Prolonged trismus post tetanus in a Nigerian boy: the role of oral baclofen- a case report and literature review

Abstract

Abstract Background: Tetanus is characterized by increased muscle tone and spasms caused by the neurotoxin, tetanospasmin. Management  principles include wound debridement, antibiotic therapy, neutralize circulating toxins, spasm control, supportive care and initiation of active immunization.

Aim: To highlight the use of oral baclofen in tetanus treatment.

Method: The management of a peculiar case of tetanus was highlighted. Medscape and Pubmed were also searched for some related literatures.

Case Presentation: A nine year old boy with antecedent history of dirty wound presented with trismus and generalized spasms of one week duration. Though fully conscious, he could neither talk nor eat. He was from a poor socio-economic background.
He had wound debridement, I.V metronidazole for seven days, a cocktail of diazepam infusion 5mg/ kg/day, I.V chlorpromazine 25mg 12hourly and I.M phenobarbitone for 14 days. Five days into treatment the spasms stopped but trismus persisted up to the third week. By this time the maximal interincisors distance was 0.5cm. Baclofen syrup was commenced at 10mg daily. Five days later the maximal inter-incisors’ distance was 1.0cm, and a week later it was 2.5cm. By the second week of oral baclofen there was complete resolution of trismus and recovery of speech.

Conclusion: This report suggests the need for further studies on the use of enteral baclofen during tetanus. Although intratheccal baclofen is in use, during recovery from tetanus, treatment with oral baclofen may reduce morbidity.

Keywords: Prolonged trismus tetanus oral baclofen