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A 4-year-old boy developed oculobulbar paralysis with fixed dilated pupils in the face of a normal level of consciousness. Serological and bacteriological studies did not confirm a diagnosis of botulism, but electromyographic changes supported the diagnosis, especially since no other cause for the patient's clinical state was found. Electromyographic abnormalities included a very small grouped muscle action potential (MAP) response to a single nerve stimulus; marked tetanic and posttetanic MAP facilitation at fast rates of repetitive nerve stimulation; increased nerve excitability; and a "supernormal" mixed nerve action potential response, enhanced after a calcium infusion.