Adverse neurological events following botulinum toxin type A: A case series of post-injection seizures and paralysis

Within the field of rehabilitation and aesthetic medicine, botulinum neurotoxin (BoNT), particularly type A (BoNT-A), has gained significant popularity for its unique muscle-relaxing properties including muscular spasticity and reducing wrinkles. Nevertheless, its widespread use is accompanied by the inherent risk of poisoning. This report presents two distinct patterns of neurological adverse events observed across three patients involving BoNT-A. In the first pattern, Patients 1 and 2, who had cerebral infarction and cerebral hemorrhage, respectively, both developed seizures after BoNT-A injection in the context of multiple seizure risk factors, but with no definitive causal link between BoNT-A and seizures. In the second pattern, Patient 3, a healthy woman, developed severe generalized muscular weakness after receiving BoNT-A injection for cosmetic purposes. Based on a comprehensive review of the patients' clinical manifestations, auxiliary examinations, and rehabilitation treatments, this report underscores the importance of prompt recognition, accurate diagnosis, and timely intervention to improve patient outcomes and prevent complications such as seizures.