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Botulinum toxin can diffuse through fascial planes to affect adjacent muscles that are not primary targets. For example, diffused toxin that affects the cholinergic innervation of the detrusor musculature can produce loss of bladder control.
Rare reported reactions include a flu-like syndrome, excessive weakness, rare cutaneous reactions, dry mouth, a brachial plexopathy, and polyradiculoneuritis. However, there have been no reports of adverse effects in patients with cerebral palsy and spasticity treated with BOTOX®.