Intrathecal baclofen in tetanus: four cases and a review of reported cases

Abstract

A catheter position higher than T11 would possibly have yielded better results. It may be necessary to adapt the dose during the course of the illness. The preservation of respiratory drive and voluntary movements is the main advantage of treating tetanus with intrathecal baclofen. Additionally it helps to reduce sympathetic hyperactivity. Mortality may thereby be reduced.

Magnesium sulfate for control of muscle rigidity and spasms and avoidance of mechanical ventilation in pediatric tetanus

“…Intrathecal baclofen, a specific ␥-aminobutyric acid-B agonist, has been utilized to treat muscle rigidity and spasms in tetanus (13)(14)(15)(16)(17). Saissy et al (15) prospectively evaluated repeated intrathecal injections of baclofen in the treatment of ten patients with severe tetanus.…”

“…Thus, there remains a continuing search for therapies that can control muscle spasms and rigidity without the need for prolonged deep sedation or artificial ventilation. Opioids (4,9,11,12), benzodiazepines (3-6, 9, 10), baclofen (13)(14)(15)(16)(17), dantrolene (18 -21), and propofol (22) have all been utilized in cases of severe tetanus to control muscle spasms and rigidity. However, adverse effects associated with these therapies often limit their use.…”

Diretrizes para o manejo do tétano acidental em pacientes adultos

“…However, several methodological limitations limit any conclusions, even in the pediatric population. Several case reports and case series have been published using other treatment schedules, e.g., intrathecal baclofen, (71)(72)(73)(74)(75)(76) dexamedetomidine (77) or midazolam with or without propofol, (78,79) or propofol alone. (80,81) Experience with diazepam is more extensive, supporting it as the first choice of a muscle relaxant until appropriate studies can be conducted.…”

Behandlungsstrategien des Tetanus

“…Weil es die Blut-Hirn-Schranke nicht überwindet, ist jedoch eine intrathekale Gabe vonnöten. Jedoch wurde in allen bislang veröffentlichten Studien bei einem signifikanten Teil der Patienten trotz allem eine Beatmung nötig, und somit muss auch hier die Möglichkeit der Ventilation gegeben sein [15,26]. Zudem beinhaltet die invasive intrathekale Gabe ein erhöhtes Infektions-und Blutungsrisiko und ist sehr kostenintensiv.…”

“…Auch das bereits genannte Baclofen zeigte zumindest in einer Fallserie einen Effekt in der Kontrolle der kardiovaskulären Instabilität, jedoch waren auch diese Ergebnisse nicht reproduzierbar [15,26,32]. Zudem bleiben die Nachteile der notwendigen intrathekalen Applikation.…”