-125 - 破傷風に対する芍薬甘草湯 AbstractSuccessful treatment of tetanus using the herbal medicine shakuyakukanzoto: a report of three cases Tetanus can rapidly develop into muscle spasm accompanied by respiratory failure and result in fatal outcomes. Although the management of muscle spasticity and rigidity is of great importance, there is no consensus on the best treatment modality. Recently, the herbal medicine shakuyakukanzoto has been reported to be effective for the treatment of the muscle disorder in 2 patients with tetanus. Here, we report a comparison of 3 cases of tetanus that were successfully treated with shakuyakukanzoto with 3 cases treated without shakuyakukanzoto. All patients with tetanus presented with neck stiffness, dysphagia, and trismus, and received intravenous anti-tetanus human immunoglobulin and penicillin G with or without the oral administration of shakuyakukanzoto. Improvements in muscle spasticity and rigidity were found only in patients with shakuyakukanzoto, and not in those treated without: the latter needed to be managed with mechanical ventilation. Shakuyakukanzoto may be useful for the treatment of muscle spasticity and rigidity in patients with tetanus.

A 25-years-old man experienced fever and diarrhea. Ten days later he noticed difficulty walking (day 1). On admission neurological examination revealed lethargy, dysarthria and weakness of limbs. Oculocephalic response was not be elicited and extensor toe signs were positive. In spite of treatment with aciclovir and methylprednisolone, he continued to show progressive deterioration developing to coma with decorticate posture. Autonomic symptoms (hyperhidrosis, hypersalivation and fever) and groaning were observed. Brain magnetic resonance image and brainstem evoked potential presented no abnormality, but electroencephalographic study showed a spindle pattern indicating spindle coma. Laboratory tests including cerebrospinal fluids showed no specific results. High-dose immunoglobulin was administered from day 6, and his consciousness level improved. External ophthalomoplegia and ataxic gait were observed after he became more alert. Because he had IgG type anti-GQ1b antibodies in the serum, a diagnosis was made of Bickerstaff's brainstem encephalitis (BBE). Six months after discharge he had complete resolution of his symptoms. This is the first report of spindle coma observed in a case of serologically confirmed BBE.

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