A large number of botulism cases occur in Colorado because the boiling temperature at high altitudes is too low to destroy spores. Clinical features in 14 patients representing five outbreaks included normal pupils in most, improvement in muscle strength after administration of edrophonium chloride in two, and nearly total long-term recovery in survivors. Guanidine hydrochloride, which enhances the release of acetylcholine at the nerve terminal, sometimes is useful in treating botulism. However, respiratory muscles respond to a lesser degree than do limb and extraocular muscles. In severe cases, or overwhelming poisoning, the drug effect may be negligible.
Electrical abnormality in botulism resembles that seen in Eaton-Lambert syndrome but may not be apparent early in the disease. Moderately paralyzed patients can show a greater potentiation with rapid repetitive nerve stimulation than those severely paralyzed.
Cherington M. BotulismTen-Year Experience. Arch Neurol. 1974;30(6):432–437. doi:10.1001/archneur.1974.00490360008003
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