig 1-2) After receiving BoNT, the patient experienced diarrhea for the first two days, followed by constipation that has persisted ever since. From the first day, the patient suffered from severe dry mouth. About 4-5 days after receiving Botox, she experienced trouble swallowing, and he had trouble consuming tiny meals. Eventually speech problems started to emerge. The patient has never suffered from urinary incontinence. Localized pain occurred in the jaw and neck. Around the chin and face, there was extensive redness. She made no mention of injection site bleeding, flu-like symptoms, or pneumonia. While she was in the intensive care unit, botox antitoxin was administered. uncorrected proof