[Continuous intrathecal injection of baclofen in generalized tetanus. A therapeutic alternative].
BACKGROUND
In France, tetanus is diagnosed predominantly in the elderly due to the absence of vaccination in this population. Mortality remains high and is mainly related to complications secondary to prolonged hospitalization, intravenous administration of benzodiazepines, and at times curares. Baclofen, a selective agonist of GABAB receptors, directly counteracts the effects of the tetanic toxin.


METHODS
We report the case of a 92-year-old man suffering from tetanus, who fully recovered after a myorelaxant treatment based solely on intrathecal baclofen administration. Continuous intrathecal administration of baclofen 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 determine the optimal dose of baclofen which provides a substantial myorelaxation together with minor central effects. Low concentration of baclofen may facilitate its diffusion.


CONCLUSIONS
Continuous intrathecal administration of barclofen appears to be a valuable alternative therapy in tetanus. This new therapeutic modality promises to improve the prognosis of this condition, especially in the elderly.
François
B
B
Service de Réanimation polyvalente, CHU Dupuytren, Limoges.
Clavel
M
M
Desachy
A
A
Vignon
P
P
Salle
J Y
JY
Gastinne
H
H
D000368:Aged; D000369:Aged, 80 and over; D001418:Baclofen / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007278:Injections, Spinal; D008297:Male; D009125:Muscle Relaxants, Central / Q000008:administration & dosage* / Q000627:therapeutic use; D013742:Tetanus / Q000188:drug therapy*
D009125:Muscle Relaxants, Central; D001418:Baclofen
Injection intrathécale continue de baclofène en cas de tétanos généralisé. Une alternative thérapeutique.