The muscle weakness of<unk>  characteristically starts in the muscles supplied by the cranial nerves—a group of twelve nerves that control eye movements, the facial muscles and the muscles controlling chewing and swallowing. Double vision, drooping of both eyelids, loss of facial expression and swallowing problems may therefore occur. In addition to affecting the voluntary muscles, it can also cause disruptions in the autonomic nervous system. This is experienced as a dry mouth and throat (due to decreased production of saliva), postural hypotension (decreased blood pressure on standing, with resultant lightheadedness and risk of blackouts), and eventually constipation (due to decreased forward movement of intestinal contents). Some of the toxins (B and E) also precipitate nausea, vomiting, and difficulty with talking. The weakness then spreads to the arms (starting in the shoulders and proceeding to the forearms) and legs (again from the thighs down to the feet). Severe<unk>  leads to reduced movement of the muscles of respiration, and hence problems with gas exchange. This may be experienced as dyspnea (difficulty breathing), but when severe can lead to respiratory failure, due to the buildup of unexhaled carbon dioxide and its resultant depressant effect on the brain. This may lead to respiratory compromise and death if untreated. Clinicians frequently think of the symptoms of<unk>  in terms of a classic triad: bulbar palsy and descending paralysis, lack of fever, and clear senses and mental status ("clear sensorium"). Infant<unk>  An infant with<unk> ː despite not being asleep or sedated, he cannot open his eyes or move; he also has a weak cry. Infant<unk>  (also referred to as floppy baby syndrome) was first recognized in 1976, and is the most common form of<unk>  in the United States. Infants are susceptible to infant<unk>  in the first year of life, with more than 90% of cases occurring in infants younger than six months. Infant<unk>  results from the ingestion of the C. botulinum spores, and subsequent colonization of the small intestine. The infant gut may be colonized when the composition of the intestinal microflora (normal flora) is insufficient to competitively inhibit the growth of C. botulinum and levels of bile acids (which normally inhibit clostridial growth) are lower than later in life. The growth of the spores releases botulinum toxin, which is then absorbed into the bloodstream and taken throughout the body, causing paralysis by blocking the release of acetylcholine at the neuromuscular junction. Typical symptoms of infant<unk>  include constipation, lethargy, weakness, difficulty feeding, and an altered cry, often progressing to a complete descending flaccid paralysis. Although constipation is usually the first symptom of infant<unk> , it is commonly overlooked. Honey is a known dietary reservoir of C. botulinum spores and has been linked to infant<unk> . For this reason, honey is not recommended for infants less than one year of age. Most cases of infant<unk> , however, are thought to be caused by acquiring the spores from the natural environment. Clostridium botulinum is a ubiquitous soil-dwelling bacterium. Many infant<unk>  patients have been demonstrated to live near a construction site or an area of soil disturbance. Infant<unk>  has been reported in 49 of 50 US states (all save for Rhode Island), and cases have been recognized in 26 countries on five continents. Complications Infant<unk>  has no long-term side effects, but can be complicated by hospital-acquired infections.<unk>  can result in death due to respiratory failure. However, in the past 50 years, the proportion of patients with<unk>  who die has fallen from about 50% to 7% due to improved supportive care. A patient with severe<unk>  may require mechanical ventilation (breathing support through a ventilator) as well as intensive medical and nursing care, sometimes for several months. The person may require rehabilitation therapy after leaving the hospital.
Botulism
Guillain–Barré syndrome
Tardive dyskinesia
Lambert–Eaton myasthenic syndrome
Quadrigia
Myasthenia gravis
Sadism
Amyotrophic lateral sclerosis