Thomas Jefferson University Hospital
Philadelphia, Pennsylvania, United States
Mitchell H. Paulin
Director, The center for Tone Management
Rehabilitation Associates of the Main Line
Paoli, Pennsylvania, United States
Patient with diffuse hyperhidrosis and Parkinson’s disease with spasticity and cervical dystonia treated with rimabotulinumtoxinB specifically for the side effect of anhidrosis.
The patient is a 59 year old male with past medical history of diffuse hyperhidrosis and Parkinson’s disease with deep brain stimulator in place who presented for management of spasticity in the right tibialis anterior and posterior and cervical dystonia involving the sternocleidomastoid and posterior scalenes on the left. The patient initially underwent successful diagnostic selective motor nerve blocks followed by chemodenervation of the aforementioned muscles. Notably, the patient also suffered from diffuse severe hyperhidrosis involving his entire body including axillae, hands, and torso. Subsequently, when selecting a choice of neurotoxin, the decision was made to utilize rimabotulinumtoxinB specifically for its known side effect of anhidrosis. On patient’s five week follow up, the use of rimabotulinumtoxinB was successful at significantly reducing his diffuse hyperhidrosis, even in areas that were not directly injected with neurotoxin, as well as effectively managing both his spasticity in the right lower extremity and cervical dystonia.
When selecting a choice of neurotoxin for the treatment of spasticity and/or dystonias, consider the patient’s comorbidities and the selected neurotoxin’s side effects. In this case, rimabotulinumtoxinB, with its known side effect of anhidrosis, was effective at treating the patient’s diffuse hyperhidrosis as well as spasticity and cervical dystonia. While neurotoxin has been used off label to treat focal hyperhidrosis, with injection to the local affected areas, this case suggests that with the use of rimabotulinumtoxinB, there can be generalized effect of decreased perspiration beyond the area where rimabotulinumtoxinB is injected.
RimabotulinumtoxinB should be considered as a chemodenervation agent of choice when treating patients with spasticity and/or dystonias with underlying diffuse hyperhidrosis.