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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.52 no.3 São Paulo Sept. 1994

https://doi.org/10.1590/S0004-282X1994000300021 

Botulinum toxin A for trismus in cephalic tetanus

 

Toxina botulínica A para o trismo no tétano cefálico

 

 

Luiz Augusto F. AndradeI; Sonia Maria D. BruckiII

IMovement Disorders Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina: Associate Professor
IIMovement Disorders Division, Department of Neurology and Neurosurgery, Escola Paulista de Medicina: Postgraduate

 

 


SUMMARY

Cephalic tetanus is a localized form of tetanus. As in generalized forms , trismus is a prominent feature of the disease, leading to considerable difficulty in feeding, swallowing of the saliva and mouth hygiene. These difficulties often precede respiratory problems and aspiration bronchopneumonia is a frequent life-threatening complication. Muscle relaxants other than curare drugs may show a limited benefit for relieving trismus. Tetanospasmin, the tetanic neurotoxin, and botulinum toxin share many similarities, having a closely related chemical structure, an origin from related microorganisms (Clostridium tetani and Clostridium botulinum, respectively), and presumably, the same mechanisms of action in the neuron. The difference between the two lies in their peculiar neurospecificity, acting in different neurons. Injection of minute doses of botulinum toxin in the muscles involved in focal dystonias or other localized spastic disorders have proved to be very effective in these conditions. We describe the use of botulinum toxin A in the successful treatment of trismus in a patient suffering from cephalic tetanus. We believe that this form of treatment may be of value in lowering the risk of pulmonary complications in tetanic patients.

Key words: tetanus, cephalic tetanus, trismus, botulinum toxin A.


RESUMO

O tétano cefálico é uma forma localizada de tétano. Da mesma maneira que nas formas generalizadas, o trismo é componente clínico proeminente, que leva a grande dificuldade na alimentação, na deglutição da saliva e para a higiene da boca. Essas dificuldades freqüentemente precedem os problemas respiratórios e as pneumonias aspirativas, que se constituem em complicações que ameaçam a vida dos pacientes. Drogas relaxantes musculares de outro tipo que as drogas curarizantes trazem pouco benefício para o trismo. A neurotoxina tetânica (tetanospasmin) e a toxina botulínica compartilham muitas semelhanças, como estrutura química símile, origem de microorganismos relacionados (Clostridium tetani e Clostridium botulinum, respectivamente) e, presumivelmente, os mesmos mecanismos de ação no neurônio. A diferença entre as duas reside na sua peculiar neuroespecificidade, atuando em diferentes neurônios. Injeção de doses reduzidas da toxina botulínica em músculos envolvidos em distonias focais ou outras desordens com espasticidade muscular localizada tem se mostrado eficaz em abolir as contrações. Descrevemos o uso da toxina botulínica A com sucesso no tratamento do trismo num paciente sofrendo de tétano cefálico. Acreditamos que esta forma de tratamento possa ser de valor no sentido de diminuir o risco de complicações pulmonares nos pacientes com tétano.

Palavras-chave: tétano, tétano cefálico, trismo, toxina botulínica A.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

Acknowledgement - This work was supported in part by a grant from CAPES and CNPq. Botox R was kindly offered by Allergan.

 

REFERENCES

1. Bleck TP. Tetanus: pathophysiology, management and prophylaxis. Dis Mon 1991, 37: 545-603.         [ Links ]

2. Cate TR. Clostridium tetani (tetanus). In Principles and practice of infeccious diseases. Ed 3. Mandell GL, Douglas RG, Benett JE (eds) New York: Churchill Livingstone, 1990, p 1842-1846.         [ Links ]

3. Edmondson RS, Flowers MW. Intensive care in tetanus: management, complications, and mortality in 100 cases. Br Med J 1979, 1: 1401-1404.         [ Links ]

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5. Schiavo G, Boquet P, Dasgupta BR, Montecucco C. Membrane interactions of tetanus and botulinum neurotoxins: a photolabelling study with photoactivatable phopholipids. J Physiol (Paris) 1990, 84: 180-187.         [ Links ]

6. Simpson LL. Molecular pharmacology of botulinum toxin and tetanus toxin. Ann Rev Pharmacol Toxicol 1986, 26: 427-453.         [ Links ]

7. Singh BR. Identification of specific domains in botulinum and tetanus neurotoxins. Toxicon 1990, 28: 992-996.         [ Links ]

8. Weinstein L. Tetanus. N Engl J Med 1973, 289: 1293-1296.         [ Links ]

 

 

Aceite: 10-janeiro-1994.

 

 

Dr. Luiz Augusto Franco de Andrade - Disciplina de Neurologia, Escola Paulista de Medicina - Rua Botucatu 740 -04023-900 - São Paulo SP - Brasil.

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