Can I treat this pregnant patient with botulinum toxin?

Botulinum toxin type A (BoNT-A) is used extensively in the neurological setting, most commonly for the management of dystonia and spasticity. It is inevitable that female patients who derive a significant benefit from botulinum toxin treatment may inadvertently be injected in as-yet undiagnosed pregnancy or may be planning to become pregnant. Following an examination of the evidence for the safety of botulinum toxin in pregnancy, physicians and patients should be reassured as to the absence of evidence of harm in case reports of botulism and accidental or intentional botulinum toxin injection and the improbability of crossing the placenta. Consequently, judgment should be made that acknowledges that when botulinum toxin treatment is to continue through pregnancy it should be because this will represent the lesser harm in view of the severity of the mother’s symptoms and the physical and psychological harm caused by withholding treatment. It is also normally appropriate to reassure patients inadvertently injected.This article is available to RD&E staff via NHS OpenAthens login. Click on the 'Additional Link' above and log in with NHS OpenAthens if prompted.Accepted manuscript