The Treatment of Tetanus with Intrathecal Baclofen

Abstract

The treatment of severe tetanus generally requires prolonged mechanical ventilation. We describe two cases managed with continuous intrathecal infusion of baclofen via a subcutaneous tunnelled spinal catheter and an abdominal injection port. Baclofen, by diminishing spasms and spasticity, allowed reduced sedation and paralysis requirements. This potentially decreases the time and resources required for intensive care management. Complications include sedation, hypotension and CSF infection. After appropriate dose adjustment, baclofen improves the management of severe tetanus.

Pharmacological management of tetanus: an evidence-based review

“…Many reports on the efficacy of baclofen are limited to case reports of either one or a few patients, but so far there are more than 30 case reports in the published literature [41-50]. Boots and colleagues [42] treated two patients using a similar mechanism to deliver the drug and noted a reduction in the need for sedation and paralysis. Brock and colleagues [51] also note that baclofen alone was an effective measure in promptly abolishing prolonged muscle spasms at a dose of 850 μg/day delivered via an intrathecal infusion pump.…”

Treatment of Severe Tetanus With Intrathecal Baclofen via Implantable Infusion Device: A Case Report

“…This is only the second case report in the United States of use of an implantable pump with internalized catheter, versus an externalized catheter, for ITB delivery. The use of baclofen in cases of severe tetanus has been reported in Europe, Asia, Africa, and Australia in bolus form or via an external catheter . Only one other case has been documented in which severe tetanus was successfully treated via an implantable pump with internalized catheter for intrathecal delivery .…”

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.…”

“…Five of the ten patients treated developed coma and respiratory depression, which was attributed to the intrathecal baclofen. Other adverse effects of intrathecal baclofen include coma, hypotension, bradycardia, and meningitis (15)(16)(17)45).…”

“…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.…”