Generalized Tetanus Treated with Intrathecal Baclofen Infusion

Mun, Yeung Chul; Son, Won-gyun; Byeon, Gyeong-Jo; Lee, Eun Hwa; Shin, Jin‐Hong

doi:10.17340/jkna.2023.3.8

J Korean Neurol Assoc

2023

DOI: 10.17340/jkna.2023.3.8

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Generalized Tetanus Treated with Intrathecal Baclofen Infusion

Yeung Chul Mun¹,

Won-gyun Son²,

Gyeong-Jo Byeon³

et al.

Abstract: Tetanus is a bacterial infection by Clostridium tetani. Its neurotoxin causes spastic paralysis and autonomic dysfunction. Intrathecal infusion of baclofen has been suggested as a pertinent treatment for generalized spasm. Our case describes a patient who had a severe generalized form of tetanus, and was effectively treated with intrathecal baclofen infusion. He showed cerebral and brainstem dysfunction during baclofen infusion, which were reversed without sequelae when baclofen was discontinued.

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2024

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Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus

Aiello,

Roy,

Chitty

et al. 2024

Reg Anesth Pain Med

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IntroductionThis case report presents the management of a 62-year-old woman with generalized grade 4 tetanus, focusing on the innovative use of intrathecal baclofen (ITB) therapy. The patient initially presented with a laceration and subsequently developed severe tetanic spasms, necessitating interventions beyond standard tetanus immunoglobulin and antibiotics due to the condition’s progressive and life-threatening nature. The preference for ITB over oral baclofen is highlighted, considering ITB’s enhanced bioavailability in the central nervous system and its efficacy in reducing spinal cord reflexes, which is critical for managing severe spasticity.On her return to the emergency department with symptoms of tetanus, the patient received ITB following the failure of oral baclofen to control the spasms. ITB administration necessitated a lumbar drain, which was later substituted with a tunneled intrathecal catheter due to the extended requirement for baclofen infusion and the unavailability of suitable infusion pumps. This scenario represented a significant application of a CADD-Solis external pump for continuous ITB infusion.Transitioning the patient from ITB to oral baclofen was a crucial management step to facilitate discharge and recovery, underscoring the importance of a careful approach to prevent withdrawal symptoms and maintain care continuity. Despite initial complications, including an infection signaled by leucocytosis and confirmed through cerebrospinal fluid culture, the patient was effectively treated and discharged.ConclusionThis report contributes to the sparse literature on prolonged ITB use for generalized grade 4 tetanus treatment, underlining the need for interdisciplinary collaboration for the best patient outcomes. It showcases the potential of ITB in spasticity management, in reducing the need for sedation, and in shortening the duration of mechanical ventilation, advocating for a tailored approach that utilizes a full spectrum of pharmacological and supportive therapies.

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Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus

Aiello,

Roy,

Chitty

et al. 2024

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

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Generalized Tetanus Treated with Intrathecal Baclofen Infusion

Cited by 1 publication

References 6 publications

Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus

Prolonged administration of intrathecal baclofen in a patient with generalized grade 4 tetanus

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