Botulism and Guanidine

A 57-year-old woman with a fatal disease, presumably botulism, was treated intermittently with guanidine hydrochloride over a 20-day period. Guanidine was given because it enhances the release of acetylcholine at the neuromuscular junction. During treatment, ptosis and extraocular palsies were relieved, strength in proximal muscles improved, and muscle-action potentials increased from 1 to 2 mV to 4 to 7 mV.