Chronic intrathecal baclofen administration for the treatment of severe generalized tetanus via a synchromed infusion pump

Centers for Disease Control (CDC) data indicate that the incidence of tetanus in the United States is highest among the elderly. Conventional therapies for the control of accompanying generalized muscle spasms include large doses of oral or intravenous GABA agonists as antispasticity agents. We describe a case of an elderly patient with severe symptoms of tetanus who developed a prolonged encephalopathy and ventilatory insufficiency with oral baclofen and benzodiazepine therapy. Intrathecal baclofen adequately controlled her severe extensor spasms, facilitated her ventilatory management, and did not compromise her mental status during her extended convalescence. Accordingly, we report the first placement of a permanent implanted infusion pump for this disease. This noodality offers advantage for continuous long-term titration of medication for spasms or rigidity control without the systemic sedative effects of conventional therapy.