Botulinumtoxin as a solution for atypical muscular spasms after Baroreflex activation therapy (BAT) surgery

A 37 year old patient suffering from therapy resistant arterial hypertension received a carotid baroreflex activation therapy (BAT) in March 2014. Baroreflex activation therapy (BAT) evokes a sympathoinhibitory effect by electrical stimulation of the carotid sinus and thus lowering blood pressure in patients with therapy resistant hypertension. Postoperatively the patient suffered ipsilateral muscular spasms and contraint head and neck movements. The patient also complained about paresthesia localized at the scar tissue (cervical right) while her blood pressure was adequately adjusted since the surgical BAT.

Several revision surgeries as well as moving the device to the contralateral side did not improve the patients symptoms. Electrical stimulation of the right sternocleidoid muscle was suspected to cause the patients complaints. Changing the device's software or a special encasement of the unit in further revision surgeries to prevent possible current leakage didn't solve the problem. Finally the BAT had to be deactivated leading to an increased blood pressure of more than 50 mmHg.

In March 2017 the patient consulted botulinumtoxin experts at the Department of Otolaryngology. On the basis of atypical muscular spasms and contraint head and neck movements 2 × 15 IE botulinumtoxin were injected into the patients right sternocleidoid muscle. Since then the symptoms were decreasing. The patient returns for botulinumtoxin-injections on a regular basis of ca. 9 weeks without the need of deactivating the BAT and suffering from arterial hypertension.

Publication History

Publication Date:
23 April 2019 (online)