{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:34:24Z","timestamp":1791923664267,"version":"4.3.4"},"reference-count":5,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2023,8,29]],"date-time":"2023-08-29T00:00:00Z","timestamp":1693267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Euro J of Neurology"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Although\u2014considering the risk\u2013benefit ratio\u2014botulinum neurotoxin A (BoNT\/A) is unequivocally recommended to treat severe neurological diseases such as dystonia, this has not yet been determined for its endoscopic intragastric injection aimed at weight reduction in obesity. However, severe adverse effects of intragastric BoNT\/A had not yet been reported, prompting some European countries to endorse its (off\u2010label) use and treat patients transnationally. We here present three cases of botulism after intragastric BoNT\/A injections for obesity treatment in a Turkish hospital. Patients presented with cranial nerve affection, bulbar symptoms, and descending paresis, and benefited from treatment with BoNT antitoxin and pyridostigmine. We assume that iatrogenic botulism was induced by overdosing in combination with toxin spread via the highly vascularized gastric tissue. Of note, within a few weeks, more than 80 cases of iatrogenic botulism were reported across Europe after identical intragastric BoNT\/A injections. These cases demonstrate the risks of BoNT\/A injections if they are not applied within the limits of evidence\u2010based medicine. There is a need for international guidelines to define the indication and a safe dosing scheme, especially in the context of medical tourism.<\/jats:p>","DOI":"10.1111\/ene.16040","type":"journal-article","created":{"date-parts":[[2023,8,16]],"date-time":"2023-08-16T16:05:54Z","timestamp":1692201954000},"page":"3979-3981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Botulism after intragastric botulinum toxin injections for weight reduction"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2091-4638","authenticated-orcid":false,"given":"Christina","family":"Hennen","sequence":"first","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seda","family":"Demir","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haidar Salimi","family":"Dafsari","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilbert","family":"Wunderlich","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boris","family":"B\u00f6ll","sequence":"additional","affiliation":[{"name":"First Department of Internal Medicine; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"H\u00fcser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Thomas","family":"Barbe","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gereon Rudolf","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"},{"name":"Institute of Neuroscience and Medicine (INM\u20103)  J\u00fclich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Adele","family":"Rueger","sequence":"additional","affiliation":[{"name":"Department of Neurology University of Cologne, Faculty of Medicine and University Hospital Cologne  Cologne Germany"},{"name":"Institute of Neuroscience and Medicine (INM\u20103)  J\u00fclich Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgh.15847"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/toxins13010042"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1024907920934901"},{"key":"e_1_2_8_5_1","unstructured":"PfauslerB.DGN Guideline Botulism."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2023.28.23.2300203"}],"container-title":["European Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ene.16040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,27]],"date-time":"2024-02-27T12:03:36Z","timestamp":1709035416000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ene.16040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,29]]},"references-count":5,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1111\/ene.16040"],"URL":"https:\/\/doi.org\/10.1111\/ene.16040","archive":["Portico"],"relation":{},"ISSN":["1351-5101","1468-1331"],"issn-type":[{"value":"1351-5101","type":"print"},{"value":"1468-1331","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,29]]},"assertion":[{"value":"2023-05-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-29","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}