Botulinum toxin A for trismus in cephalic tetanus

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.

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The good toxin: 10 years of experience with botulinum toxin A in the treatment of benign essential blepharospasm

European Journal of Ophthalmology ◽

10.1177/1120672120925630 ◽

2020 ◽

pp. 112067212092563

Author(s):

Kenneth KH Lai ◽

Andrew KT Kuk ◽

Edwin Chan ◽

Simon TC Ko

Keyword(s):

Botulinum Toxin ◽

Botulinum Toxin A ◽

Onset Time ◽

Surgical Correction ◽

First Year ◽

Common Complication ◽

Toxin A ◽

Essential Blepharospasm ◽

Threatening Condition ◽

Life Threatening

Purpose: To describe the efficacy and safety of botulinum toxin A (Botox) in patients with benign essential blepharospasm. Methods: Retrospective review of operation, injection, and medical records. Results: Information of 29 patients (nine males) was reviewed, and the average age of benign essential blepharospasm onset was 59.1 years. The average number of injections per patient was 14.2 ± 8.2 (5–44) and the average follow-up was 75.8 ± 47.3 months (15–180). The average unit dose was 14.2 ± 8.2 (10–30) ipsilaterally in the patient’s first year and was 21.4 ± 5.0 (12.5–30) ipsilaterally in their last year (p = 0.00458). The average onset time was 3.8 ± 1.9 (1–7) days in a patient’s first year and was 3.6 ± 1.7 (2–7) days in their last year (p = 0.549). The average effective duration was 2.86 ± 1.1 months in a patient’s first year and was 2.53 ± 0.9 in their final year (p = 0.187). The Subjective Spasm Alleviation Scale was 1.72 ± 0.4 at the first year and was 1.79 ± 0.5 in the last year (p = 0.187). Ten (34.5%) patients with eyelid disease had surgical correction. The Subjective Spasm Alleviation Scale was 1.50 ± 0.5 before and was 2.0 ± 0 six months after the operation (p = 0.0268). Post-injection complications were experienced in eight (27.6%) patients. The most common complication was ptosis (n = 7), followed by diplopia (n = 1), dry eye (n = 1), and tearing (n = 1). No life-threatening complication was reported. Conclusion: Botox was a safe and effective treatment in benign essential blepharospasm which required an increased dosage over time. Ptosis was the most common complication and no life-threatening condition was reported. Surgical correction of those with eyelid diseases showed subjective improvement of subsequent Botox treatment.

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