Successful treatment of a 15 years-old obese adolescent patient with botulinum anti-toxin after gastric Botox and systemic botulism findings: a case report
Tratamiento exitoso de un paciente adolescente obeso de 15 años con antitoxina botulínica posterior a Botox gástrico y hallazgos de botulismo sistémico: reporte de un caso
Muhammed Furkan Yücer, Alper Kaçar, Hüseyin Dağ, Ahmet İrdem
Abstract
Obesity is an increasingly common public health problem in children. The main goal in the fight against obesity is to prevent the development of obesity by healthy eating, increasing physical activity and reducing screen time. Patients with obesity should be treated in a multidisciplinary manner in accordance with the guidelines. In children and adolescents, applications such as gastric Botox, which are not included in the guidelines and for which there is insufficient literature information, should be avoided. Obese patients with Botulism side effects should be questioned about this application and Botulism antitoxin should be administered in appropriate cases. In this case report, we present a 15-year-old adolescent girl who developed botulism after gastric Botox administration in another medical institution and was successfully treated with Botulism antitoxin and prostigmine.
Keywords
Resumen
La obesidad es un problema de salud pública cada vez más común en los niños. El objetivo principal en la lucha contra la obesidad es prevenir el desarrollo de la obesidad mediante una alimentación saludable, aumentando la actividad física y reduciendo el tiempo de pantalla. Los pacientes con obesidad deben ser tratados de forma multidisciplinar de acuerdo con las guías. En niños y adolescentes deben evitarse aplicaciones como el botox gástrico, que no están incluidas en las guías y para las que no existe suficiente información bibliográfica. Los pacientes obesos con efectos secundarios del botulismo deben ser interrogados acerca de esta aplicación y la antitoxina del botulismo debe administrarse en los casos apropiados. En este reporte de caso, presentamos a una adolescente de 15 años que desarrolló botulismo luego de la administración de botox gástrico en otra institución médica y fue tratada exitosamente con antitoxina botulínica y prostigmina.
Palabras clave
References
1. Hampl SE, Hassink SG, Skinner AC, Armstrong SC, Barlow SE, Bolling CF, et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023;151(2):e2022060640. doi: 10.1542/peds.2022-060640.
2. Styne DM, Arslanian SA, Connor EL, Farooqi IS, Murad MH, Silverstein JH, et al. Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709-57. doi: 10.1210/jc.2016-2573.
3. Kelly AS, Barlow SE, Rao G, Inge TH, Hayman LL, Steinberger J, et al. Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches: a scientific statement from the American
Heart Association. Circulation. 2013;128(15):1689-712. doi: 10.1161/CIR.0b013e3182a5cfb3.
4. Skinner AC, Skelton JA. Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA Pediatr. 2014;168(6):561-6. doi: 10.1001/jamapediatrics.2014.21.
5. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-14. doi: 10.1001/jama.2014.732.
6. Alper Z, Ercan İ, Uncu Y. A Meta-Analysis and an Evaluation of Trends in Obesity Prevalence among Children and Adolescents in Turkey: 1990 through 2015. J Clin Res Pediatr Endocrinol. 2018;10(1):59-67. doi: 10.4274/jcrpe.5043.
7. Skinner AC, Perrin EM, Moss LA, Skelton JA. Cardiometabolic Risks and Severity of Obesity in Children and Young Adults. N Engl J Med. 2015;373(14):1307-17. doi: 10.1056/NEJMoa1502821.
8. Ranjani H, Pradeepa R, Mehreen TS, Anjana RM, Anand K, Garg R, et al. Determinants, consequences and prevention of childhood overweight and obesity: An Indian context. Indian J Endocrinol Metab. 2014;18(Suppl 1):S17-25. doi: 10.4103/2230-8210.145049.
9. Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE, et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics. 2007;120 Suppl 4:S254-88. doi: 10.1542/peds.2007-2329F.
10. Brown CL, Perrin EM. Obesity Prevention and Treatment in Primary Care. Acad Pediatr. 2018;18(7):736-45. doi: 10.1016/j.acap.2018.05.004.
11. Schilling PL, Davis MM, Albanese CT, Dutta S, Morton J. National trends in adolescent bariatric surgical procedures and implications for surgical centers of excellence. J Am Coll Surg. 2008;206(1):1-12. doi: 10.1016/j.jamcollsurg.2007.07.028.
12. Tsai WS, Inge TH, Burd RS. Bariatric surgery in adolescents: recent national trends in use and in-hospital outcome. Arch Pediatr Adolesc Med. 2007;161(3):217-21. doi: 10.1001/archpedi.161.3.217.
13. Wheeler A, Smith HS. Botulinum toxins: mechanisms of action, antinociception and clinical applications. Toxicology. 2013;306:124-46. doi: 10.1016/j.tox.2013.02.006.
14. Tighe AP, Schiavo G. Botulinum neurotoxins: mechanism of action. Toxicon. 2013;67:87-93. doi: 10.1016/j.toxicon.2012.11.011.
15. Gui D, Mingrone G, Valenza V, Spada PL, Mutignani M, Runfola M, et al. Effect of botulinum toxin antral injection on gastric emptying and weight reduction in obese patients: a pilot study. Aliment Pharmacol Ther. 2006;23(5):675-80. doi: 10.1111/j.1365-2036.2006.02773.x.
16. Humeau Y, Doussau F, Grant NJ, Poulain B. How botulinum and tetanus neurotoxins block neurotransmitter release. Biochimie. 2000;82(5):427-46. doi: 10.1016/s0300-9084(00)00216-9.
17. Rao AK, Sobel J, Chatham-Stephens K, Luquez C. Clinical Guidelines for Diagnosis and Treatment of Botulism, 2021. MMWR Recomm Rep. 2021;70(2):1-30. doi: 10.15585/mmwr.rr7002a1.
18. Schussler E, Sobel J, Hsu J, Yu P, Meaney-Delman D, Grammer LC 3rd, et al. Workgroup Report by the Joint Task Force Involving American Academy of Allergy, Asthma & Immunology (AAAAI); Food Allergy, Anaphylaxis, Dermatology and Drug Allergy (FADDA) (Adverse Reactions to Foods Committee and Adverse Reactions to Drugs, Biologicals, and Latex Committee); and the Centers for Disease Control and Prevention Botulism Clinical Treatment Guidelines Workgroup-Allergic Reactions to Botulinum Antitoxin: A Systematic Review. Clin Infect Dis. 2017;66(suppl_1):S65-S72. doi: 10.1093/cid/cix827.
19. Yu PA, Lin NH, Mahon BE, Sobel J, Yu Y, Mody RK, et al. Safety and Improved Clinical Outcomes in Patients Treated With New Equine-Derived Heptavalent Botulinum Antitoxin. Clin Infect Dis. 2017;66(suppl_1):S57-S64. doi: 10.1093/cid/cix816.
20. Armstrong SC, Bolling CF, Michalsky MP, Reichard KW; SECTION ON OBESITY, SECTION ON SURGERY. Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices. Pediatrics. 2019;144(6):e20193223. doi: 10.1542/peds.2019-3223.
21. Pratt JSA, Browne A, Browne NT, Bruzoni M, Cohen M, Desai A, et al. ASMBS pediatric metabolic and bariatric surgery guidelines, 2018. Surg Obes Relat Dis. 2018;14(7):882-901. doi: 10.1016/j.soard.2018.03.019.
22. Bibbins-Domingo K, Coxson P, Pletcher MJ, Lightwood J, Goldman L. Adolescent overweight and future adult coronary heart disease. N Engl J Med. 2007;357(23):2371-9. doi: 10.1056/NEJMsa073166.
23. Pratt JS, Lenders CM, Dionne EA, Hoppin AG, Hsu GL, Inge TH, et al. Best practice updates for pediatric/adolescent weight loss surgery. Obesity (Silver Spring). 2009;17(5):901-10. doi: 10.1038/oby.2008.577.
24. Gök MA, Demir M, Yeğen F, Kafadar MT, Şenol M, Kocaoğlu AE, et al. Endoscopic Intra-gastric Botulinum Toxin-A for Obesity Treatment: Is It Effective? Kocaeli Med J. 2022;11(2):149-52. doi: 10.5505/ktd.2022.62593.
25. Tayyem RM, Qandeel HG, Al-Balas HI, Tayyem FR, Fataftah JZ, Al-Balas MI. Comparison of safety and efficacy of intragastric botulinum toxin-A versus gastric balloon. Saudi J Gastroenterol. 2022;28(4):276-81. doi: 10.4103/sjg.sjg_534_21.
26. Yen YA, Wang CC, Sung WW, Fang KC, Huang SM, Lin CC, et al. Intragastric injection of botulinum toxin A for weight loss: A systematic review
and meta-analysis of randomized controlled trials. J Gastroenterol Hepatol. 2022;37(6):983-92. doi: 10.1111/jgh.15847.
27. Albani G, Petroni ML, Mauro A, Liuzzi A, Lezzi G, Verti B, Marzullo P, Cattani L. Safety and efficacy of therapy with botulinum toxin in obesity: a pilot study. J Gastroenterol. 2005;40(8):833-5. doi: 10.1007/s00535-005-1669-x.
28. Park JS, Zheng HM, Kim JM, Kim CS, Jeong S, Lee DH. The Effect of Intragastric Administration of Botulinum Toxin Type A on Reducing Adiposity in a Rat Model of Obesity Using Micro-CT and Histological Examinations. Gut Liver. 2017;11(6):798-806. doi: 10.5009/gnl16557.
29. Elshakh H, El-Ejji K, Taheri S. The Role of Endoscopic Intra-Gastric Botulinum Toxin-A for Obesity Treatment. Obes Surg. 2017;27(9):2471-8. doi: 10.1007/s11695-017-2806-3.
30. Şen O, Türkçapar AG. Gastric Botulinum Toxin-A Application for Weight Loss Therapy. Turk J Gastroenterol. 2021;32(1):66-9. doi: 10.5152/tjg.2020.20076.
31. Bustamante F, Brunaldi VO, Bernardo WM, de Moura DTH, de Moura ETH, Galvão M, et al. Obesity Treatment with Botulinum Toxin-A Is Not Effective: a Systematic Review and Meta-Analysis. Obes Surg. 2017;27(10):2716-23. doi: 10.1007/s11695-017-2857-5.
Submitted date:
05/31/2023
Reviewed date:
07/13/2023
Accepted date:
07/26/2023
Publication date:
08/04/2023
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