Intrathecal Baclofen in Tetanus

  • H. Müller
  • J. Zierski
  • U. Börner
  • G. Hempelmann


Our understanding of the pathogenesis of tetanus stems from the end of the nineteenth century. In 1884 the transfer of the infective as well as toxic agent of tetanus infection was demonstrated in animals [10, 50]. Only a few years later tetanus bacilli were isolated from human victims [44, 64] and its toxin was characterized as the pathogenic link [29]. These early hypotheses, which have been confirmed and extended during the last one hundred years, have led to the application of the principles of passive as well as active immunisation [6].


Tetanus Toxin Intrathecal Baclofen Retrograde Axonal Transport Intrathecal Catheter Dantrolene Sodium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Adams EB (1968) The prognosis and prevention of tetanus. S Afr Med J 42: 739–743PubMedGoogle Scholar
  2. 2.
    Adams EB, Laurence DR, Smith JWG (1969) Tetanus. Blackwell, Oxford EdinburghGoogle Scholar
  3. 3.
    Ambache N, Morgan RS, Payling Wright G (1948) The action of tetanus toxin on the rabbit’s iris. J Physiol (Lond) 107: 45–53Google Scholar
  4. 4.
    Aguilar Bernal OR, Bender MA, Lacy ME (1986) Efficacy of dantrolene sodium in management of tetanus in children. J R Soc Med 79: 277–281PubMedGoogle Scholar
  5. 5.
    Beaty HN (1983) Tetanus. In: Petersdorf RG, Adams RD, Braunwald E, Isselbacher UJ, Martin JB, Wilson JD (eds) Harrison’s principles of internal medicine, 10th edn. McGraw Hill, New York, pp 1003–1006Google Scholar
  6. 6.
    Behring E, Kitasato S (1890) Öber das Zustandekommen der Diphtherie-Immunität und der Tetanus-Immunität bei Heren. Dtsch Med Wochenschr 16: 1–6CrossRefGoogle Scholar
  7. 7.
    Berl S (1975) Actomyosin-like protein in brain. In: Agranoff BW, Aprison MH (eds) Advances in Neurochemistry I. Elsevier, Amsterdam, pp 157–191Google Scholar
  8. 8.
    Bizzini B, Turpin A, Raynaud M (1973) On the structure of tetanus toxin. Naunyn Schmiedebergs Arch Pharmacol 276: 271–288PubMedCrossRefGoogle Scholar
  9. 9.
    Brooks VB, Curtis DR, Eccles JC (1957) The action of tetanus toxin on the inhibition of motor neurons. J Physiol (Lond) 135: 655–672Google Scholar
  10. 10.
    Carle L, Rattone I (1884) Studio esperimentale sull eziologia del tetano. G Accad Med Torino 32: 174Google Scholar
  11. 11.
    Carrea R, Lanari A (1962) Chronic effects of tetanus toxin applied locally to the cerebral cortex of the dog. Science 137: 342–343PubMedCrossRefGoogle Scholar
  12. 12.
    Carrington da Costa RB (1986) Tizanidine in treatment of tetanus. European Congress of Intensive Care Medicine, 11.-14. 6. 1986, HamburgGoogle Scholar
  13. 13.
    Collingridge GL, Collins GGS, Davies J, James TA, Neal MJ, Tongroach P (1980) Effect of tetanus toxin on transmitter release from the substantia nigra and striatum in vitro. J Neurochem 34: 540–547PubMedCrossRefGoogle Scholar
  14. 14.
    Cornil A, Thys IP, Extors M, Degaute I (1975) Tétanos et soins intensifs. In: Proceedings of the 4th International Conference on Tetanus. Fondation Merieux, Lyon, pp 535–540Google Scholar
  15. 15.
    Curtis DR, De Groat WC (1968) Tetanus toxin and spinal inhibition. Brain Res 10: 208–212PubMedCrossRefGoogle Scholar
  16. 16.
    Curtis DR, Felix D, Game CJA, McCullough RM (1973) Tetanus toxin and the synaptic release of GABA. Brain Res 51: 358–362PubMedCrossRefGoogle Scholar
  17. 17.
    Curtis DR, Lodge D, Bornstein JC, Peet MJ (1981) Selective effect of (-)baclofen on spinal synaptic transmission in the cat. Exp Brain Res 42: 158–170PubMedCrossRefGoogle Scholar
  18. 18.
    Cutting DA, Jordan CC (1975) Alternative approach to analgesia: baclofen as a model compound. Br J Pharmacol 54: 171–176PubMedGoogle Scholar
  19. 19.
    Davies J, Tongroach P (1979) Tetanus toxin and synaptic inhibition in the substantia nigra and striatum of rats. J Physiol (Lond) 290: 23–36Google Scholar
  20. 20.
    Dowell VR (1984) Tetanus in the elderly. Rev Infect Dis 65: 202–206CrossRefGoogle Scholar
  21. 21.
    Duchen LW (1973) The effect of tetanus toxin on the motor endplates of the mouse. J Neurol Sci 19: 153–167PubMedCrossRefGoogle Scholar
  22. 22.
    Duchen LW, Tonge DA (1973) The effects of tetanus toxin on neuromuscular transmission and on the morphology of motor endplates in slow and fast skeletal muscles of the mouse. J Physiol (Lond) 228: 157–172Google Scholar
  23. 23.
    Dumas M, Schwab ME, Baumann R, Thoenen H (1979) Retrograde transport of tetanus toxin through a chain of two neurons. Brain Res 165: 354–357PubMedCrossRefGoogle Scholar
  24. 24.
    Dunlap K (1981) Two types of aminobutyric acid receptors on embryonic sensory neurones. Br J Pharmacol 74: 579–585PubMedGoogle Scholar
  25. 25.
    Edmondson RS, Flowers MW (1979) Intensive care in tetanus: management, complications and mortality in 100 cases. Br J Med I:1401–1404CrossRefGoogle Scholar
  26. 26.
    Erdmann G, Habermann E (1977) Histoautoradiography of central nervous system in rats with generalized tetanus due to 125I-toxin. Naunyn Schmiedebergs Arch Pharmacol 301: 135–138PubMedCrossRefGoogle Scholar
  27. 27.
    Erdmann G, Wiegand H, Wellhöner HH (1975) Intra-axonal and extra-axonal transport of 125I-tetanus toxin in early local tetanus. Naunyn Schmiedebergs Arch Pharmacol 290: 357–373PubMedCrossRefGoogle Scholar
  28. 28.
    Eyrich K (1969) Die Klinik des Wundstarrkrampfes im Lichte neuzeitlicher Behandlungsmethoden. In: Frey R, Kern E, Mayrhofer O (eds) Anaesthesiology and Resuscitation, vol 43. Springer, Berlin Heidelberg New YorkGoogle Scholar
  29. 29.
    Faber K (1890) Die Pathogenese des Tetanus. Berl Klin Wochenschr 27: 717–720Google Scholar
  30. 30.
    Fedinec AA, Shank RP (1971) Effect of tetanus toxin on the content of glycine and aspartate in the rat spinal cord. J Neurochem 18: 2229–2234PubMedCrossRefGoogle Scholar
  31. 31.
    Furste W (1982) Epidemiology of tetanus. Trauma 22: 1032–1036CrossRefGoogle Scholar
  32. 32.
    Geinisman YY, D’Yakonova MV, Kryzhanovsky GN (1967) Effect of tetanus toxin on morphological and functional states of synapses on spinal motoneurons. Bull Exp Biol Med 64: 1203–1206CrossRefGoogle Scholar
  33. 33.
    Gullo A, Romano E, Macovero G (1983): Long-term epidural anaesthesia for management of tetanus. Anaesthesia 38: 817–820PubMedCrossRefGoogle Scholar
  34. 34.
    Gupta PS (1980) Intrathecal human tetanus immunoglobulin in early tetanus. Lancet 11: 439CrossRefGoogle Scholar
  35. 35.
    Habermann E (1970) Pharmacokinetic peculiarities of tetanus toxin and their relation to the pathogenesis of local or generalized tetanus. Naunyn Schmiedebergs Arch Pharmacol 267: 1–19PubMedCrossRefGoogle Scholar
  36. 36.
    Habermann E (1978) Tetanus. In: Vinken PJ, Bruyn GW (eds) Infections of the nervous system. North Holland Publishing, Amsterdam New York Oxford, pp 491–547Google Scholar
  37. 37.
    Habermann E, Dimpfel W (1973) Distribution of 125I-tetanus toxin and 125I-toxoid in rats with generalised tetanus, as influenced by antitoxin. Naunyn Schmiedebergs Arch Pharmacol 276: 327–340PubMedCrossRefGoogle Scholar
  38. 38.
    Habermann E, Dreyer F, Bigalke H (1980) Tetanus toxin blocks the neuromuscular transmission in vitro like botulinum A toxin. Naunyn Schmiedebergs Arch Pharmacol 311: 33–40PubMedCrossRefGoogle Scholar
  39. 39.
    Haid B (1975) 11 Tetanusfälle in 18 Jahren. Erfahrungsbericht und allgemeine Konsequenzen. MMW 117: 1149–1158Google Scholar
  40. 40.
    Hudgson P, Weightman D (1971) Baclofen in treatment of spasticity. Br Med J 4: 15–25PubMedCrossRefGoogle Scholar
  41. 41.
    Kerr JH (1981) Intensive care therapy of tetanus. Intensive Care Med 7: 209–216PubMedCrossRefGoogle Scholar
  42. 42.
    Kerr JH, Corbett JL, Prys-Roberts C, Crampton Smith C, Spalding JMK (1968) Involvement of the sympathetic nervous system in tetanus. Lancet II: 236–241CrossRefGoogle Scholar
  43. 43.
    King LE, Fedinec A (1974) Pathogenesis of local tetanus in rat: neural ascent of tetanus toxin. Naunyn Schmiedebergs Arch Pharmacol 281: 391–401PubMedCrossRefGoogle Scholar
  44. 44.
    Kitasato S (1889) Öber den Tetanusbacillus. Z Hyg Infektionskr 7: 225–234CrossRefGoogle Scholar
  45. 45.
    Kryzhanovsky GN, Glebov RN, Dmitrieva NM, Federova VI (1974) Effect of tetanus toxin on contractility of the actomyosin-like protein in rat brain. Bull Exp Biol Med 78: 1365–1368CrossRefGoogle Scholar
  46. 46.
    Mallenby J, Green J (1981) How does tetanus toxin act? Neuroscience 6: 281–300CrossRefGoogle Scholar
  47. 47.
    Mallenby J, Thompson PA (1972) The effect of tetanus toxin at the neuromuscular junction in the goldfish. J Physiol (Lond) 224: 407–419Google Scholar
  48. 48.
    McGeer PL, McGeer EG (1979) Use of the neurotoxic agents kainic acid and tetanus toxin in the extrapyramidal system. In: Ceccarelli B, Clementi F (eds) Advances in Cytopharmacology, vol 3. Raven Press, New York, pp 437–446Google Scholar
  49. 49.
    Miller MT (1983) Epidural morphine in treatment of tetanus. S Afr Med J 63: 31–33PubMedGoogle Scholar
  50. 50.
    Nicolaier A (1884) Öber infectiösen Tetanus. Dtsch Med Wochenschr 10: 842–844CrossRefGoogle Scholar
  51. 51.
    Ogatuti P (1980) Treatment of tetanus by lumbar intrathecal tetanus-antitoxin. Papua New Guinea Med J 23: 179–181Google Scholar
  52. 52.
    O’Keefe SDJ (1984) Metabolic changes in acute tetanus. Metabolism 33: 482–485PubMedCrossRefGoogle Scholar
  53. 53.
    Ortega Cerda JJ, Portela Ortiz JM, Ramirez Acosta J (1981) Dantrolene sodium in tetanus: Report of a case. Rev Invest Clin 33: 53–55Google Scholar
  54. 54.
    Osborne RH, Bradford HF (1973) Tetanus toxin inhibits amino acid release from nerve endings in vitro. Nature New Biol 244: 157–158PubMedGoogle Scholar
  55. 55.
    Patel JC, Jaog GG (1959) Grading of tetanus to evaluate prognosis. Indian J Med Sci 13: 834–840PubMedGoogle Scholar
  56. 56.
    Plötz J (1986) Tetanus — Der aktuelle Fall. Gelbe Hefte — Immunobiologische Informationen 26: 41–44Google Scholar
  57. 57.
    Prince DL, Griffin JW (1977) Tetanus toxin: retrograde axonal transport of systematically administered toxin. Neurosci Lett 4: 61–65CrossRefGoogle Scholar
  58. 58.
    Prince DL, Griffin JW, Peck K (1977) Tetanus toxin: evidence for binding at presynaptic nerve endings. Brain Res 121: 379–384CrossRefGoogle Scholar
  59. 59.
    Ramos S, Grollman EF, Lazo PS, Dyer SA, Habig WH, Hardegree MC, Kaback HR, Kohn LD (1979) Effect of tetanus toxin on the accumulation of the permanent lipophilic cation tetraphenylphosphonium by guinea-pig brain synaptosomes. Proc Natl Acad Sci USA 76: 4783–4787PubMedCrossRefGoogle Scholar
  60. 60.
    Rey M, Diop Mar I (1967) Tetanus in Dakar. In: Eckmann L (ed) Principles of tetanus. Huber, Bern, pp 377–384Google Scholar
  61. 61.
    Rocha H (1975) Myorelaxant effect of dantrolene sodium in treatment of tetanus. Rev Inst Med Trop Sao Paulo 17: 257–262PubMedGoogle Scholar
  62. 62.
    Romijn JA, Van Lieshout JJ, Velis DN (1986) Reversible coma due to intrathecal baclofen. Lancet II: 696CrossRefGoogle Scholar
  63. 63.
    Ronnevi LO, Byström J, Eriksson E, Ottava L (1973) Quantitative distribution of tetanus toxin in peripheral nerves and central nervous system. Eur Surg Res 5: 401–413PubMedCrossRefGoogle Scholar
  64. 64.
    Rosenbach D (1886) Zur Aetiologie des Wundstarrkrampfes beim Menschen. Arch Klin Chir 34: 306–317Google Scholar
  65. 65.
    Rügheimer E (1981) Tetanus. In: Lawin P (ed) Praxis der Intensivbehandlung. Thieme, Stuttgart New York, pp 52.1–52.11Google Scholar
  66. 66.
    Sanders RKM (1966) Betamethasone in tetanus. Lancet II: 1467–1468CrossRefGoogle Scholar
  67. 67.
    Schwab ME, Thoenen H (1976) Electron microscopic evidence for a trans-synaptic migration of tetanus toxin in spinal cord motoneurons: an autoradiographic and morphometric study. Brain Res 105: 213–224PubMedCrossRefGoogle Scholar
  68. 68.
    Schwab ME, Suda K, Thoenen H (1979) Selective retrograde transsynaptic transfer of a protein, tetanus toxin, subsequent to its retrograde axonal transport. J Cell Biol 82: 798–810PubMedCrossRefGoogle Scholar
  69. 69.
    Seib C, Hensel B, Weigand H, Wellhöner HH (1973) Supporting evidence for a role of neural ascent of toxin in the pathogenesis of general tetanus in cats. Naunyn Schmiedebergs Arch Pharmacol 276: 403–411PubMedCrossRefGoogle Scholar
  70. 70.
    Semba T, Kano M (1969) Glycine in the spinal cord of cats with local tetanus rigidity. Science 164: 571–572PubMedCrossRefGoogle Scholar
  71. 71.
    Seyfert W, Wilbrandt D (1964) Wirksame intralumbale Prednisolon-Behandlung des Wundstarrkrampfes. Dtsch Med Wochenschr 89: 1218CrossRefGoogle Scholar
  72. 72.
    Smith JWG (1966) Intracerebral antitoxin in experimental tetanus. Br J Exp Path 47: 17–24Google Scholar
  73. 73.
    Stoeckel K, Schwab ME, Thoenen H (1975) Comparison between the retrograde axonal transport of nerve growth factor and tetanus toxin in motor, sensory and adrenergic axons. Brain Res 99: 1–16CrossRefGoogle Scholar
  74. 74.
    Takano K, Terhaar P, Tiebert B (1976) Effect of tetanus toxin at different doses on polysynaptic reflex. Pflugers Arch Ges Physiol 362: R29Google Scholar
  75. 75.
    Tidyman M (1985) Dantrolene sodium in management of tetanus. Anesth Analg 64: 538–544PubMedCrossRefGoogle Scholar
  76. 76.
    Van Heyningen WE (1960) The assay of bacterial toxins. In: Hoppe-Seyler W, Thierfelder A (ed) Handbuch der physiologischen und pathologisch-chemischen Analyse, vol IV/I. Springer, Berlin Göttingen Heidelberg, pp 785–801Google Scholar
  77. 77.
    Wainwright JM (1926) Tetanus, its incidence and treatment. Arch Surg 12: 1062–1079CrossRefGoogle Scholar
  78. 78.
    Wellhöner HH (1982) Tetanus Neurotoxin. Rev Physiol Biochem Pharmacol 93: 1–68PubMedCrossRefGoogle Scholar
  79. 79.
    Wendon LMB (1980) On the action of tetanus toxin at the rat neuromuscular junction. J Physiol (Lond) 300: 23Google Scholar
  80. 80.
    Wilson PR, Yaksh TL (1978) Baclofen is antinociceptive in the spinal intrathecal space of animals. Eur J Pharmacol 51: 323–330PubMedCrossRefGoogle Scholar
  81. 81.
    Wilson VJ, Diecke FPJ, Talbot WH (1960) Action of tetanus toxin on conditioning of spinal motoneurones. J Neurophysiol 23: 659–666PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1988

Authors and Affiliations

  • H. Müller
  • J. Zierski
  • U. Börner
  • G. Hempelmann

There are no affiliations available

Personalised recommendations