Muscle & nerve
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Respiratory complications are a common cause of morbidity and mortality in amyotrophic lateral sclerosis (ALS). Treatment of respiratory insufficiency with noninvasive ventilation (NIV) improves ALS patients' quality of life and survival. ⋯ Despite these recommendations respiratory therapies remain underused. In this review we provide a practical guide for the clinician to prescribe and manage respiratory therapies for the patient with ALS.
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We describe 2 patients who received botulinum toxin A (BoNT) for poststroke spasticity and developed contralateral limb weakness. ⋯ Isolated weakness of the contralateral limb after BoNT injection for poststroke spasticity suggests diffusion of toxin through tissue planes from proximal upper extremity muscles, across the midline, to contralateral muscles. High doses of botulinum toxin, high dilution volumes, and injection of proximal upper extremity muscles appear to be risk factors for this adverse effect.