INTRATHECAL BACLOFEN IN TETANUS - 4 CASES AND A REVIEW OF REPORTED CASES

Objective: Spasms in patients with generalized tetanus can be suppress ed by a spinal intrathecal infusion of baclofen. We report on four pat ients and review reported cases treated by this method elsewhere. Desi gn: Intrathecal baclofen infusion was started with a bolus dose (300-5 00 mu g) and continued at a steady rate of 500-1000 mu g/day. The dose was increased in daily steps as needed. Results: Doses of baclofen of 500, 1000, or 2000 mu g/day were effective in three patients, while 1 500 mu g/day was insufficient in the fourth, Bradycardia and hypotonia occurred in one patient at a dose of 2000 mu g/day but resolved after the dose was reduced to 1500 mu g/day. Another patient developed hypo tonia when a bolus of 500 mu g was given after a steady infusion of 15 00 mu g/day. Voluntary movements were preserved in one and returned in two patients when sedation, induced by initial diazepam infusions, re ceded. The fourth patient needed diazepam during most of the treatment with intrathecal baclofen and required mechanical ventilation while b eing treated with baclofen. Conclusions: A catheter position higher th an 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 r educe sympathetic hyperactivity. Mortality may thereby be reduced.