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@ARTICLE{Hennen:1018556,
      author       = {Hennen, Christina and Demir, Seda and Dafsari, Haidar
                      Salimi and Wunderlich, Gilbert and Böll, Boris and Hüser,
                      Christoph and Barbe, Michael Thomas and Fink, Gereon Rudolf
                      and Rueger, Maria Adele},
      title        = {{B}otulism after intragastric botulinum toxin injections
                      for weight reduction},
      journal      = {European journal of neurology},
      volume       = {30},
      number       = {12},
      issn         = {1351-5101},
      address      = {Oxford [u.a.]},
      publisher    = {Wiley-Blackwell},
      reportid     = {FZJ-2023-04884},
      pages        = {3979 - 3981},
      year         = {2023},
      abstract     = {Although-considering the risk-benefit ratio-botulinum
                      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-label) 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-based medicine. There
                      is a need for international guidelines to define the
                      indication and a safe dosing scheme, especially in the
                      context of medical tourism.Keywords: botulinum toxins;
                      botulism; medical tourism; obesity.},
      cin          = {INM-3},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-3-20090406},
      pnm          = {5251 - Multilevel Brain Organization and Variability
                      (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5251},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {37584071},
      UT           = {WOS:001060540500001},
      doi          = {10.1111/ene.16040},
      url          = {https://juser.fz-juelich.de/record/1018556},
}