Disclosures: William J. Naber, II, BS: No financial relationships or conflicts of interest

Case Diagnosis: A 50-year-old male with diffuse treatment resistant spasms secondary to alcoholic cirrhosis with ascites.

Case Description: Following therapeutic paracentesis for ascites, the patient began experiencing severe abdominal spasms 4-5 times per day, minutes to hours in duration. Over a 2-year course, Baclofen, Clonazepam, Gabapentin, and an abdominal binder did not sufficiently relieve his abdominal muscle spasms. In response, 200 units of botulinum toxin type A were reconstituted using preservative-free 0.9% normal saline in a 100U/3mL concentration. Alcohol was used to cleanse the skin and back pressure was applied prior to each injection to avoid intravascular injection. Under EMG and ultrasound guidance, a series of 6 intramuscular botulinum toxin A injections per side began just medial to the junction of the inferior rib cage border and anterior axillary line. Injections progressed bilaterally in a hand-pocket direction to the inferomedial abdomen just below the umbilicus. Patient head flexion allowed for audible syringe location confirmation via EMG while visual confirmation was made via ultrasound. 80U were injected bilaterally (160U total) into the abdominal musculature.

Setting: Outpatient General Physical Medicine and Rehabilitation ClinicAssessment/

Results: By week 5 post injection, VAS Pain reduced 44.4%, while Spasm Severity and Total Daily Duration each reduced 50%. Results lasted until the final 2 days of week 12. On 12-week follow-up, the patient reported exceptional functionality and sleep improvement with no reduction of postural stability, bowel stability, or other appreciable side effects. Further findings on patient’s routine 12 week follow ups will be discussed.

Discussion: To our knowledge, this is the first case reporting the use of botulinum toxin injection therapy for liver cirrhosis induced abdominal spasms refractory to traditional interventions.

Conclusion: Botulinum toxin type A injection under EMG and US guidance is a safe and effective treatment for refractory chronic abdominal spasms.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/botulinum-toxin-type-a-injections-for-refractory-abdominal-dystonia-a-case-report/