CONTINUOUS INTRATHECAL BACLOFEN IN TETANU S - AN ALTERNATIVE MANAGEMENT

BACKGROUND: In France, tetanus is diagnosed predominantly in the elder ly due to the absence of vaccination in this population. Mortality rem ains high and is mainly related to complications secondary to prolonge d hospitalization, intravenous administration of benzodiazepines, and at times, curares. Baclofen, a selective agonist of GABA(B) receptors, directly counteracts the effects of the tetanic toxin. CASE REPORT: W e report the case of a 92-year-old man suffering from tetanus, who ful ly recovered after a myorelaxant treatment based solely on intrathecal baclofen administration. Continuous intrathecal administration of bac lofen resulted in a marked muscular relaxation with minor side effects (bradycardia, sleepiness), which rapidly stopped after the cessation of the treatment. Initial careful titration is required in order to de termine the optimal dose oi baclofen which provides a substantial myor elaxation together with minor central effects. Low concentration of ba clofen may facilitate its diffusion. DISCUSSION: Continuous intratheca l administration oi baclofen appears to be a valuable alternative ther apy in tetanus. This new therapeutic modality promises to improve the prognosis of this condition, especially in the elderly.